News Release

Women's first stroke more severe and disabling than men's

Peer-Reviewed Publication

American Heart Association

DALLAS, June 13 – Women have more severe first strokes at an older age than men and remain more disabled, Spanish researchers report in today's rapid access issue of Stroke: Journal of the American Heart Association.

The study also found gender differences in risk factors, stroke effects, complication rates and length of hospital stay.

Women in the study had higher rates of atrial fibrillation (AF) – an irregular heart rhythm in which the two upper heart chambers quiver instead of beating effectively, says Jaume Roquer, M.D., Ph.D., of the Servei de Neurología at the Hospital del Mar in Barcelona, Spain. Blood that isn't pumped completely out of the chamber can pool and form clots that may travel to the brain, causing a cardioembolic stroke. AF can be treated with anticoagulants (blood thinners), which reduce the likelihood that blood will clot.

"One of the most important therapeutic conclusions of our study is the necessity of increasing the use of preventive anticoagulation treatment in patients at risk for a cardioembolism, especially in women, because their frequency of atrial fibrillation is greater," Roquer says. "Better control of hypertension should also be another important therapeutic goal to decrease the incidence of stroke in women."

In the United States, stroke is the third-leading cause of death. Women accounted for 61.4 percent of U.S. stroke deaths in the year 2000, according to the American Heart Association.

Noting that few studies that analyzed stroke in women included vascular risk factors, the origin of the stroke, clinical presentation, and outcome, Roquer and colleagues studied all first acute stroke patients (1,581) admitted to their institution between December 1995 and January 2002. Patients underwent routine blood analysis, brain imaging, an electrocardiogram and chest radiography.

There were 772 women (48 percent) in the study and, on average, they were older than the men (75 years old versus 69 years old). The predominant risk factors in women were hypertension and cardioembolic diseases, mainly due to the higher frequency of atrial fibrillation in women than in men. In men, peripheral artery disease and alcohol overuse were more likely related to stroke. No gender differences were found for diabetes, past history of ischemic heart disease, or high cholesterol.

Aphasia – the inability to use or comprehend words – was present in 29 percent of women compared with 22 percent of men. About 17 percent of women had visual impairments compared with 14 percent of men. Dysphagia – difficulty chewing or swallowing – was found in about 20 percent of women and 14 percent of men. However, there were no differences in motor or sensory deficits.

The health condition of women at admission was worse than men, in-hospital medical complications were more frequent in women, and the length of hospital stay was longer. The death rate was higher in women but the data did not reach statistical significance.

Although no gender differences were seen in therapeutic decisions, women underwent fewer diagnostic procedures than men did.

"Many of our findings have been reported or suggested by other authors," Roquer says, "but in some of these studies conflicting data were presented. Our study strongly supports that there are many gender differences in stroke."

The researchers suggest that the reason that more women than men are incapacitated after a stroke might be due to their older age, the greater stroke severity, and higher rate of in-hospital medical complications.

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Co-authors are Ana Rodríguez Campello, M.D., and Meritxell Gomis, M.D.

Editor's note: For more information on stroke, visit the American Stroke Association Web site: strokeassociation.org.

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