Although the multivariable models were adjusted for sex, there were no sex-specific anal- yses performed in this cohort. In the Nurses Health Study, women with a history of depression had a 29% increased risk of incident total stroke (multivariate RR, 1.29; 95% CI, 1.13 In a meta-analysis of prospective studies of depres- sion and stroke, the pooled adjusted HRs were 1.45 (95% CI, 1.29 1.63) for total stroke and 1.25 (95% CI, 1.11 1.40) for IS. The cumulative ORs for studies that included only men or only women revealed no difference in the strength of associa- tion between depression and stroke compared with the cumu- lative OR for studies that included both sexes.399 Depression and Psychosocial Stress: Summary and Gaps Depression is associated with increased risk of stroke. More research is needed to understand the mechanisms underlying the association between depression and stroke, as well as to determine which women with depression may be at risk, such as those who are treated versus untreated, and whether self- reported measures such as those used in the INTERSTROKE study are the most accurate to determine stroke risk. There is also a lack of sex-specific analyses in many of the cohorts that have assessed multiple risk factors. Because depression and psychosocial stressors are more common in women, it may be reasonable to test these risk factors in a woman-specific stroke risk score. Strategies for Prevention of Stroke: Are They Different in Women? Representation of Women in Stroke Clinical Trials Women account for less than half of all subjects enrolled in National Institutes of Health funded stroke prevention clini- cal drug trials of the past decade. 