Gender Bias in Stroke Care Persists

Women Get Less Aggressive Treatment, Have Poorer Outcomes

From the WebMD Archives

Feb. 16, 2006 (Kissimmee, Fla.) -- The gender gap in stroke care shows no signs of narrowing, Italian researchers report.

In a study of more than 250 stroke victims, about twice as many women as men suffered from a potentially deadly heart rhythm known as atrial fibrillation that is associated with severe strokes. In atrial fibrillation, the heart beats irregularly, which can allow blood clots to form in the heart and then travel from the heart to the brain to cause a stroke.

Prior to their stroke, 27% of men -- vs. 17% of women -- received anticoagulant (blood thinning) medication that has been proven to prevent strokes in people with atrial fibrillation. Although blood thinning medication can help prevent the occurrence of stroke in those with atrial fibrillation, some patients may not be able to take a blood thinner due to other medical problems. Being on a blood thinner also carries the risk for serious bleeding.

The finding may explain why one year after their stroke, 24% of female victims were still severely disabled vs. 10% of the males, says researcher Marco Stramba-Badiale, MD, PhD, head of the stroke unit at the IRCCS Instituto Auxlogico Italiano in Milan. "Many more women than men were still unable to bathe or feed themselves."


"More women have atrial fibrillation, which is associated with much more damage to the brain after a stroke," he tells WebMD. "Despite this, there is much smaller use of anticoagulant therapy among females. This may explain women's poorer outcomes."

The study, which was presented here at the International Stroke Conference 2006, included 269 stroke victims, 120 of whom were women.

Doctors Treat Men More Aggressively

Ralph Sacco, MD, director of the stroke and critical care division at Columbia University in New York, and moderator of a news conference on the findings, says that the study is in line with other research showing that women are still being short-changed in areas of prevention and management of stroke.

For example, in other research presented at the meeting, female stroke victims were less likely to be given the clot-busting drug tPA after arriving at the emergency room than men. tPA is a standard treatment option for ischemic stroke, but time is of the essence: It has to be administered in the first three hours after symptoms strike.


"Doctors continue to treat men more aggressively," Sacco tells WebMD.

The result, he says, "is that the number of women who have strokes is outpacing men." And women who do suffer strokes are more likely to suffer serious and lasting disabilities such as paralysis in an arm or leg that prevents them from performing everyday activities such as washing or feeding themselves, he adds.

According to the American Stroke Association, 373,000 women suffered a new or recurrent stroke in 2003, vs. 327,000 men. And 96,243 women died of a stroke that year vs. 61,561 men, though it's important to note that women live longer than men, which contributes to this gender gap.

Cultural Bias at Play?

The $64,000 question is, of course, why women are not treated as aggressively as men, Sacco says. Lee H. Schwamm, MD, director of TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston, says he thinks cultural biases may be at play.


As a younger generation of physicians, more of whom are women, replace older doctors, "it will be interesting to see if this changes," he tells WebMD.

Stramba-Badiale says that part of the problem is that many women think of stroke and heart disease as "men's diseases."

Despite the fact that heart attack and stroke are the No. 1 killers of women, "only 40% of women know this," he says. "Most think breast cancer is a bigger threat."

The more women learn about the symptoms and management of stroke, the more they can help themselves, Sacco says.

"If your doctor doesn't take the initiative, take it yourself," he tells WebMD. For example, if a woman is brought to the ER suffering from a stroke and she thinks not enough is being done quickly, she should ask whether a clot buster is appropriate, he says.

WebMD Health News Reviewed by Louise Chang, MD on February 16, 2006


SOURCES: Marco Stramba-Badiale, MD, PhD, head of stroke unit, IRCCS Instituto Auxlogico Italiano, Milan, Italy. Ralph Sacco, MD, director, stroke and critical care division, Columbia University, New York City. Lee H. Schwamm, MD, director, TeleStroke and Acute Stroke Services, Massachusetts General Hospital, Boston. Heart Disease and Stroke Statistics-2006 Update
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