The global burden of stroke and how it disproportionately affects women is highlighted in new research published online today in the February issue of Stroke, with editors selecting 9 manuscripts that focus on stroke disparities in women in collaboration with Go Red for 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, MD, MS, FAHA, in a press release. “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.”

Two of the studies specifically address the concerns about the lack of women in stroke clinical trials, causing a dearth in information to ensure appropriate stroke treatment for women, which has been an issue for scientists.

The study, “Why Are Women Less Represented in Intracerebral Hemorrhage Trials?” examined the different reasons men and women were excluded from a major trial for a treatment for hemorrhagic strokes. The iDEF trial evaluated the use of deferoxamine mesylate versus placebo, or saline, infusions in patients with hemorrhagic strokes at 40 hospitals in Canada and the United States. Only 38.2% of the 293 participants were women, as the major reason for this disparity being the exclusion of participants over 80 years of age, according to the authors.

The second study, “The Under-Enrollment of Women in Stroke Clinical Trials: What Are the Causes and What Should be Done About It?” addresses the age barrier to stroke research and the discrepancies in the enrollment of women in stroke clinical trials.

The recommendations made by the authors for addressing these challenges include:
  • More research, both quantitative and qualitative, should be undertaken to identify the causes and barriers to enrolling women in stroke clinical trials, particularly to understand how the attitudes and beliefs of women toward research and health in general may be affecting their participation in studies.
  • Stroke trials should avoid using an upper age limit as an exclusion criterion, since this has been shown to have a disproportionate effect on the number of women enrolled in trials.
  • Researchers should make greater efforts to collect appropriate data from trial screening logs to better identify specific factors that could help in understanding why women may be under-enrolled in stroke trials.
  • The number of trial investigators and research staff who are women should be increased and has the potential to create environments in which more women are enrolled in stroke clinical trials.
Other studies in the issue include sex-related differences in clinical features, influence of pregnancy on hemorrhage risk in women with cerebral and spinal cavernous malformations, and absence of consistent sex differences in outcomes from symptomatic carotid endarterectomy and stenting trials.

Despite some advances, women still face disparities of the global burden of stroke. American Heart Association. Published January 25, 2021. Accessed January 25, 2021.