Racial and Gender Disparities in Stroke Risks

MedicalResearch.com Interview with:

Virginia J. Howard,PhD, FAHA, FSCT   
 Professor of Epidemiology
The University of Alabama at Birmingham

MedicalResearch.com:  What is the background for this study?

Response: This study comes from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national cohort study of 30,239 non-Hispanic black and white community-dwelling participants aged 45 years and older who lived in the 48 contiguous US states. 

REGARDS was designed to study risk factors for the development of stroke, with a focus on black and white comparisons as well as comparisons across geographic regions of the US.

MedicalResearch.com: What are the main findings?

·        For both blacks and whites, there was a lower risk of stroke for women than men aged 45-64, and a similar risk of stroke for women and men aged 75 and older.  However ,for ages 65-74,  white women were at lower risk of stroke than white men, but for blacks in this age group, the stroke risk was similar for women and men.

·        For whites, there were differences by sex in the association of diabetes, blood pressure, antihypertensive medication use, and heart disease on stroke risk.  In Whites, after controlling for other risk factors and socioeconomic factors, women with diabetes, higher systolic blood pressure and history of heart disease had greater stroke risk than men with these risk factors.  Also in whites, women on antihypertensive medications had lower stroke risk than men.  For blacks, there was no evidence of a sex difference for any risk factor.

MedicalResearch.com: What should readers take away from your report?

Response: The results suggests that it may not be ‘one size fits all’ when it comes to stroke prevention. For example, overall, black women may need better risk factor management and more aggressive risk factor management at younger ages than white women.

This report should remind people that stroke is preventable in all race, sex and age groups, but the strategies to prevent stroke may need to be targeted in different ways.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Clearly, additional study and confirmation of these findings should be considered.  We cannot explain why we observed differential effects of risk factors by sex in white individuals but not black individuals. We can only speculate and one of the reasons could be racial differences in the severity or extent of control of risk factors that were not accounted for in our analyses.  So that future research should examine these and other potential reasons.  It is clear that more work needs to be done in other studies with sufficient sample sizes in each of the four race-sex groups in order to further investigate these findings.

MedicalResearch.com: Is there anything else you would like to add?

Response:  We would really like to acknowledge and thank the > 30,000 participants from all over the US who joined the study back in 2003-2007 and have contributed so much of their time and information to help us learn more about stroke prevention.

We also thank and acknowledge the funding institutes from the National Institutes of Health: the National Institute of Neurological Disorders and Stroke and the National Institute on Aging who co-fund the REGARDS study.

And thanks to all the co-authors and other team members for their contributions to all aspects of the conduct of this research.


Howard VJ, Madsen TE, KleindorferDO, et al. Sex and Race Differences in the Association of Incident IschemicStroke With Risk Factors. JAMA Neurol. Published online December 10, 2018. doi:10.1001/jamaneurol.2018.3862


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Last Updated on December 11, 2018 by Marie Benz MD FAAD