Reducing Stroke in Women With Risk Factor Management
Reducing Stroke in Women With Risk Factor Management
Stroke is a major cause of death and disability in adults worldwide. Prevention focused on modifiable risk factors, such as hypertension and hyperlipidemia, has shown them to be of significant importance in decreasing the risk of stroke. Multiple studies have brought to light the differences between men and women with regards to stroke and these risk factors. Women have a higher prevalence of stroke, mortality and disability and it has been shown that preventive and treatment options are not as comprehensive for women. Hence, it is of great necessity to evaluate and summarize the differences in gender and stroke risk factors in order to target disparities and optimize prevention, especially because women have a higher lifetime risk of stroke. The purpose of this review is to summarize sex differences in the prevalence of hypertension and hyperlipidemia. In addition, we will review the sex differences in stroke prevention effectiveness and adherence to blood pressure and cholesterol medications, and suggest future directions for research to reduce the burden of stroke in women.
Stroke is the fourth leading cause of death in the USA, after heart disease, cancer and chronic lower respiratory disease, and the most common cause of permanent disability in adults worldwide. Statistics from the American Heart Association (AHA) Heart Disease and Stroke 2014 updates shows that the relative rate of stroke death fell by 35.8% and the actual number of stroke deaths declined by 22.8% from 2000 to 2010. Yet each year, 795,000 new or recurrent strokes occur in the USA with approximately 610,000 first attacks and 185,000 recurrent attacks. One of every 19 deaths in the USA is due to stroke. On average, every 40 s, someone in USA has a stroke and dies of one approximately every 4 min.
Hypercholesterolemia and hypertension are well-established risk factors for stroke, they are modifiable, and thus are a major focus of stroke prevention. The identification of patients who may be targeted for prevention with lifestyle changes is also well established. In addition, the AHA has identified total cholesterol less than 200 mg/dl (untreated) and untreated blood pressure (BP) less than 120/<80 mm Hg for adults as two of the seven components of ideal cardiovascular health. According to 2014 AHA statistics, 77% of patients with first-time stroke have BPs greater than 140/90.
Elevated total cholesterol levels are also a major focus of prevention programs because nearly 32 million adults over 20 years of age have total cholesterol levels greater than 240, for a prevalence of 13.8%. In addition, 33.0% of US adults, or approximately 78 million people over 20 years of age, have hypertension. Unfortunately, this is a major public health problem because although nearly 82% of people with hypertension are aware of their condition, a smaller fraction (75%) are using antihypertensive medication; but more important, only 53% of those with hypertension are controlled to target levels. Statistics for these risk factors are even worse in developing countries compared with developed countries. Although patients are prescribed medications for these conditions, they are not effectively treated, so the numbers of patients who reach treatment goals in developing countries are lower compared with the USAA and Europe.
Considering there are 795,000 strokes per year in the USA and that hypertension has a 49% population attributable risk for stroke, approximately 390,000 strokes could be prevented with adequate BP control. For cholesterol, an estimated 168,000 strokes could be prevented if adequately treated. Hypertension and hyperlipidemia account for a very large proportion of preventable strokes in men and women.
In this review, we performed a literature search using Medline for articles focused on sex differences in hypertension and hyperlipidemia in relationship to primary and secondary stroke prevention. We also included carotid atherosclerosis as an intermediate outcome for stroke because hypertension and hyperlipidemia are major contributors to carotid disease. We selected cohort studies of both sexes and those with women only if BP and cholesterol were the focus. Also, clinical trials were included if they included the topics of interest, but we excluded case reports. Only studies with stroke or carotid atherosclerosis as outcomes were included.
Abstract and Introduction
Abstract
Stroke is a major cause of death and disability in adults worldwide. Prevention focused on modifiable risk factors, such as hypertension and hyperlipidemia, has shown them to be of significant importance in decreasing the risk of stroke. Multiple studies have brought to light the differences between men and women with regards to stroke and these risk factors. Women have a higher prevalence of stroke, mortality and disability and it has been shown that preventive and treatment options are not as comprehensive for women. Hence, it is of great necessity to evaluate and summarize the differences in gender and stroke risk factors in order to target disparities and optimize prevention, especially because women have a higher lifetime risk of stroke. The purpose of this review is to summarize sex differences in the prevalence of hypertension and hyperlipidemia. In addition, we will review the sex differences in stroke prevention effectiveness and adherence to blood pressure and cholesterol medications, and suggest future directions for research to reduce the burden of stroke in women.
Introduction
Stroke is the fourth leading cause of death in the USA, after heart disease, cancer and chronic lower respiratory disease, and the most common cause of permanent disability in adults worldwide. Statistics from the American Heart Association (AHA) Heart Disease and Stroke 2014 updates shows that the relative rate of stroke death fell by 35.8% and the actual number of stroke deaths declined by 22.8% from 2000 to 2010. Yet each year, 795,000 new or recurrent strokes occur in the USA with approximately 610,000 first attacks and 185,000 recurrent attacks. One of every 19 deaths in the USA is due to stroke. On average, every 40 s, someone in USA has a stroke and dies of one approximately every 4 min.
Hypercholesterolemia and hypertension are well-established risk factors for stroke, they are modifiable, and thus are a major focus of stroke prevention. The identification of patients who may be targeted for prevention with lifestyle changes is also well established. In addition, the AHA has identified total cholesterol less than 200 mg/dl (untreated) and untreated blood pressure (BP) less than 120/<80 mm Hg for adults as two of the seven components of ideal cardiovascular health. According to 2014 AHA statistics, 77% of patients with first-time stroke have BPs greater than 140/90.
Elevated total cholesterol levels are also a major focus of prevention programs because nearly 32 million adults over 20 years of age have total cholesterol levels greater than 240, for a prevalence of 13.8%. In addition, 33.0% of US adults, or approximately 78 million people over 20 years of age, have hypertension. Unfortunately, this is a major public health problem because although nearly 82% of people with hypertension are aware of their condition, a smaller fraction (75%) are using antihypertensive medication; but more important, only 53% of those with hypertension are controlled to target levels. Statistics for these risk factors are even worse in developing countries compared with developed countries. Although patients are prescribed medications for these conditions, they are not effectively treated, so the numbers of patients who reach treatment goals in developing countries are lower compared with the USAA and Europe.
Considering there are 795,000 strokes per year in the USA and that hypertension has a 49% population attributable risk for stroke, approximately 390,000 strokes could be prevented with adequate BP control. For cholesterol, an estimated 168,000 strokes could be prevented if adequately treated. Hypertension and hyperlipidemia account for a very large proportion of preventable strokes in men and women.
In this review, we performed a literature search using Medline for articles focused on sex differences in hypertension and hyperlipidemia in relationship to primary and secondary stroke prevention. We also included carotid atherosclerosis as an intermediate outcome for stroke because hypertension and hyperlipidemia are major contributors to carotid disease. We selected cohort studies of both sexes and those with women only if BP and cholesterol were the focus. Also, clinical trials were included if they included the topics of interest, but we excluded case reports. Only studies with stroke or carotid atherosclerosis as outcomes were included.
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