 By LEE BOWMAN Scripps Howard News Service September 27, 2005
Although the tests aren't used in men as often as they should be either, the gender difference may help explain why women tend to have worse outcomes following a stroke, the researchers said. "Diagnostic evaluations that should be done on every ischemic stroke (caused by a blocked artery) patient still aren't being performed on a third to a half of patients, and they're less likely to be performed on women," said Dr. Lewis Morgenstern, director of the stroke program at the University of Michigan Cardiovascular Center. The findings, published Tuesday in the journal Neurology, come from a study of 1,234 stroke patients treated in Texas community hospitals in 2000-2002. The Michigan researchers analyzed detailed records from a random sample of 381 patients, 220 of them female. Morgenstern is a stroke neurologist who leads the Brain Attack Surveillance in Corpus Christi (Texas), or BASIC, the study from which the new data were gathered. He also holds professorships in neurology, neurosurgery and emergency medicine at UM. The researchers found that women were 36 percent less likely than men to receive an echocardiogram, an ultrasound "movie" of the heart that looks for clot-producing conditions. And women were 43 percent less likely to have exams of their carotid (neck) arteries, which can become narrowed by cholesterol plaque that blocks blood flow and increases the risk of clots forming. About 88 percent of all strokes are caused by blood clots in the brain or clots in the carotid arteries that supply blood to the brain. One in every seven people who has a stroke will have another one within a year. Doing the screening tests after a first attack can guide doctors in prescribing preventive treatment and help patients understand what they must to prevent a second stroke. Sixty-two percent of U.S. stroke deaths are among women, although a higher percentage of men suffer strokes. "Previous studies have shown that the rate of stroke is lower in women than in men, but that women have worse outcomes than men," said research associate Melinda Smith Cox. "Our results may give us a reason for that disparity." The new paper is the fourth from the researchers that show gender differences in some aspect of stroke diagnosis and outcome. They've already shown that stroke-related death is more common in women than in men in Texas, and that women suffering strokes reach the hospital later than men and are moved into emergency treatment more slowly than men. This means that they're less likely to be treated with important clot-busting medicine within the first three hours of an attack. The team is now doing a study of stroke symptoms, treatment and outcomes among patients at UM hospitals to see if gender differences also exist in Ann Arbor, Mich.
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