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(Stroke. 2006;37:343.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Gender and Carotid Artery Stenosis

Walsall Manor Hospital, Wasall, UK

To the Editor:

The recent study by Dick et al¹ suggests that male patients with a severe carotid stenosis are at a higher risk of vascular events (mainly stroke) compared with women. I was surprised that the authors did not include atrial fibrillation as a potentially confounding variable in the multivariate analysis.

A community-based study reported that the prevalence of atrial fibrillation is greater in men compared with women.² Atrial fibrillation is an important risk factor for stroke. If the cohort of men recruited for this study have a higher prevalence of atrial fibrillation, compared with women, this may explain their increased risk of vascular events.

References

1. Dick P, Sherif C, Sabeti S, Amighi J, Minar E, Schillinger M. Gender differences in outcome of conservatively treated patients with asymptomatic high grade carotid stenosis. Stroke. 2005; 36: 1178–1183.[Abstract/Free Full Text]
2. Frieberg J, Scharling H, Gadsboll N, Jensen GB. Sex-specific increase in the prevalence of atrial fibrillation (The Copenhagen City Heart Study). Am J Cardiol. 2003; 92: 1419–1423.[CrossRef][Medline] [Order article via Infotrieve]

Response:

Medical University Vienna, Vienna General Hospital, Vienna, Austria

We have read with interest the letter of Dr Epstein, and we agree that this limitation has to be considered. Unfortunately, we did not monitor patients for persistence or occurrence of atrial fibrillation during the study period, and as outlined by Dr Epstein, there may have been differences between the genders in the study population. However, looking at the huge frequencies of cardiovascular adverse events in males and females, it seems unlikely that the entire effect may be explained by the differences in atrial fibrillation, although admittedly we cannot rule out a confounding effect of atrial fibrillation.

This Article Full Text (PDF) All Versions of this Article: 37/2/343    most recent 01.STR.0000199662.48362.e2v1 Alert me when this article is cited Alert me if a correction is posted 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 Google Scholar Google Scholar Articles by Epstein, E. Articles by Schillinger, M. Search for Related Content PubMed PubMed Citation Articles by Epstein, E. Articles by Schillinger, M.