Published Online
on July 20, 2006

A more recent version of this article appeared on September 1, 2006

This Article Full Text (PDF) All Versions of this Article: 37/9/2387    most recent 01.STR.0000236053.37695.15v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bushnell, C. D. Articles by Simpkins, J. Search for Related Content PubMed PubMed Citation Articles by Bushnell, C. D. Articles by Simpkins, J. Pubmed/NCBI databases Medline Plus Health Information Stroke Women's Health Related Collections Acute Cerebral Infarction

Submitted on June 13, 2006
Accepted on June 28, 2006

Advancing the Study of Stroke in Women. Summary and Recommendations for Future Research From an NINDS-Sponsored Multidisciplinary Working Group

Cheryl D. Bushnell MD, MHS^*; Patricia Hurn PhD; Carol Colton PhD; Virginia M. Miller PhD; Gregory del Zoppo MD, MS; Mitchell S.V. Elkind MD; Barney Stern MD; David Herrington MD; Gwendolyn Ford-Lynch MD; Philip Gorelick MD, MPH; Andra James MD, MPH; Candice M. Brown PhD; Emily Choi MD; Paul Bray MD; L. Kristin Newby MD, MHS; Larry B. Goldstein MD; and James Simpkins PhD

From the Department of Medicine, Division of Neurology (C.D.B., C.C., L.B.G., E.C.), Duke University Medical Center, Durham, NC; the Department of Anesthesiology and Perioperative Medicine (P.H.), Oregon Health Sciences University, Portland, Ore; the Departments of Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, Minn; the Department of Molecular and Experimental Medicine (G.d.Z), Scripps Research Institute, La Jolla, Calif; the Department of Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, NY, NY; the Department of Neurology (B.S.), University of Maryland, College Park, Md; the Department of Medicine (D.H.), Division of Cardiology, Wake Forest University Baptist Hospital, Winston-Salem, NC; the Department of Neurology (G.F.-L.), Case-Western Reserve University, Cleveland, Ohio; the Department of Neurology (P.G.), University of Illinois at Chicago, Chicago, Ill; the Department of Obstetrics and Gynecology (A.J.), Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC; the Department of Physiology and Biophysics (C.M.B.), University of Washington, Seattle, Wash; the Department of Medicine (P.B.), Division of Hematology, Baylor College of Medicine, Houston, Tex; the Department of Medicine (L.K.N.), Division of Cardiology, Duke Clinical Research Institute, Durham, NC; and the Department of Pharmacology and Neuroscience (J.S.), University of North Texas Health Science Center, Fort Worth, Tex.

^* To whom correspondence should be addressed. E-mail: Cheryl.bushnell{at}duke.edu.

Background and Purpose--Women have poorer outcomes from stroke than men. Women also have risk factors that are unique, including pregnancy and hormone therapy. Hormone therapy for postmenopausal replacement increased the risk of ischemic stroke according to results of the Women’s Health Initiative clinical trials. Based on the current understanding of the mechanisms of action of estrogen, the reasons for this increased risk are uncertain. One method to better understand the reasons for this increased risk is to re-evaluate estrogen’s role in the neurovascular unit, simplistically comprised of the neurons, glia, and endothelial cells, as well as the processes of inflammation, and hemostasis/thrombosis. Besides the role of estrogen there are many gaps of knowledge about issues specific to women and stroke.

Summary of Review--A multidisciplinary workshop was held in August 2005 to summarize the current evidence for estrogen and, more generally, stroke in women, and to provide recommendations for future basic, preclinical, and clinical research studies.

Conclusions--These studies may ultimately change the approach to stroke prevention and treatment in women.

Key words: estrogen • minority groups • stroke • women

This article has been cited by other articles:

				L. B. Goldstein, P. Amarenco, M. LaMonte, S. Gilbert, M. Messig, A. Callahan, M. Hennerici, H. Sillesen, K. M. A. Welch, and on behalf of the SPARCL Investigators Relative Effects of Statin Therapy on Stroke and Cardiovascular Events in Men and Women: Secondary Analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Study Stroke, September 1, 2008; 39(9): 2444 - 2448. [Abstract] [Full Text] [PDF]

				V. M. Miller and S. P. Duckles Vascular Actions of Estrogens: Functional Implications Pharmacol. Rev., June 1, 2008; 60(2): 210 - 241. [Abstract] [Full Text] [PDF]

				S D Treadwell, B Thanvi, and T G Robinson Stroke in pregnancy and the puerperium Postgrad. Med. J., May 1, 2008; 84(991): 238 - 245. [Abstract] [Full Text] [PDF]

				E. Touze and P. M. Rothwell Sex Differences in Heritability of Ischemic Stroke: A Systematic Review and Meta-Analysis Stroke, January 1, 2008; 39(1): 16 - 23. [Abstract] [Full Text] [PDF]

				K. M. Barrett and B. B. Worrall Sex and stroke: Are they really different in midlife? Neurology, November 13, 2007; 69(20): 1894 - 1895. [Full Text] [PDF]

				A. Towfighi, J. L. Saver, R. Engelhardt, and B. Ovbiagele A midlife stroke surge among women in the United States Neurology, November 13, 2007; 69(20): 1898 - 1904. [Abstract] [Full Text] [PDF]

				N. Inoue, A. Hashiguchi, H. Ichimura, S. Yoshioka, S. Goto, and Y. Ushio Stroke in Women During Long-Term Hormone Replacement Therapy Influencing Coagulation Systems Stroke, May 1, 2007; 38(5): e10 - e10. [Full Text] [PDF]

				C. D. Bushnell and G. J. Del Zoppo Response to Letter by Inoue et al Stroke, May 1, 2007; 38(5): e11 - e11. [Full Text] [PDF]