Update on specificities of stroke in women

Summary The majority of strokes occur in women who in crude numbers have poorer outcome including higher mortality from stroke than men. This may, however, to a large degree be explained by the preponderance of women in the older age groups. Nevertheless, incidence of stroke is higher in men than in women. Overall rates of stroke decline, but more in men than in women; consequently the excess number of strokes in women will be on the rise in the years to come. Risk factors differ between men and women: e.g. rates of atrial fibrillation and hypertension are higher in women with stroke, while rates of e.g. smoking or high alcohol consumption are higher in men, while some risk factors including diabetes or smoking carries a higher risk in women than in men. Especially older women are less well represented in many trials, which reduces the generalizability of results to this from a stroke perspective extremely important population, however, in areas of treatment where sufficient data is available, e.g. i.v. thrombolysis or mechanical thrombectomy the benefit is equal between sexes and may even be higher in women due to their longer life expectancy. Access to care varies between regions depending both on cultural factors and the overall access to care; in especially lower income countries though data is very scarce the impression is that women's access to care is restricted in comparison to men. Specific female risk factors including pregnancy or sex hormone therapy are rare causes of stroke especially in high-income countries, however these stroke events occur early in life and have massive effect of individual families. Evidence on stroke care in these events is extremely limited and more data, also including prospective generalizable observational data is urgently needed to guide clinicians. Further more specific data on women and stroke is needed to identify if gender in some instances should guide treatment and care.