1. Plans and Projects

2. LSS Plans and Projects Priorities Ready to utilize the network infrastructure of study sites for studies that engage more of the LSS centers. New telemedicine sites coming on-line. Expand LSS relationships across the state to expand groups of study sites. Low-tech, but high impact studies of stroke prevention that all stroke centers can do. Leverage LSS infrastructure and to obtain external funding.

3. Lone Star Stroke Center for Research in Women Women’s stroke and response to therapy is different than men’s, especially in aged women There are few large-scale research programs that focus on sex-specific studies of stroke. Women of color are particularly understudied, despite the heavy stroke burden borne by African American, Hispanic and Asian-American women.

4. American Heart Association’s Go Red For Women Research Network Three integrated projects: – Laboratory based – Population Health – Clinical Study Training of 3 research fellows (Markey and Brey) $3.7M over 4 years

5. Pre-clinical Study LD McCullough This age effect is well-captured in animal models where stroke-associated infarction is lower in young females as compared to males, but worse in aged females as compared to aging males. Hypothesis that age-related changes in endocrine systems create a pervasive alteration in epigenetic modifiers, and consequently affect stroke pathophysiology. Animal model results inform the development of new treatments in patients.

6. Differential outcomes to acute stroke treatments by race and sex in a diverse Texas population TA Kent Develop a matched cohort of stroke patients through the Lone Star Stroke research network that present at its hub and spokes. Patients will be stratified by race and sex. Biological and social factors will be obtained. Test for differences in 90 day outcome when treated with intravenous rt- PA and/or endovascular interventions. Social factors associated with outcome in cardiovascular disease and biological factors supported by our preliminary data, including inflammatory and coagulation proteins will be investigated The high risk of stroke and poorer outcomes seen in African American women and the lack of comprehensive outcome data in Hispanic women necessitates a prospective study in which the latest therapies are employed to better understand how to prioritize access to these therapies.

7. Sex differences in cerebral vascular and hemodynamic factors predict differential stroke outcomes and therapeutic response. S Warach In large sample of acute strokes from existing datasets within Lone Star Stroke, identify sex differences, stratified by race/ethnicity, in vascular and hemodynamic factors known to predict stroke outcomes and response to reperfusion therapy. Prospectively test and validate sex differences in the prognostic imaging markers identified in LSS centers Test the hypothesis that variability in hormonal exposure in women predicts variability in the prognostic imaging markers.