Women at heightened risk for stroke death

Women already account for more than 60% of stroke deaths in the United States, and that rate is projected to grow over the next decade, according to research published online Feb. 10 in a special issue of the American Heart Assn.'s journal, Stroke.

Stroke in women is a major health issue that has long been neglected, wrote Tobias Kurth, MD, assistant professor of epidemiology at Harvard Medical School in Boston, and Marie-Germaine Bousser, MD, head of the neurology department at the Hospital Lariboisiere in Paris. They co-authored an editorial in the journal.

With the aging of the population, the prevalence and incidence of stroke are expected to increase among both men and women, they note. But by 2050, mortality from stroke will be 30% higher in women than men.

Since women live longer than men and strokes most often occur among older women who likely have other comorbidities, some researchers have suggested that these factors alone account for women's poorer outcomes.

Others disagree.

"I believe there is still a residual effect of poorer stroke outcomes in women that are not explained by age or prestroke comorbidities," said the lead author of one study, Mathew Reeves, PhD, associate professor of epidemiology at Michigan State University.

Reeves and his colleagues compared seven different treatments indicative of excellent, evidence-based stroke care in more than 380,000 men and women hospitalized with ischemic stroke. They found that women had about a 10% lower chance of receiving that ideal care than did men.

Among the treatments studied was timely use of the clot-busting tissue plasminogen activator. Other interventions examined included aspirin, blood thinners, cholesterol treatment, smoking cessation and the prevention of blood clots in the legs. The largest differences between men and women occurred with the use of tPA and statins, Reeves said.

Although variations were not great when considered alone, when added together they could cause harm, Reeves said.

The data were gathered from more than 1,100 hospitals that participated from 2003 to 2008 in Get with the Guidelines-Stroke, an American Heart Assn./American Stroke Assn.'s quality improvement program.

Additional gender differences

The researchers also found, after considering differences in age and other variables, that women had similar in-hospital death rates after strokes as men did but were 16% less likely to be discharged home after a stroke.

Reeves intends to look at social factors that could explain why women were more likely to be discharged to nursing home care. "Did they have a spouse? A network of friends and family?" he asked. "There are certainly a lot of unknowns, and the area hasn't been studied very well or for very long."

An accompanying study, also from Michigan State University researchers, found that women were less likely than men to present with typical warning signs. Women were less likely to have problems with speech or walking but more likely to have atrial fibrillation or pain, said Julia Gargano, an epidemiologist at MSU and lead author of the study.

But even taking into account this difference in symptoms that could delay diagnosis, the researchers determined that women with acute stroke experienced longer waits for treatment in emergency departments.

In other studies in the same issue, researchers found additional gender differences. An analysis of a Get with the Guidelines-Stroke database in Colorado concluded that while men had more coronary artery disease, high cholesterol and diabetes, women had a higher incidence of atrial fibrillation and hypertension.

An analysis of data from the long-running Framingham Heart Study revealed that women were significantly older than men at the time of a first stroke. Women also were significantly more disabled before stroke and in the acute phase of stroke. At three to six months after a stroke, women were more likely than men to be disabled and institutionalized.

"These new research findings showing women have unique risk factors for stroke and are more greatly impacted by the consequences of stroke should be a wake-up call for women to raise their awareness of stroke risk and for health care providers to close treatment gaps that can save lives," said Lori Mosca, MD, director of preventive cardiology at New York-Presbyterian Hospital and spokeswoman for the AHA's Go Red for Women campaign to fight heart disease.