This Article Full Text Full Text (PDF) All Versions of this Article: 36/8/1771    most recent 01.STR.0000173398.99163.9ev1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Simpson, C.R. Articles by Williams, D. Search for Related Content PubMed PubMed Citation Articles by Simpson, C.R. Articles by Williams, D. Related Collections Secondary prevention Anticoagulants Antiplatelets Epidemiology

(Stroke. 2005;36:1771.)
© 2005 American Heart Association, Inc.

Original Contributions

Evidence for Age and Sex Differences in the Secondary Prevention of Stroke in Scottish Primary Care

From the Department of General Practice & Primary Care (C.R.S., P.C.H.), Foresterhill Health Centre, Westburn Road, The University of Aberdeen, UK; and the Department of Clinical Pharmacology (C.W., D.W.), Grampian Universities Trust, Foresterhill, Aberdeen, UK.

Correspondence to Dr Colin Simpson, Department of General Practice & Primary Care, Foresterhill Health Centre, Westburn Road, The University of Aberdeen, AB25 2AY, UK. E-mail c.simp{at}abdn.ac.uk

Background and Purpose— Secondary preventive measures play an important role in the reduction of stroke, the third largest cause of death in Scotland. We investigated whether sex, age, or deprivation differences existed in the secondary prevention of stroke in primary care.

Methods– A retrospective cross-sectional study using a computerized database with 61 practices (377 439 patients) to identify group differences in secondary preventive therapy between March 2003 and April 2004 for 10 076 patients with a diagnosis of any stroke.

Results— Women with any stroke were more likely than men to be prescribed a thiazide (odds ratios [OR], 1.60; 95% confidence interval [CI], 1.46 to 1.75) but less likely to be prescribed an angiotensin-converting enzyme inhibitor (OR, 0.73; 95% CI, 0.67 to 0.81). Women with ischemic stroke were less likely to receive either an antiplatelet or warfarin (OR, 0.84; 95% CI, 0.75 to 0.94) or statin therapy (OR, 0.82; 95% CI, 0.74 to 0.90) than men. Women with atrial fibrillation received less warfarin (OR, 0.62; 95% CI, 0.48 to 0.81) but more antiplatelet therapy than men (OR, 1.30; 95% CI, 1.00 to 1.68). The oldest patients (older than 75 years) with ischemic stroke received more antiplatelet therapy than the youngest patients (younger than 65 years) (OR, 1.83; 95% CI, 1.64 to 2.06). No significant differences in secondary preventative treatment across deprivation groups were found.

Conclusion— Important sex and age differences exist in the care of patients with stroke and suggest that women and the elderly need to be targeted for secondary prevention therapy.

Key Words: age • anticoagulation • antihypertensive agents • antiplatelet drugs • database • epidemiology • prevention • sex • stroke management

This article has been cited by other articles:

				J. W. Gargano, S. Wehner, and M. Reeves Sex Differences in Acute Stroke Care in a Statewide Stroke Registry Stroke, January 1, 2008; 39(1): 24 - 29. [Abstract] [Full Text] [PDF]

				C. R. Simpson, P. C. Hannaford, K. Lefevre, and D. Williams Effect of the UK Incentive-Based Contract on the Management of Patients With Stroke in Primary Care Stroke, September 1, 2006; 37(9): 2354 - 2360. [Abstract] [Full Text] [PDF]

				B. Ovbiagele, N. K. Hills, J. L. Saver, S. C. Johnston, and for the CASPR Investigators Secondary-prevention drug prescription in the very elderly after ischemic stroke or TIA Neurology, February 14, 2006; 66(3): 313 - 318. [Abstract] [Full Text] [PDF]