Stroke Hits Women Later But Harder

Study suggests more aggressive preventive treatment needed

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THURSDAY, June 12, 2003 (HealthDayNews) -- A woman is likely to be older than a man when she first has a stroke, but her stroke will probably be more severe and disabling, according to new research that demonstrates distinct gender differences.

The average age at which the stroke hit was 75 for a woman versus 69 for a man, the Spanish researchers found. Their study is reported in the June 13 online issue of the journal Stroke.

Other gender differences found in the study point to the need for more aggressive treatment for some women at risk of stroke, says Dr. Jaume Roquer, the lead author of the study and a physician at the Servei de Neurologia at the Hospital del Mar in Barcelona.

That's because women in the study had higher rates of an irregular heart rhythm known as atrial fibrillation, in which the two upper heart chambers quiver rather than beat effectively, Roquer says.

This condition boosts the risk of a type of stroke known as cardioembolic stroke because blood that isn't pumped out of the chamber as it should be can pool and form clots that can travel to the brain.

For men in the study, the risk factors for a first stroke were more likely to be peripheral artery disease or alcohol abuse.

The good news from the study: atrial fibrillation in women can be treated with blood thinners, called anticoagulants, thus reducing the stroke risk if they have this condition, Roquer says.

To find the gender differences, Roquer and his co-researchers evaluated 1,581 subjects -- 722 women and 809 men -- admitted to their hospital for a first, acute stroke between late 1995 and early 2002. They gathered information on risk factors, effects of the stroke and the patients' outcomes.

Women were more likely to have speech difficulties as well as visual impairments and difficulty chewing or swallowing after the stroke than were men. They also had longer hospital stays -- 15.4 days versus 13.5 for men, and were more disabled after the stroke.

Death rates were 12.1 percent for women and 10.6 percent for men, a statistically insignificant difference.

While other studies have reported similar findings, Roquer says the new study clearly demonstrates gender differences in stroke.

"Moreover, we clarify some previously controversial data. For instance, we clearly demonstrate a higher prevalence of hypertension and cardioembolic disease in women suffering their first-ever acute stroke," he says.

More aggressive treatment may be wise, Roquer adds, if a woman's physician detects atrial fibrillation. "Specifically, a cardiologist must consider anticoagulant [blood thinner] treatment with warfarin if an atrial fibrillation is detected," he says.

Another stroke expert, Dr. Andrew K. Oh, a neurologist at Santa Monica-UCLA Medical Center, says the new study is valuable to physicians because it clarifies that strokes are often different in men and women. "There is some data suggesting that, but this really clarifies it," he says.

And the study sends a message to physicians, Oh adds.

"When a woman starts to have atrial fibrillation, don't pooh pooh it and say, 'Put her on aspirin [a common treatment] and see how she does,' " he says. "We have suspected aggressive treatment [such as anticoagulants] is needed to prevent strokes."

The study results support the more aggressive treatment approach, especially to prevent strokes related to atrial fibrillation, he says.

In response to the study, Oh says he plans to become more aggressive in stroke-prevention treatment for women.

Women can take a number of steps to reduce their stroke risk, Roquer says. "Avoid obesity, smoking, alcohol or drug abuse," he says. Keep blood pressure under control and get treatment for other problems such as diabetes or high blood cholesterol, he adds.

In another stroke study in the same journal, researchers say younger women who want to reduce their stroke risk but also want to use oral contraceptives should be prescribed low-dose oral contraceptives, the most commonly prescribed formulas today.

Researchers identified 234 women, average age 42 years, who had suffered a stroke and compared them with an equal number of women in a control group of the same age range. They found no evidence of an association between stroke and low-dose birth control pills.

In the study, women taking a pill with less than 50 micrograms of estrogen were at no greater risk of ischemic stroke, in which a blood clot blocks an artery to the brain. Many low-dose pills used today contain 30 to 35 micrograms of estrogen.

More information

For stroke warning signs and other information, visit the American Heart Association. For more information on stroke and women, check with the American College of Emergency Physicians.

SOURCES: Jaume Roquer, M.D., Ph.D., physician, Servei de Neurologia at the Hospital del Mar, Barcelona, Spain; Andrew K. Oh, M.D., assistant clinical professor of neurology, University of California, Los Angeles' David Geffen School of Medicine, Los Angeles, and neurologist at Santa Monica-UCLA Medical Center, Santa Monica, Calif.; June 13, 2003, Stroke
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