World Stroke Organization The Paper of The Month – March
17 Mar 2025Advancing Stroke Care for Women – A Global Priority
Advancing Stroke Care for Women – A Global Priority
By Prof. Octavio Marques Pontes-Neto, MD, PHD – WSA Editor-in-Chief
This article is a commentary on the following: Strategies to Advance Stroke Care in Women: An International Conversation – https://www.ahajournals.org/doi/10.1161/STROKEAHA.124.044507
Commentary:
March 8th marks International Women’s Day. A timely occasion to emphasize that women have unique health care needs and are at higher risk for certain health conditions. In this context, our World Stroke Academy article of the month is “Strategies to Advance Stroke Care in Women: An International Conversation” by Khedr et al.1 An article that underscores an urgent and often overlooked issue in stroke research and clinical practice: the persistent sex- and gender-based disparities in stroke outcomes, care, and research representation. Despite medical advancements, women continue to face higher stroke-related mortality, greater post-stroke disability, and reduced access to optimal acute interventions. Addressing these inequities requires a paradigm shift in stroke prevention, treatment, and research methodologies, ensuring a more inclusive and equitable healthcare system.
Women experience stroke differently from men. The epidemiological data presented in the article highlights a bimodal pattern of stroke risk in women, peaking at ages below 30 and above 80. Several sex-specific risk factors—including pregnancy complications, hormonal influences, and higher rates of atrial fibrillation—contribute to their increased vulnerability. Furthermore, postmenopausal changes exacerbate cerebrovascular risks, necessitating tailored prevention and management strategies. The article effectively articulates how these biological and hormonal factors interplay with societal determinants of health, further compounding disparities.
A critical issue addressed in the article is the systematic underrepresentation of women in stroke clinical trials. Despite the fact that women bear a substantial stroke burden, they are less frequently enrolled in studies assessing treatment efficacy, leading to a lack of sex-specific data. Moreover, when included, their data are rarely analyzed separately, preventing an accurate understanding of treatment responses in women. This deficiency in evidence-based practice contributes to suboptimal therapeutic strategies and reinforces gender disparities in outcomes.
Additionally, the article sheds light on socioeconomic and structural barriers to care, such as delayed diagnosis due to atypical symptom presentations, limited healthcare access, and caregiver burdens that disproportionately fall on women. These challenges are even more pronounced in low- and middle-income countries, where cultural norms and healthcare infrastructure further limit women’s access to timely stroke care.
The authors propose a comprehensive set of strategies to address these disparities, emphasizing the importance of education, research diversity, health policy reforms, and gender-sensitive clinical guidelines. A key takeaway is the need for targeted interventions, such as improved training for healthcare providers to recognize stroke symptoms in women, increased recruitment of women in clinical trials, and implementation of women-specific stroke prevention and treatment guidelines. The call for work-life balance policies for female healthcare professionals is particularly relevant, as gender equity in leadership and research roles can drive systemic change.
International partnerships are essential to mitigating gender disparities in stroke care. The article highlights successful initiatives, such as the Women and Stroke campaign by the World Stroke Organization and similar efforts by other stroke societies worldwide. Expanding these initiatives and promoting collaboration between researchers, policymakers, and advocacy groups will be crucial in shaping a future where sex and gender no longer dictate stroke outcomes.
The compelling arguments laid out by Khedr et al. make it abundantly clear that gender disparities in stroke care are not just an issue of scientific oversight but a matter of health equity and justice. The time for action is now. Stroke prevention, treatment, and research must be inclusive, considering the unique challenges faced by women across different life stages and socio-economic backgrounds. By promoting gender-sensitive policies and ensuring robust representation in clinical trials, we can move toward a future where all individuals receive equitable and effective stroke care, regardless of gender.
References:
- Khedr EM, Al-Attar G, Rosales J, Sampaio Silva G, Sebastian IA, Orjuela KD, de Souza AC. Strategies to Advance Stroke Care in Women: An International Conversation. Stroke. 2025 Feb;56(2):e51-e54. doi: 10.1161/STROKEAHA.124.044507. Epub 2024 Aug 22. PMID: 39171414.
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