Effect of Sex on Outcome after Recurrent Stroke in African Americans: Results from the African American Antiplatelet Stroke Prevention Study

Testai, Fernando D.; Cursio, John F.; Gorelick, Philip B.

doi:10.1016/j.jstrokecerebrovasdis.2009.05.008

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 19, Issue 4 , Pages 321-325, July 2010

Effect of Sex on Outcome after Recurrent Stroke in African Americans: Results from the African American Antiplatelet Stroke Prevention Study

Fernando D. Testai, MD, PhD
- Department of Neurology and Rehabilitation, Section of Cerebrovascular Disease and Neurological Critical Care, University of Illinois College of Medicine at Chicago
- Address correspondence to Fernando D. Testai, MD, PhD, Department of Neurology and Rehabilitation, Section of Cerebrovascular Disease and Neurological Critical Care, University of Illinois College of Medicine at Chicago, 912 S Wood St, Room 855N NPI, Chicago, IL 60612.
John F. Cursio, MS
- Center for Stroke Research, Department of Neurology and Rehabilitation, University of Illinois Medical Center at Chicago
Philip B. Gorelick, MD, MPH
- Department of Neurology and Rehabilitation, Section of Cerebrovascular Disease and Neurological Critical Care, University of Illinois College of Medicine at Chicago
- Center for Stroke Research, Department of Neurology and Rehabilitation, University of Illinois Medical Center at Chicago

Received 2 April 2009; received in revised form 19 May 2009; accepted 29 May 2009. published online 05 May 2010.

Background

Sex-related disparities in stroke have been previously reported. However, the influence of sex on the outcome of recurrent stroke in African Americans is less clear. Our objective was to investigate the effect of sex on the outcome of recurrent nonfatal stroke in the African American Antiplatelet Stroke Prevention Study (AAASPS).

Methods

The AAASPS is a double-blind, randomized, controlled trial of recurrent stroke prevention in African Americans. Participants (967 women and 842 men) with noncardioembolic ischemic stroke were assigned to receive ticlopidine or aspirin and were followed up for up to 2 years. The National Institutes of Health Stroke Scale (NIHSS) score, modified Barthel score (mBS), and Glasgow Outcome Scale (GOS) score were determined at enrollment, at prespecified times thereafter, and at the time of recurrent stroke. Survival analysis was used to test for a significant difference in the time to recurrent stroke between women and men.

Results

Of the total 1809 subjects enrolled in AAASPS, 186 (89 women and 97 men) experienced recurrent nonfatal stroke. At enrollment, the NIHSS score (2.87 for women and 3.00 for men; P=.73), the mBS (18.26 for women and 18.52 for men; P=.47) and the GOS score (1.49 for women and 1.51 for men; P=.86) were not significantly different. In follow-up and at the time of stroke recurrence, the NIHSS score, mBS, and GOS score were similar for both groups, except for the mBS at the 6-month visit, which was lower in women (18.49) than in men (19.37) (P=.02). In the survival analysis, no significant difference in the time to recurrent stroke was found between women and men (P=.69).

Conclusions

Although sex-related stroke disparities have been reported, in the AAASPS cohort outcomes for recurrent nonfatal noncardioembolic ischemic stroke for women were not significantly different than for men. Differences in study populations and methodologies may explain discrepancies in results from the various studies.

Key Words: African Americans, ischemic stroke, advances in stroke, database, sex