Treatment may vary

Women who experience an ischemic stroke or even a transient ischemic attack, when blood flow to the brain stops for a brief period, are typically treated with tissue plasminogen activator (tPA), just as men are. However, there is growing evidence of disparity in both the effectiveness and administration of this clot-busting drug.

It now seems that women who don't get tPA fare worse than men who fail to get the treatment. A 2010 study in Neurology found that while both men and women fared equally well under tPA treatment, women who did not receive tPA were 12 percent less likely than men to have a good outcome six months later.

And a study in the journal Women's Health published in 2011 discovered that tPA is in fact underutilized in women, although the research suggested that the differences are specific to local conditions and populations.

This seeming paradox—that women may need tPA more than men but get it less often—suggests that stroke sufferers and their families or caregivers should pay close attention to treatments given at their local hospitals.

Taking preventive measures

Prevention is one way to narrow the gender divide in stroke. Research suggests that the overwhelming majority of recommendations to prevent cardiovascular disease are similar for women and men. Mostly these have to do with maintaining "ideal cardiovascular health," a concept defined by the American Heart Association (AHA) as

  • the absence of cardiovascular disease and the presence of ideal levels of total cholesterol, blood pressure and fasting blood glucose
  • a body mass index (BMI) of less than 25
  • regular physical activity
  • a healthy eating pattern
  • not smoking

When achieved or maintained into middle age, "ideal cardiovascular health" is associated with greater longevity, a dramatic reduction in risk for cardiovascular disease events, and a greater quality of life as a person ages. But there's more to stroke prevention than simply following a checklist.

The AHA suggests that heart and blood vessel disease should not simply be considered a "have-or-have-not" condition: The medical community now looks at a "continuum of risk" that requires intermittent appraisal by health care providers. In other words, see your doctor regularly and talk about the best ways you can lower your risk of stroke.

Publication Review By: Lawrence Appel, M.D., and Rafael H. Llinas, M.D.

Published: 15 Jul 2013

Last Modified: 06 Oct 2015