Effect of sex on outcome after recurrent stroke in African Americans: results from the African American Antiplatelet Stroke Prevention Study
journal contributionposted on 2011-03-01, 00:00 authored by Fernando D. Testai, John F. Cursio, Philip B. Gorelick
Background: Sex-related disparities in stroke have been previously reported. However, the influence of sex on the outcome of recurrent stroke in blacks is less clear. Our objective is to investigate the effect of sex on the outcome of recurrent non-fatal stroke in the African American Antiplatelet Stroke Prevention Study (AAASPS) Methods: The AAASPS is a double-blind, randomized, controlled trial of recurrent stroke. Participants -967 black women and 842 black men- with non-cardioembolic ischemic stroke were assigned to receive ticlopidine or aspirin and followed for up to two years. The NIH Stroke Scale (NIHSS), modified Barthel score (mBS), and the Glasgow Outcome Scale (GOS) were determined at enrollment, at pre-specified 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 1,809 subjects enrolled in AAASPS, 186 subjects (89 women and 97 men) suffered recurrent non-fatal stroke. At enrollment, the NIHSS (2.87 for women and 3.00 for men; p=0.73), the mBS (18.26 for women and 18.52 for men; p=0.47) and the GOS (1.49 for women and 1.51 for men; p=0.86) were not significantly different. In follow-up and at the time of stroke recurrence, the NIHSS, mBS, and GOS 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=0.02). In the survival analysis, no significant difference in the time to recurrent stroke was found between women and men (p=0.69). Conclusions: Although sex-related stroke disparities have been reported, in the AAASPS cohort outcomes for recurrent non-fatal non-cardioembolic 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.