Women face a disproportionate burden of stroke mortality and disability. Researchers from the Brigham’s Division of Women’s Health are interested in understanding the contribution of biologic sex and sociocultural gender on stroke risk factors, assessment, treatment and outcomes. In a review paper published in Circulation Research, Kathryn M. Rexrode, MD, MPH and co-authors detail what is currently known about the impact of sex and gender on stroke, knowledge gaps and areas of future inquiry. Rexrode told us more about this area of research in this Q&A:

Q: What are some examples of the impact of biological sex and sociocultural gender on stroke risk factors?

KR: In women with diabetes, there is a higher risk for stroke than in men. Additional female-specific risk factors include a history of certain pregnancy complications such as preterm delivery or hypertensive disorders of pregnancy.

Q: What do you want the public to know about the risk factors for stroke?

KR: For women in particular, a focus on female-specific risk factors, including early menopause, use of oral estrogens for contraception or postmenopausal hormone therapy, and pregnancy-related factors, can have an impact on the risk of stroke.

Q: What questions remain unanswered?  

KR: For many of the observed differences in stroke between men and women, we need to try to evaluate and separate the impact of both biological sex and gender. Moreover, although female-specific stroke risk factors have been identified, these have not been incorporated into stroke risk prediction models. Additionally, we need research on how to reduce risk among individuals with a history of pregnancy complications. Data on the impact of gender-affirming hormone therapy on the risk of stroke in transgender populations is also needed.

Q: Moving forward, how can institutions increase patient and provider knowledge about the impact of sex and gender on stroke?

KR: Greater inclusion of women and gender diverse individuals in clinical trials of stroke is essential.

To read Dr. Rexrode’s full paper, visit: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.121.319915