Disease Severity Greater in Women than in Men
In patients with coronary heart disease (CHD), statin therapy is associated with a decreased risk of stroke but not of stroke severity or mortality, according to the results of a new study published in (2006;37:1427-1431).
Statins have been shown to reduce the incidence of stroke in patients with heart disease, but reports on their effects on stroke severity and functional outcomes have been inconsistent. Women generally have poorer stroke outcomes than men and thus could obtain greater benefits from statin treatment, but this remains unproven.
The effects of statin treatment on stroke incidence and outcomes were examined in 8191 statin users and 14,752 statin nonusers. The study population represented a pooled cohort from 3 secondary prevention trials of oral glycoprotein IIb/IIIa inhibitors in patients with CHD.
Stroke was the primary end point in one trial and a secondary end point in the other two. All 3 trials used similar approaches to identify patients with suspected strokes and used Canadian Neurological Scale scores to grade stroke severity.
A total of 217 trial participants had strokes. Primary hemorrhagic stroke was significantly more common in women than in men (16.7% vs 5.6%; = .013), but there was no difference in stroke type based on statin use.
The unadjusted and risk-adjusted hazard ratios for stroke were lower in statin users than in nonusers. Independent predictors of increased stroke risk included age, diabetes, history of stroke, baseline beta-blocker use, and transient ischemic attack at study entry.
Stroke fatality rates were higher in women than in men (16.9% vs 10.3%), but the difference was not statistically significant. The risk of fatal stroke was similar in statin users and nonusers (11.8% vs 12.8%).
Stroke severity was significantly greater in women than in men ( = .035). Female gender remained a significant risk factor for increased stroke severity after adjusting for age, atrial fibrillation, and statin use.
After adjusting for female gender, no significant association was found between statin use and stroke severity scores, nor was there any significant interaction between statin use and female gender.
The reasons for the differences in stroke outcomes by gender remain unclear. “One possible explanation could be that women with CHD have greater stroke severity than men with CHD,” write Cheryl Bushnell, MD, of Duke University Medical Center, Durham, NC, and colleagues. “Support for this notion comes from data showing that women with CHD have a higher stroke severity than women without CHD.”