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Heart Disease/Stroke

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Men are four times more likely than women to suffer a stroke due to large-vessel atherosclerosis

Over 400,000 men and women suffer from a first ischemic stroke each year in the United States. Although these strokes may be classified by the several different causes that produce them, scant data exist on the incidence rates and risk factors for different types of ischemic stroke.

A recent study, supported in part by the Agency for Healthcare Research and Quality (Stroke Prevention Patient Outcomes Research Team, PORT, 290-91-0028), examined some of these incidence rates and risk factors. It found that men and women had significantly different rates for strokes due to atherosclerosis with stenosis (narrowing of the blood vessel). After adjustment for age, men had four times the rate of this type of stroke as women (47 vs. 12 per 100,000), a difference in incidence that could explain why U.S. rates of carotid endarterectomy (surgical opening of a blocked carotid artery) are 30 to 60 percent higher in men than in women.

For this study, the researchers used the Rochester Epidemiology Project medical records linkage system to identify all 454 Rochester, MN, residents who suffered a first ischemic stroke between 1985 and 1989. Ninety-six percent of the population of Rochester is white, and 51 percent is female. The age- and sex-adjusted incidence rates of ischemic stroke per 100,000 in this population were 27 were due to large-vessel cervical or intracranial atherosclerosis with over 50 percent stenosis; 40 due to cardioembolic causes (blood clots originating from the heart); 25 due to lacunae (strokes due to blockages in tiny blood vessels deep in the brain); 52 due to uncertain cause; and 4 due to other or uncommon cause. Hypertension occurred with strikingly similar frequency among study patients with stroke due to large-vessel disease, cardioembolic stroke, and lacunae. There was no difference in history of prior transient ischemic attack.

Subtype-specific stroke incidence rates also provide a means of more accurately comparing racial differences and differences between men and women in stroke mechanisms. In comparing this study with a study of blacks in metropolitan Cincinnati, OH, the researchers found that although blacks had a higher overall age- and sex-adjusted ischemic stroke incidence compared with whites (246 vs. 147 per 100,000), the incidence of stroke due to large-vessel atherosclerosis with stenosis was significantly greater among whites than blacks (27 vs. 17 per 100,000). This difference could not be attributed to a disparity in procedure rates since the same proportion (54 percent) of patients in both studies received diagnostic tests to detect carotid stenosis.

Details are in "Ischemic stroke subtypes: A population-based study of incidence and risk factors," by George W. Petty, M.D., Robert D. Brown, Jr., M.D., Jack P. Whisnant, M.D., and others, in the December 1999 Stroke 30, pp. 2513-2516.

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