Stroke in Women
Interesting differences without clear reason
An interesting news item appeared on CHIhealth.com today. The journal Stroke is publishing a series of studies looking at the issue of stroke in women and some of these papers are summarized in a nice report. It turns out that women who experience a stroke receive less aggressive preventive treatment, have a poorer understanding of their disease, and suffer significant delays in emergency therapy. This comes as no surprise to me.
A few years back a couple of doctors and I queried the enormous National Registry of Myocardial Infarction database of over 600,000 patients in order to tease out the differences between men and women who suffer stroke in the first few days following a heart attack. We found that women were more likely to die or have personal disability after stroke than men. Using the magic of statistics we were able to eliminate the effect of certain variables that are inherent to the female heart attack population, such as the fact that women weigh less than men and tend to be older when they suffer heart disease. Despite controlling the data for these and around 26 other factors, we found that women were at least 50% more likely to suffer bad outcomes with stroke. I was able to present these data at a national conference but was unable to answer the most obvious question that arose in the meeting: why do women do worse? Why aren’t women more like men?
Wide ranging research with more to come
I don’t have an answer now, either, and it’s clear that my research was not an outlier in this field. Most research in this area supports a worse outcome for women. Consider the research soon to appear in the journal Stroke:
- There were significant differences between genders on 47 of 126 “elements” studied. The analysis of the Colorado Stroke Registry found that women were older and fared worse after a stroke than men. Risk factors also differed, with men more likely to have coronary artery disease, high cholesterol, diabetes, narrowing of the blood vessels and to be smokers, while women were more likely to have atrial fibrillation and hypertension as contributing factors. Women tended not to be treated as aggressively as men.
- A new analysis of data from The Framingham Heart Study found that women tended to be older than men (75.1 vs. 71.1) at the time of their first stroke; had more strokes after the age of 85 than men, although fewer in other age brackets and a higher incidence overall. Women tended to have more trouble dressing, grooming and moving from a bed to a chair both before, during and after a stroke. They were more than three times as likely as men to end up in an institution after a stroke.
- Women with acute stroke were delayed longer in emergency rooms and were less likely to experience some of the warning signs of a stroke. “We’ve done a good job teaching people about symptoms of a heart attack. We need to have a similar message for stroke,” Mosca said. “A lot of people don’t realize if you have numbness or loss of function in your face, arms, legs, one side of your body or you have a sudden headache, these things can actually indicate a stroke, so it’s hugely important for you to call 911. The warning signs are not on the radar screen as they are for heart attack.”
- Women showed a troubling lack of knowledge when it came to identifying risk factors for stroke or knowing what behaviors might actually prevent such an eventuality. The women in the study, who were mostly white, also tended to underestimate their risk.
- Finally, other researchers advocated a national registry to help determine which preventive drug would be most effective in pregnant women with a history of stroke.
So here is our challenge. It appears that better awareness of the risk of stroke in women can be useful for both us as healthcare providers and for women, and focusing on this is at least a start. This may not account for all the difference between men and women but we need to start working on problems we can identify.
Of course there may be another explanation. Half the men in my clinic who have had heart attacks are alive only because their wives brought them to the ER kicking and screaming. In this group the difference between life and death was the presence of a persistent wife. So the real question is not “why can’t women be more like men?”, but rather “why can’t husbands can’t be more like their wives?”