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(Stroke. 2004;35:2642.)
© 2004 American Heart Association, Inc.

Articles

Sex, Steroids, and Stroke

Introduction

From the Department of Anesthesiology and Perioperative Medicine (P.D.H.), Oregon Health and Sciences University, Portland, Ore; and the Departments of Neurology and Epidemiology (R.L.S.), College of Physicians and Surgeons, Columbia University, New York, NY.

Correspondence to Prof Patricia D. Hurn, Department of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, UHS-2, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098. E-mail hurnp@ohsu.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Stroke remains a major source of mortality and disability, particularly among women. Stroke statistics consistently show a greater number of strokes occurring in women, more hospital discharges for stroke among women, and more women dying from stroke each year than men. American Stroke Association statistics show that 53% of the stroke fatalities each year are among women.¹ Largely a function of the longer life-expectancy among women and the marked increasing stroke incidence with age, there may be other contributing factors to this stroke gender disparity. Most epidemiological studies have shown a greater age-specific stroke incidence for men compared with women. In Northern Manhattan, we observed an attenuation in the male–female incidence ratio with age and a greater stroke incidence for women compared with men, only in our oldest age category of 85 years and older.²

Many women have used hormone replacement therapy (HRT) in hopes of reducing cardiovascular disease and stroke, as well as perimenopausal symptoms. The basis for this practice arose from the early epidemiological observation that women’s stroke risk increases after the menopause and numerous observational studies that repeatedly associated HRT with reduced cardiovascular disease risk in women, including stroke. Furthermore, data from diverse animal and cell models of ischemic and/or hemorrhagic stroke indicate that estrogen is neuroprotective. At physiological doses, both chronic and acute estrogen pre-injury or postinjury treatment reduce histological brain damage.³ The concept that HRT is protective in cerebrovascular disease has recently been laid aside, based on the findings of 3 large, multicenter, randomized trials. . . . [Full Text of this Article]