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| Stroke risk: midlife women have a 2.39-fold higher stroke risk than midlife men |
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November 2007
Investigators found that strokes in middle age strike women more than twice as often as they do men.
Amytis Towfighi, MD, and his colleagues from the UCLA Medical Center, Los Angeles, California, analysed sex differences in stroke prevalence among individuals of midlife age (35 to 64 years) in the United States and determined factors predicting strokes.
The investigators analysed a nationally representative sample of 17,061 US adults, registered in the National Health and Nutrition Examination Survey (NHNES) between 1999 and 2004, to assess sex differences in stroke prevalence and to identify independent predictors of stroke occurrence among middle-aged individuals.
They found that women aged 45 to 54 years had a 2.39-fold higher risk of having experienced a stroke vs men of the same age. Furthermore, a 2.13-fold higher stroke risk was seen in 45- to 54-year-old women vs 35- to 44-year-old women, but the investigators were not able to detect significant differences in stroke rates in 55- to 64-year-old women vs 45- to 54-year-old women. Men in the 55 to 64 age group were significantly more likely to have a stroke than those between 35 and 44 or 45 and 54 years of age.
Furthermore, the investigators detected significant gender differences in the factors that contributed to stroke risk: race, ethnicity, waist circumference, systolic blood pressure, homocysteine, glycohaemoglobin, total cholesterol, and history of hypertension, diabetes, smoking, and coronary artery disease.
In women aged 45 to 54 years, independent predictors of stroke were coronary artery disease and waist circumference. In addition, several vascular risk factors including systolic blood pressure and total cholesterol levels increased at higher rates among women compared with men in each successively older cohort from 35 to 64 years.
The results of a separate multivariate analysis for severe headache or migraine (reported for the three months before the survey) indicated that this was also an independent predictor of stroke among women.
The investigators concluded that a higher prevalence of stroke may exist among women aged 45 to 54 years compared with similarly aged men and suggest that this possible disparity may be due in part to inadequate stroke-risk-factor modification in women. The authors pointed out that the findings reaffirm the need for improved risk factor modification among women, because women are known to receive less preventive and diagnostic cardiovascular care than men.
Amytis Towfighi and colleagues noted that the study's cross-sectional design "may limit any strong inferences from being drawn at this time" as to the reasons for the gender disparities in midlife stroke and suggested further studies to evaluate this phenomenon.
They concluded that "in the meantime, our study suggests a substantial toll of stroke among women aged 45 to 54 years that may be amenable to optimal control of modifiable vascular risk factors."
Reference:
Neurology 2007; 69 (20): 1898–1904.
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