BACKGROUND AND PURPOSE: Gender differences in stroke are matters of increasing interest. The American Stroke Association's patient management tool, Get with the Guidelines-Stroke (GGS) is widely used to increase adherence to quality indicators in stroke care, but it also provides an opportunity to analyze gender differences in the acute stroke setting. METHODS: We used a state-wide database, based on GGS, to explore gender differences in stroke in Colorado. We analyze demographics, risk factors, lifestyles, treatments, and responses to treatment. RESULTS: Of 126 data elements examined, statistically significant gender differences were noted for 47 (37%). As compared to men, women in Colorado were older and more significantly impacted by acute stroke. Risk factor profiles differed between the 2 genders, with men having a higher incidence of coronary artery disease, dyslipidemia, diabetes, carotid stenosis and tobacco smoking, while women had a higher incidence of atrial fibrillation and hypertension. Lipids were less aggressively treated and antithrombotics were less commonly used in women. Overall, acute stroke treatment of women appeared "less aggressive" than for men. CONCLUSIONS: GGS may be used not only for quality improvement initiatives in individual hospitals. It can also give an overview of clinical aspects of stroke at a state level, and may shed light on gender differences.