The discovery could prompt the discovery of drug treatments to help those at highest risk.

This protein it produces plays a role in the growth of blood vessels. but too much of it may increase stroke risk.

Writing in the journal Nature Genetics, the scientists said people with certain forms of a gene called PDE4D may be most at risk.

Proteins from a similar “family”, called phosphodiesterase (PDE), are linked to other illnesses, such as asthma, inflammation and even erectile dysfunction.

This suggests that it may be possible to develop a drug to block the effects of the gene - the breakthrough impotence drug Viagra already works by targeting another member of the PDE family.

Solveig Gretarsdottir and colleagues at a company called deCode Genetics in Reykjavik believe this gene is associated with an increased risk of stroke.

They carried out DNA tests on over 1,700 people in Iceland, half of whom had suffered strokes.

The Icelandic population is generally regarded as the best testing ground for .

This is because the gene pool is relatively pure. Unlike most other countries, there has been little since the first Vikings arrived almost 1,000 years ago.

Scientists working on this latest study say they have identified genetic differences between those people who have had strokes and those who have not.

These differences centre on the gene PDE4D, located on chromosome 5.

They have found that three different isoforms of the gene were expressed at lower levels in people who had strokes.

Isoforms are groups of proteins that are produced by a gene.

They also found different combinations of genes in regions of chromosome 5 flanking the PDE4D gene in people who had strokes.

It is already known that this gene provides the coding which enables a protein called a phosphodiesterase to work.

Stroke risk

But the Icelandic scientists believe that too much of it may increase the risks of atherosclerosis - furring up of the arteries.

This causes the arteries to narrow, which can trigger a stroke.

“We propose that PDE4D is involved in the pathogenesis of stroke, possibly through atherosclerosis, which is the primary pathological process underlying ischemic stroke,” the scientists said.

They believe that blocking the protein in people with these potentially problematic forms of the PDE4D gene could protect them against stroke.

There are already drugs available to do this. These so-called phosphodiesterase inhibitors are used to treat asthma, inflammation and erectile dysfunction, with Viagra probably the best known.

However, much further study is needed before these drugs could be used to treat people who may have a high risk of having a stroke.

Viagra, for one, has potentially serious side effects if taken by men with underlying health problems.

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The drug's maker Pfizer says it is considering submiting an to European regulatory authorities to clear it for sale in pharmacies.

An estimated 27 million men have already used the little blue pill for erectile on prescription.

Medics said a change would be welcome but might mean other linked diseases were missed with no health check ups.

Ups and downs

Often, men with erectile dysfunction have underlying health problems such as diabetes, which can be spotted by their GP at the time they come for an anti-impotence prescription.

“If men can buy Viagra and rival anti-impotence drugs over-the-counter without a prescription, this opportunity is missed,” said Dr David Ralph from the Institute of Urology at University College London.

But there would be benefits too, he said, such as combating the problem of Viagra sold illegally on the internet from unknown sources, which may be fake and if taken with some medicines could be fatal.

He said it would be safe to buy over-the-counter provided the pharmacist did the necessary checks to ensure the medication was suitable for the patient.

Embarrassment factor

It might also be a more attractive option to men as going to see the GP about sexual problems can be embarrassing, he added.

But he cautioned: “There is more to sexual relations than an erection. There may be other problems.”

Viagra works by relaxing the blood vessels in the penis. This allows blood to flow into the penis causing an erection.

However, the drug is not an and does not increase sex drive.

It is licensed only as a treatment for men who have been diagnosed by a doctor as having impotence.

Also, some men, such as those with severe heart disease or low blood pressure, should avoid it because of possible risks and side effects.

Viagra is not licensed for use in women and its safety in women has not been established.

A Pfizer spokesman said: “As with many of our products, Pfizer has routinely evaluated a number of options including different formulations, new indications, over-the-counter and continues to do so.”

He added that despite speculation there were no plans to pursue a spray version of the drug.

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July 26, 2000 –Until last week, Jennifer Erickson was just an ordinary pharmacist, working at a drugstore in Seattle. Now, the 26-year-old married woman is the poster girl for women everywhere who have had to plunk down their own money to pay for birth control.

On July 19, Erickson, who says she would like to have children some day but is not ready yet, filed suit against her employer, Bartell Drug Co., charging them with sex discrimination for paying for other prescription drugs, but not prescription birth control. Erickson is one of approximately 42 million women in this country who use birth control. Although she has a good job and can afford the more than $300 per year that her prescription birth control pills cost, she doesn’t think she and millions of others should have to pay for them. And neither do plenty of medical professionals and health policy experts.

“Contraception is a fundamental part of health care, just like vaccinations,” says David A. Grimes, MD. “It’s good, cost-effective, preventive health care.”

Grimes is vice-president of medical affairs at Family Health , a nonprofit group in Research Triangle Park, N.C., that helps men and women get access to family-planning services and methods. He says that from a corporate viewpoint, makes sound economic sense. By averting a birth, the company saves money, especially if that birth is premature or there are other , he tells WebMD.

Approximately half of all large group insurance plans will not pay for any form of prescription birth control. Only about a third of health-insurance policies include oral contraceptives in their prescription drug coverage. Most HMOs do cover the Pill, but only about 40% cover the other four FDA-approved contraceptive options: IUDs, diaphragms, Depo-Provera shots, and Norplant implants.

“As women, we’ve been excluded from so much,” says Karen Rashke, staff attorney for the Center for Reproductive Law and Policy. “We’ve just sort of taken it in stride. I don’t think a lot of us thought much about this until recently.”

Although plenty of women have complained for years about being refused coverage for what many see as a basic health need, until the Erickson lawsuit was filed last week, no single person had ever stood up to an employer and demanded that they pay. Erickson’s lawsuit seeks birth control coverage for herself and all other non-union female employees of Bartell Drug Co., which has more than 45 pharmacies in the state of Washington.

In a statement to the media, of Bartell Drug Co. said they believe their insurance plan is “lawful and nondiscriminatory.” They point out that they do not pay for Viagra, infertility drugs, drugs for weight reduction, immunization agents, drugs for cosmetic purposes, and various other items.

Roberta Riley of Planned Parenthood of Western Washington, who is the lead attorney in Erickson’s, case, says her client repeatedly asked her employer to change its policy and cover birth control. When they continued to refuse, she decided to sue.

“I think it was only a matter of time before something like this happened,” says Cynthia Dailard, senior public policy associate at the Alan Guttmacher Institute in Washington, D.C. “If the lawsuit is successful, it will put many employers on notice that they could face similar lawsuits if they do not cover contraceptives, and that it is a matter of gender discrimination.”

Both Planned Parenthood of Western Washington and Planned Parenthood Federation of America, which is also representing Erickson, say birth control prevents unintended pregnancies and reduces the need for abortion.The group cites 1998 statistics showing that nearly half of all pregnancies in the U.S. are unintended, and many of these pregnancies end in abortion.

Experts who spoke to WebMD agree that one thing that has increased women’s anger over this lack of coverage is the advent of Viagra.

“Viagra is covered by many [insurance] programs and was scooted onto the market so quickly, while women have been struggling for decades to get coverage of contraception,” Grimes says. He believes the discrepancy amounts to nothing less than discrimination against women, many of whom cannot afford $20-$30 per month for birth control pills.

It is estimated that women of childbearing age pay about 68% more out of their own pockets for medical expenses than men. And now, even the Viagra pills — at $10 apiece — are often covered, while birth control is not. According to estimates, paying for birth control would cost insurers only about $1.43 per month for each female employee. That would provide them with all available FDA-approved forms of contraception; the cost would be even less if the employer only provided coverage for some methods.

Some in Congress are trying to force change by passing a law that would require all employers and insurance companies to pay for birth control. Progress has been slow, but individual states have passed such laws on their own. States that require companies who pay for other prescription drugs to pay for prescription birth control include Maryland, Georgia, Vermont, Maine, Nevada, Connecticut, North Carolina, Hawaii, New Hampshire, California, Iowa, Delaware, and Rhode Island. But nine of the 13 states have provisions that let employers, enrollees, or insurers who object to such coverage on “religious grounds” off the hook.

Most experts say individual states will probably continue to pass laws, and people will keep a close eye on the progress of Jennifer Erickson’s lawsuit. But what can a woman who is paying for her own birth control do in the meantime?

“Employees have the ability and the right to speak to their benefits manager,” attorney Rashke says. “There’s no reason an employee can’t go to the benefits manager and say, ‘I notice in my prescription coverage there’s an exclusion for contraception.’ That’s the first step.” If you don’t want to do it on your own, Rashke advises talking to other women you work with to see if they will take the concerns to the benefits manager as a group.

“One person can do a lot by raising the issue at cocktail parties, writing a letter to the editor … just point out this lack of coverage that so many of us haven’t even thought about,” she says.

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