Sex differences in stroke

Abstract

Increasing evidence suggests that sex differences exist in the etiology, presentation, treatment, and outcome from stroke. The reasons for these sex disparities are becoming increasingly explored, but large gaps still exist in our knowledge. Experimental studies over the past several years have demonstrated intrinsic sex differences both in vivo and in animal models which may have relevance to our understanding of stroke in clinical populations. A greater understanding of the differences and similarities between males and females with respect to the risk factors, pathophysiology, and response to stroke will facilitate the design of future clinical trials and enhance the development of treatment strategies to improve stroke care in both sexes. This article reviews the current literature on sex differences in stroke with an emphasis on the clinical data, incorporating an analysis of bench research as it pertains to the bedside.

Fig. 1

Differential effect of aspirin on stroke risk and myocardial risk in men and women (reproduced with permission from the Massachusetts Medical Society from fig. 3 of Ridker et al. [36]; copyright © 2005 Massachusetts Medical Society; all rights reserved). BDT = British Doctors’ Trial; PHS = Physicians’ Health Study; TPT = Thrombosis Prevention Trial; HOT = Hypertension Optimal Treatment Trial; PPP = Primary Prevention Project; WHS = Women's Health Study.

Fig. 2

Pleiotropic effects of estrogen depending upon the vasculature's degree of inflammation.