Objective:

To evaluate the prevalence of female-specific risk factors for stroke in women in a real-world population and develop a systematic method for collecting these data from electronic health records.

Background:

Female-specific risk factors, including hypertensive disorders of pregnancy, endometriosis, hysterectomy/oophorectomy, oral contraceptive use (OCP), hormone replacement therapy (HRT), prior in vitro fertilization (IVF)/miscarriage/abortions, age at menopause, vasomotor symptoms, and migraine with aura, have been associated with an increased risk of stroke. Determining the prevalence of these risk factors in the stroke belt could aid in targeting stroke prevention for women.

Design/Methods:

Get With the Guidelines-Stroke database, was the source for a retrospective chart review of 100 women aged 18 to 65 with a discharge diagnosis of ischemic or hemorrhagic stroke from 1/1/2019-12/31/2022. Women with cerebral venous sinus thrombosis, cancer with presumed hypercoagulability, endocarditis, trauma, or stroke during pregnancy were excluded. Demographics, stroke etiology, baseline stroke risk factors were abstracted. Sex-specific risk factors were entered into the search box in Epic: hypertensive disorders of pregnancy, endometriosis, hysterectomy/oophorectomy, use of OCP or HRT, prior IVF/miscarriage/abortions, age at menopause, menopausal vasomotor symptoms, and migraine with aura. Women were stratified into pre-, peri, or post-menopausal. 

Results:

Preliminary analysis indicated that 59% of these women were post-menopausal. 12% with history of hypertensive disorders of pregnancy, 5% endometriosis, 8% migraine with aura, 8 miscarriages, 1 abortion, and no incidences of IVF. Surgical history included 26% with hysterectomy, 7% with oophorectomy, and 10% with bilateral salpingectomy. Only 12% reported hot flashes or night sweats as vasomotor symptoms of menopause.

Conclusions:

Preliminary assessment revealed limitations in determination of female stroke specific risk factors likely due to underreporting and lack of EMR documentation. We plan further retrospective data collection on 650 patients to achieve larger sample size with comparison to a cohort of women without stroke for assessment of true prevalence.