Despite some advances, women still face disparities of the global burden of stroke

January 25, 2021

DALLAS, Jan. 25, 2021 -- The continued global burden of stroke and how it disproportionately affects women are highlighted in new science published online today in the February issue of Stroke, a journal of the American Stroke Association, a division of the American Heart Association. Stroke editors selected nine manuscripts focused on stroke disparities in women in this collaboration with Go Red for Women®, the Association's global movement to end heart disease and stroke in women.

"Stroke continues to be a leading cause of death and disability worldwide, with women being more adversely affected by the global burden of stroke," said Stroke Editor-In-Chief Ralph L. Sacco, M.D., M.S., FAHA, a past president of the American Heart Association. "As our population ages, the number of stroke survivors will continue to rise, especially among women. We must include more women in stroke research so we can enhance the critical evidence necessary to provide the appropriate stroke treatments needed to save and improve lives."

Worldwide, stroke is the second leading cause of death. More than 101 million people have a stroke each year, and more than 6.6 million people die of a stroke, annually. About 1 in 4 stroke survivors will experience another stroke within five years.

"The papers highlighted in this issue feature international research and perspective from more than half a dozen countries," said Sacco, chair of the department of neurology, the Olemberg Family Chair in Neurological Disorders and executive director of the Evelyn F. McKnight Brain Institute at the University of Miami Leonard Miller School of Medicine, in Miami, Florida. "This collective work from some of the most renowned scientists in the field offers important insight, recommendations and guidance for addressing this critical topic."

Two of the studies addressed concerns about the lack of women in stroke clinical trials, thus limiting information to ensure appropriate stroke treatment for women, which has long been an issue for scientists.

Why Are Women Less Represented in Intracerebral Hemorrhage Trials? - Tatiana Greige et al.  Researchers examined the different reasons men and women were excluded from a major trial about treatment for hemorrhagic, or bleeding, strokes.

The intracerebral hemorrhage DEFeroxamine (iDEF) trial was a prospective, multicenter, randomized, placebo-controlled, double-blind, phase 2 trial that evaluated the use of deferoxamine mesylate versus placebo (saline) infusions in patients with hemorrhagic strokes at 40 hospitals in Canada and the U.S. While iDEF included 293 participants, only 38.2% of participants were women. The major reason for this disparity was the exclusion of participants over the age of 80 -- 22.4% of women were not included in the trial for this reason versus 12.61% of men.

The under-enrollment of women in stroke clinical trials: What are the causes and what should be done about it? - Cheryl Carcel; Matthew Reeves

Addressing the age barrier to stroke research is one of several recommendations offered in a commentary of presentations made at the European Stroke Organization-World Stroke Organization 2020 virtual conference. The authors noted that discrepancies in the enrollment of women in stroke clinical trials raises concerns about the generalizability of trial results, as well as the potential for reduced access and use of new therapies in women. Their recommendations for addressing this include: Below are highlights of some of the other manuscripts in this issue, which can be accessed in full here.

Sex, age, and socioeconomic differences in non-fatal stroke incidence and subsequent major adverse outcomes - Ralph K. Akyea et al.

Researchers for this large cohort study used data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) to assess stroke incidence in the general population of the United Kingdom from 1998-2019. During this time, 82,774 people survived a stroke, of which 44,614 (53.9%) were women. Men in the study experienced stroke at a younger age compared to women (71.4 vs 76.9 years, respectively). Men ages 30-74 years had higher stroke incidence rates compared to women; however, among those ages 75 and older, the incidence rates were much higher in women.

The rate of stroke incidence among people ranked in the lowest ranking of socioeconomic status was 10% higher than the rate in the highest socioeconomic status rank. Those rankings were based on such factors as income; employment; education, skills and training; health and disability; crime; barriers to housing and services; and living environment.

The researchers also examined a subset of 68,877 stroke survivors who had not had previous complications. Of those: The researchers noted their findings show a higher burden of major adverse outcomes (such as a cardiovascular event, stroke or death) observed in women when compared to men after first non-fatal stroke is largely accounted for by age and socioeconomic status.

Advances in Stroke: Stroke in Women - Moira K. Kapral et al.

This paper highlights recent advances in the understanding of sex differences in the benefits of endovascular therapy, outcomes after stroke and the potential to prevent stroke in women with a history of hypertensive disorders of pregnancy. This perspective paper includes data analysis from several clinical trials. The researchers found: The other studies in this special issue include: Authors' disclosures and funding sources for all studies in the special issue are listed in the individual manuscripts.

"We are pleased to publish this important research to enhance our understanding of the unique differences in the diagnosis, treatment and prevention of stroke in women," Sacco said. "Our essential goal is to prevent stroke, reduce disability and ultimately save lives; education and awareness are critical first steps."

To raise awareness about how participation in research could further scientific understanding of cardiovascular health, the American Heart Association and Verily, Alphabet's life sciences and healthcare arm, have launched Research Goes Red. Research Goes Red aims to empower women to contribute to health research. Learn more at
Additional Resources: Statements and conclusions of studies published in the American Heart Association's scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here

About the American Stroke Association

The American Stroke Association is a relentless force for a world with fewer strokes and longer, healthier lives. We team with millions of volunteers and donors to ensure equitable health and stroke care in all communities. We work to prevent, treat and beat stroke by funding innovative research, fighting for the public's health, and providing lifesaving resources. The Dallas-based association was created in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit Follow us on Facebook and Twitter.

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