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(Stroke. 2006;37:2387.)
© 2006 American Heart Association, Inc.

Comments, Opinions, and Reviews

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 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.

Correspondence to Cheryl Bushnell, MD, MHS, Duke Center for Cerebrovascular Disease, PO Box 2900, Duke University Medical Center, Durham, NC 27710. 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

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