Addressing sex and gender differences in stroke risk and management: A scientific statement from the World Stroke Organization
Cheryl Carcel, Else Charlotte Sandset, Mariam Ali, Ma.Ignacia Allende, Maria Giulia Mosconi, Ana Claudia de Souza, Lachlan L. Dalli, Paula Muñoz Venturelli, Yuki Sakamoto, Ahmed Nasreldein, Amy Yu, Silke Walter, Natasha A. Lannin, Avril Drummond, Valeria Caso, Suvarna Alladi, Cheryl Bushnell, Mathew J. Reeves, Seana Gall
Abstract
This World Stroke Organization Scientific Statement highlights how sex and gender differences shape stroke risk, treatment, care, and research. Estrogen confers a relative protection before menopause, with risk increasing thereafter. Beyond shared cardiovascular determinants (hypertension, atrial fibrillation, and diabetes), women face sex-specific risks-hypertensive disorders of pregnancy, menopause, and hormone therapy, with clear implications for stroke prevention and management. Despite comparable efficacy of acute and secondary stroke therapies in women and men, women are less likely to receive timely acute treatment and often experience delays in recognition and access. The statement recommends gender-responsive prevention and care pathways; systematic consideration of pregnancy-related and menopausal factors; and public and professional education to improve stroke symptom recognition and purposeful inclusion of women across the research continuum. By integrating evidence from epidemiology, acute care, and secondary prevention, this statement provides clear and timely guidance for reducing inequities and shaping future research and policy to achieve equitable stroke care globally.