Sex differences in treatment may explain variance in outcomes after stroke

By Michael Woodhead

21 Nov 2019

Dr Cheryl Carcel

Women have better survival than men after ischaemic stroke – but they are also more disabled and have poorer quality of life, an Australian-led study shows.

Researchers from the George Institute for Global Health in Sydney made the findings  after investigating sex differences in treatment and outcomes in 19,652 participants in five international randomised controlled trials involving men and women after a stroke.

Compared to men, women with ischaemic stroke had higher survival at 3-6 months (odds ratio [OR] 0.82), but higher likelihood of disability (OR 1.20), and worse quality of life (weighted mean difference -0.07)

Women were more likely to be admitted to an acute stroke unit (OR 1.17), but less likely to be intubated (OR 0.58), treated for fever (OR 0.82), or admitted to an intensive care unit (OR 0.83).

Women also had different treatment of risk factors compared to men prior to the stroke. For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22) and lower odds of being prescribed antiplatelets (OR 0.86) or lipid-lowering agents (OR 0.85)

Lead author Dr Cheryl Carcel, a neurologist and Conjoint Senior Lecturer, Faculty of Medicine, UNSW Sydney, said the findings were consistent with other studies of sex differences that found men have considerably higher mortality for various causes including cardiovascular disease across age groups due to interactions with culture and environment.

But while women were more likely to be admitted to an acute stroke unit, it was not clear it was this could explain the better outcomes compared to men.

“While we know women tend to be older when they have a stroke and are more likely to have key risk factors such as high blood pressure and irregular heart rhythms than men, whether they are treated differently and how that affects their longer term outlook was less certain,” said Dr Carcel.

The sex differences in use of preventative medication for stroke may influence post-stroke disability via differences in brain injury and repair, she added

“It is clear that women and men require different types of support after stroke but physicians may also need to pay more attention to risk factor control in women,” said Dr Carcel.

“Preclinical studies of ischaemic stroke suggest that ageing brain in women is more sensitive to ischaemia than in men, in relation to declining oestrogen, increased systemic inflammation, and an alteration in gene expression,” she wrote in Neurology.

Dr Carcel has  been awarded the $20,000 2019 Paul Korner Innovation Award as well as a Postdoctoral Fellowship, to better understand why women and men experience medical care differently after developing heart disease.

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