Spotlight on Stroke & Women
A Multidisciplinary Network Researching Women & Stroke.
A stroke occurs when there is not enough blood flow to the brain because of a blocked or burst blood vessel.
Stroke is both a cerebrovascular disease and neurological condition, and a major global health burden. The Global Stroke Fact Sheet 2025 published in International Journal of Stroke estimates that there are 12 million new strokes occurring annually and nearly 94 million people worldwide living with stroke-related disability.
THERE ARE SEX AND GENDER DIFFERENCES IN STROKE PREVALENCE AND OUTCOMES.
The 2025 World Stroke Organization’s scientific statement in International Journal of Stroke shows that men generally have a higher age-specific incidence of stroke across much of adulthood when compared to women.
Among younger individuals, stroke incidence is higher in women compared to men. Women tend to experience poorer functional outcomes and greater post-stroke disability compared to men. Women are less likely than men to achieve functional independence following stroke, and sex- and gender-related differences persist across stroke care processes and recovery. These findings highlight the need to consider sex- and gender-informed approaches in stroke prevention, care, and recovery.
In 2024, Dr. Amy Yu, a stroke neurologist and senior scientist at Sunnybrook Health Sciences Centre in Toronto and associate professor in the Department of Medicine at the University of Toronto, and her team were awarded a $5-million grant from Brain Canada, Heart & Stroke, and the Government of Canada, for StrokeGoRed, a pan-Canadian network of research excellence.
“As a funding agency, we have a responsibility to champion these considerations in the research we support – we must all recognize that sex and gender differences are real and consequential,” says Brain Canada President and CEO Dr. Viviane Poupon.
“We know these differences influence every dimension of health and disease, which means we can no longer accept clinical trials dominated by male participants and assume the results will apply to women.”
ENSURING THAT BOTH SEXES ARE MEANINGFULLY REPRESENTED IN RESEARCH IS ESSENTIAL, AND STUDIES LIKE STROKEGORED PLAY A CRUCIAL ROLE IN CLOSING THAT GAP.
Mind Over Matter® interviewed Dr. Yu to learn more about stroke and women, and her new research that examines female-specific risk factors and experiences.
IN THE TIME THAT YOU HAVE BEEN A STROKE NEUROLOGIST, WHAT ARE SOME OF THE MAJOR CHANGES THAT YOU’VE OBSERVED IN OUR KNOWLEDGE OF STROKES AND RISK FOR WOMEN?
Stroke has always been a devastating condition because it is sudden and people who survive stroke will often be left with differences in their ability to function. Stroke is a leading cause of death in Canada and around the world, and the leading cause of disability among adults. If we can prevent a stroke, we are not just saving lives, we are also improving quality of life.
With regards to stroke in women, there have been so many improvements in various aspects, from stroke prevention to management. One of the things that the stroke community has worked very hard on is to increase public awareness that stroke can affect women just like it can affect men.
WHAT ARE SOME OF THE KEY RISK FACTORS FOR STROKE, AND HOW DO THEY DIFFER FOR WOMEN?
The typical risk factors that we’ve known about for decades still account for most vascular diseases, including stroke: high blood pressure, high sugars, high cholesterol, and smoking. Factors that bring down risk of stroke are physical activity, healthy weight, and healthy diet.
Understanding sleep has been an exciting recent development. We now understand that sleep plays an important role in health. Having good quality sleep and treating sleep disorders, like obstructive sleep apnea, is important for vascular health and brain health.
Within the realm of women’s health, we now know that health conditions or symptoms that affect a woman earlier on in her life can impact her long-term cardiovascular health and brain health.
This includes complications during pregnancy, premature menopause due to cancer surgery or chemotherapy, exposure to hormones like estrogen, and even certain perimenopausal symptoms, particularly hot flashes and night sweats. These are associations that researchers are observing, but whether these conditions or symptoms cause strokes is less understood. It is a really exciting time to take on this research.
WHAT’S INTERESTING WITH THE CHANGES THAT YOU HAVE MENTIONED, HORMONAL CHANGES IN A WOMAN’S LIFE, AND LIFESTYLE FACTORS LIKE POOR SLEEP, IS THAT THEY’RE NOT TRADITIONALLY FOUND WITHIN A SINGLE MEDICAL DISCIPLINE. IT SOUNDS LIKE THERE ARE MANY DIFFERENT RESEARCHERS AND CLINICIANS THAT COULD HELP US TO UNDERSTAND STROKE. CAN YOU TELL US ABOUT YOUR ONGOING PROJECT, STROKEGORED AND HOW BRINGING TOGETHER PEOPLE FROM DIFFERENT DISCIPLINES HAS HELPED YOU TO LOOK AT STROKE RISK FACTORS FOR WOMEN IN A NEW WAY?
I agree, medical research is best done collaboratively. When clinicians, researchers, or patients with lived experiences speak to each other, we can really learn from one another. Until recently, women’s health has often not been prioritized. As an example, menopause is one of the most common health changes in women, but it is not well studied or understood.
With StrokeGoRed, our approach is about studying stroke in women throughout the continuum of care.
StrokeGoRed stands for Stroke in Women: Growing Opportunities to Realize optimal Evaluation, Diagnosis, and outcomes.
It is funded through a team grant in partnership with Brain Canada, Heart and Stroke Foundation, and the Canadian Institutes of Health Research (CIHR) Institute of Gender and Health. This incredible opportunity has allowed us to build a multidisciplinary research network across provinces.
Instead of focusing on just one aspect of care, like what are we doing with people when they come to the emergency department, or, how are we preventing stroke after they leave the hospital, the StrokeGoRed network has brought together a range of people who are specializing in different areas like in management of minor strokes, often treated in the clinic, hyperacute or acute stroke care, imaging, and rehabilitation.
We are studying care in the clinic, in the hospital, and when they are ready to be discharged. We are asking questions about what kind of rehabilitation is needed and offered, and what are the barriers to getting care.
OUR MULTIDISCIPLINARY GROUP COLLABORATED CLOSELY TO UNDERSTAND DIFFERENT PHASES OF THE PATIENT EXPERIENCE AFTER A STROKE.
Instead of working in silos, we are working together and asking questions like, what is happening in the clinics to prevent a stroke so that someone does not end up in a hospital, and what happens once a patient is in the hospital and are there different considerations given for women versus men with stroke? At the time of discharge, we are looking at who is going to rehab and who is not? Who is going back to work? Who is going back to driving?
HOW WILL YOU BE SELECTING PATIENTS ALONG THE CONTINUUM OF CARE?
To answer our questions, we are building two cohorts of patients. One cohort is from the clinic, where patients are seeking evaluations on whether or not they have had a transient ischemic attack or minor stroke. The second cohort of people will be comprised of people hospitalized with stroke.
WOULD SOME OF THE WAYS TO PREVENT A STROKE FROM OCCURRING IN THE FIRST PLACE – THAT IS, PRIMARY PREVENTION – MATCH THOSE OF SECONDARY PREVENTION, REDUCING THE RISK OF ANOTHER STROKE FROM HAPPENING?
Primary stroke prevention – that is preventing a first-ever stroke from happening – is very important. This includes paying attention to the risk factors we spoke about, like managing blood pressure, cholesterol, sugar, diet, exercise, promoting sleep, and avoiding smoking.
Researchers have shown that high blood pressure or diabetes during pregnancy (gestational diabetes) is associated with higher risk of chronic hypertension and diabetes outside of pregnancy, and higher risk of vascular events like stroke later in life.
In a 2025 research paper published in Circulation, we showed that in everyday care in Ontario, half of women who experienced hypertension or diabetes during pregnancy did not get regular testing for diabetes or high cholesterol. Yet regular screening for vascular risk factors is important because these conditions are treatable, and early detection can make a big difference to prevent stroke and heart attack.
For secondary prevention, the focus is on the same risk factors, but treatment targets may be different in terms of how closely the blood pressure needs to be followed or how stringent the cholesterol level needs to be controlled.
WHAT ARE SOME OF THE FEMALE-SPECIFIC RISK FACTORS YOU WILL LOOK AT THROUGH STROKEGORED?
We are looking at many female-specific risk factors of stroke like pregnancy complications, exposure to hormones, and symptoms of menopause around mid-life.
We hope StrokeGoRed will be able to quantify how important these risk factors are for stroke in women to guide treatments, and which ones are contributing the most to the risk of stroke or affecting stroke recovery.
THE GRANT FOR STROKEGORED WAS AWARDED ABOUT A YEAR AGO. IN CLOSING, WHAT ARE SOME OF THE KEY ACCOMPLISHMENTS OVER THE FIRST YEAR THAT YOU WOULD LIKE TO SHARE WITH OUR READERS?
It has been a really exciting year. We received funding in October of 2024, and then in November, we had our first in-person meeting that brought the entire network together: patient partners, researchers, clinicians, study co-ordinators, and trainees. It was an invigorating meeting that accelerated our work. I also had the opportunity to visit several First Nations communities with the StrokeGoRed Indigenous health lead, Margaret Hart, an Ininiw scholar, and I learned a lot about their perspectives on the burden of stroke.
In terms of recruitment, the clinic-based study has been launched with five active participating sites. At Sunnybrook, we have started recruitment for the in-patient cohort. We are planning a sub-study where patients will be wearing a device to monitor their sleep while they are in hospital so we can look at how fragmented their sleep is.
We have also funded two post-doctoral fellows who are working in sex- and gender-based stroke research. We also just announced a new call for applications to fund one post-doctoral fellow and one clinical fellow working on sex- and gender-based analysis in stroke diagnosis, treatment, and rehabilitation.
Things are moving quickly, and I am sincerely blown away by the level of engagement and motivation by members of our StrokeGoRed network. We are grateful for the opportunity to build Canada’s first network focused on stroke in women, and we are excited about what we can learn together.
Source: Mind Over Matter 22