Morbidity and mortality rates for stroke are higher in men than women with the exception of subarachnoid hemorrhage. Temporal trends are similar in the two sexes with a slowdown in the decline in mortality rates and a leveling or increase in morbidity rates. Women are more likely than men to have cervical bruits but less likely to have carotid stenosis on ultrasonography. Some factors associated with stroke are unique to women: pregnancy, use of oral contraceptives, postmenopausal hormonal replacement, and choriocarcinoma. Postmenopausal hormonal use is associated with a decreased risk of stroke in observational studies but clinical trials are needed. Control of hypertension and cessation of smoking to reduce the risk of stroke is equally effective in both sexes. Aspirin and ticlopidine are effective in secondary prevention of stroke in women, whereas women may be more sensitive to warfarin than men.
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