30 Nov Stroke: Sex Differences in Treatment and Outcome
MedicalResearch.com Interview with:
Cheryl Carcel MD
Research Fellow, Stroke & Women’s Health Program
Conjoint Senior Lecturer, Faculty of Medicine, UNSW Sydney
Associate Lecturer, Sydney Medical School, The University of Sydney
The George Institute for Global Health | Australia
MedicalResearch.com: What is the background for this study?
Response: This study builds on previous findings of differences in the presentation, treatment and outcome for women and men who experience stroke. For this analysis, we pooled five large international, multicenter, randomized controlled trials that included the following: the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT-1 and -2 studies), the alteplase-dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke study (ENCHANTED), the Head Position in Acute Stroke Trial (HeadPoST), and the Scandinavian Candesartan Acute Stroke Trial (SCAST).
MedicalResearch.com: What are the main findings?
Response: Our study provides new evidence on sex differences in disability and health-related quality of life overall and by stroke subtype (ischemic and hemorrhagic stroke). The main findings were that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life after the stroke than men. Variations in hospital management (women were more likely to be admitted to acute stroke units than men) and out-of-hospital management of stroke risk factors may partly explain the disparities. While the five trials we looked at were not specifically studying these treatments, there was also a hint that women were more likely to be taking blood pressure lowering medication, but less likely to have been prescribed blood thinning, glucose-lowering or lipid-lowering medication prior to their stroke than men.
MedicalResearch.com: What should readers take away from your report?
Response: It is important to acknowledge that there are key differences in how women and men experience disease and it’s treatment, not only in stroke but in many other conditions. The first step towards addressing these differences is to report the data and therefore it is vital that clinical trials – especially drug trials – disaagregate results by sex and report them.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to explore whether there are sex differences in how stroke risk factors are being controlled and whether guideline-prescribed medication varies in women and men. Real-world data in the form of registries and linked real-world data will help us answer these questions.
MedicalResearch.com: Is there anything else you would like to add?
Response: Higher healthcare costs due to unnecessary tests and treatment, and poorer quality of care are the unwelcome consequences of failing to account for differences in the way women and men experience common diseases and respond to therapies. We recently published a call to action for Australian universities and other training institutions, learned academies and professional societies, governments, medical and health research funders, peer-reviewed journals and industry to address this gap in medical research.
I have no disclosures.
Carcel C, Wang X, Sandset EC, Delcourt C, Arima H, Lindley R, et al. Sex differences in treatment and outcome after stroke. Pooled analysis including 19,000 participants. 2019:10.1212/WNL.0000000000008615
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