Stroke, obesity and gender: a review of the literature

Cerebrovascular disease constitutes one of the main causes of morbidity, disability and mortality worldwide. Obesity, a major health problem reaching global epidemic proportions, is also associated with morbidity and mortality. The present review provides an update on the current knowledge regarding the association of gender and obesity with stroke prevalence and outcome. We also discuss the areas that future research needs to point towards. In general, gender differences in relation to stroke are increasingly being recognized and evaluated. Age-specific stroke incidence is generally higher in men, except in the elderly. Women are treated less frequently with intravenous thrombolysis compared with men stroke patients and the two genders seem to respond differently to aspirin and statins. Regarding obesity, although it is a well-known predictor of cardiovascular disease, there is a growing body of evidence revealing the presence of an inverse relationship between obesity and outcome in patients with stroke or established cardiovascular disease, the so-called obesity paradox. Further research is warranted on these important topics, as human population is continuously aging and becoming more obese. In this context, the causes of gender differences in stroke prevalence and outcome and the obesity-stroke paradox should be further investigated in future studies.