Recurrent stroke risk decreasing, with twice the decline among women vs. men in South Texas

The risk of recurrent stroke has decreased in all stroke survivors over the past 20 years, with the decrease being twice as large in women compared to men, according to preliminary research conducted in South Texas and at the 2023 International Stroke Conference The meeting, to be held in person in Dallas, February 8-10, 2023, is a world-leading gathering for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Stroke Association, a division of the American Heart Association, after a first stroke, about 1 in 4 people will have another. The majority of recurrent strokes can be prevented with the same lifestyle changes and, where appropriate, medications that can help prevent a first stroke or other cardiovascular disease.

As part of the Brain Attack Surveillance in Corpus Christi (BASIC) project in south Texas, researchers analyzed the frequency of recurrent strokes between January 1, 2000 and December 31, 2019 among nearly 6,000 survivors of the first ischemic stroke. Half of the stroke survivors were women, and their median age was 69 years. Participants self-identified as Mexican (52.5%), non-Hispanic White (40.4%), and other racial or ethnic origin (7.1%).

The analysis revealed:

• Overall, nearly 14 out of 100 stroke survivors had a second stroke within about 8 years.
• In 2000, about 11 out of 100 women had another stroke within a year, compared to 8 out of 100 men.
• Over the two decades, the risk of recurrent stroke decreased for all stroke survivors; However, women experienced a double reduction compared to men. Less than 4 in 100 women had another stroke a year after their first stroke, compared with nearly 5 in 100 men.
• Similar results occurred five years after a first stroke, with 8 in 100 women having a recurrent stroke compared to 10 in 100 men.

“Secondary stroke prevention has been successful, but has not been as effective in male stroke survivors in recent years,” said study lead author Chen Chen, MS, a Ph.D. candidate in epidemiology at the University of Michigan at Ann Arbor. “We were somewhat surprised that our results showed that men had similar or even higher odds of having a second stroke compared to women over the past few years.”

The study had some limitations. One caveat is that all study participants lived in a community in South Texas (Nueces County, Texas), so the results may not apply to people living in other areas. Another limitation is that the study did not provide details on recurrent stroke subtypes, which may indicate additional risk factors and the need for more targeted secondary prevention strategies.

“Further research is needed to understand the reasons for the encouraging decreasing trends in stroke recurrence in both sexes, particularly the reasons for differences over time by gender,” Chen said. “This information will help policymakers understand where to focus their efforts to further improve secondary stroke prevention and reduce or prevent health inequalities.”

According to the American Stroke Association, a division of the American Heart Association, stroke is the second leading cause of death worldwide after heart disease. A stroke is a medical emergency that occurs when the blood vessels to the brain become blocked, which is an ischemic stroke, the most common type, or they can rupture, which is a hemorrhagic stroke. Prompt treatment to restore blood flow and oxygenation to the brain can help prevent permanent disability. The acronym FAST—for Face Drooping, Arm Weakness, Speech Difficulty, Time to call 911—is a useful tool for recognizing the warning signs of a stroke and calling for help.

Co-authors are Kevin He, Ph.D.; Mathew J. Reeves, Ph.D.; Lewis B. Morgenstern, MD; Karen B. Farris, Ph.D.; and Lynda D. Lisabeth, Ph.D.