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Review
. 2022 Feb 18;130(4):512-528.
doi: 10.1161/CIRCRESAHA.121.319915. Epub 2022 Feb 17.

The Impact of Sex and Gender on Stroke

Kathryn M Rexrode  1 , Tracy E Madsen  2   3 , Amy Y X Yu  4 , Cheryl Carcel  5 , Judith H Lichtman  6 , Eliza C Miller  7
Affiliations
Review

The Impact of Sex and Gender on Stroke

Kathryn M Rexrode et al. Circ Res. .

Abstract

Women face a disproportionate burden of stroke mortality and disability. Biologic sex and sociocultural gender both contribute to differences in stroke risk factors, assessment, treatment, and outcomes. There are substantial differences in the strength of association of stroke risk factors, as well as female-specific risk factors. Moreover, there are differences in presentation, response to treatment, and stroke outcomes in women. This review outlines current knowledge of impact of sex and gender on stroke, as well as delineates research gaps and areas for future inquiry.

Keywords: gender identity; hemorrhagic stroke; ischemic stroke; sex; stroke; women.

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Figures

Figure 1.
Figure 1.
Sex- and age-specific ranking, percentage, and total number of deaths attributed to cerebrovascular diseases in 2015 Data from: National Vital Statistics System (NVSS), 2015. LCWK1: Deaths, percent of total deaths, and death rates for the 15 leading causes of death in 5-year age groups, by race and sex: United States, 2015. https://www.cdc.gov/nchs/data/dvs/LCWK1_2015.pdf. Accessed October 13, 2021.
Figure 2:
Figure 2:
Sex differences in Stroke Risk Factors; size of figures indicates differences in strength of association between given risk factors and stroke; MHT: menopausal hormone therapy; GHT: gender-affirming hormone therapy
Figure 3:
Figure 3:
Panel 1: Stroke in pregnancy or puerperium can occur due to pathological mechanisms throughout the cerebrovascular tree, including cardioembolism (A), cervical artery dissection (B), venous sinus thrombosis (C), rupture of vascular malformations (D), hypertensive intraparenchymal hemorrhage (E), or reversible cerebral vasoconstriction syndrome causing intracranial vasospasm and/or convexity subarachnoid hemorrhage (F). Panel 2: Physiological changes of pregnancy affecting the cardiovascular, hematological, and immune systems may all increase stroke risk. Pathological complications of pregnancy such as peripartum cardiomyopathy or preeclampsia exacerbate this risk. Panel 3: At the microvascular level, pathophysiological changes associated with preeclampsia may contribute to increased stroke risk, including neuroinflammation, leakiness of the blood-brain barrier, abnormal cerebral autoregulation, and sympathetic hyperreactivity. Created with BioRender.com
Figure 4.
Figure 4.. Case study: 54-year-old woman with a history of migraine with aura presents with 15 minutes of right arm heaviness and hand clumsiness.
This occurred during a stressful work meeting. She needed to concentrate to speak at the meeting, but she does not think her colleagues noticed anything. She experienced a headache afterwards. She presents to medical attention.
Central illustration:
Central illustration:
The impact of sex and and gender on stroke (Biologic sex is shown in red, gender in blue, combined in purple) IV rtPA intravenous recombinant tissue plasminogen activator. APO: adverse pregnancy outcomes
See this image and copyright information in PMC

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