Strokes on the decline in men but not in women, study finds

— -- The good news is that we are seeing fewer strokes affecting the United States population in the past two decades. But a new report suggests that the stroke rate in men, not women, is declining faster.

Stroke has dropped to the fifth leading cause of death among men but remains the fourth leading cause among women, according to a new study by a group of investigators from Brown University, University of Cincinnati, Indiana University and Baylor College of Medicine.

Researchers looked at data on a total of 1.3 million participants living in a five-county area that captured southwest Ohio and northern Kentucky. They found that while the stroke rate for men declined significantly during the 15-year study period, for women there was no significant difference.

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Meanwhile, common stroke risk factors, such as high blood pressure, high cholesterol and diabetes, are all on the rise – a finding that likely reflects an aging population overall. They also found significant increases in the number of people taking medications against stroke risk factors, in particular cholesterol and blood pressure lowering medications and aspirin.

Women had an average age at first stroke of 72. Men had an average age of 68 at first stroke. After standardizing their findings with U.S. Census data, the researchers found that overall stroke rates for men went from 263 strokes per 100,000 men at the start of the study to 192 per 100,000 at the end of the study. For women, the rate went from 217 strokes per 100,000 women to 198 per 100,000, but this difference was not statistically significant.

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"More providers need to recognize that more and more women are at increased risk of stroke," said Dr. Tracy Madsen, the study's lead author. "We need to consider being especially aggressive about risk factor control in women," she added, noting that physicians may not counsel women about their risk factors as frequently as they do for men.

Prior studies have shown that women are less likely to have their blood pressure at goal as compared to men. Madsen said that "there may be biologic differences in how risk factors lead to stroke between men and women."

Another possible reason for the more pronounced rate decrease in men may be changes of an aging population.

The main limitation of this study is that all of the data pertaining to risk factors and incidence of stroke were self-reported.

Furthermore, the researchers did not report information on other important stroke risk factors, such as prevalence of atrial fibrillation, or those unique to or more prevalent in women, namely the use of hormone replacement therapy and migraines. Further research is needed to confirm the findings and to examine why the declining rate was more pronounced in men.