Published Online
on July 21, 2005

A more recent version of this article appeared on August 1, 2005

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Submitted on January 21, 2005
Revised on May 24, 2005
Accepted on May 26, 2005

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

C. R. Simpson PhD^*; C. Wilson MB; P. C. Hannaford MD; and D. Williams PhD

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.

^* To whom correspondence should be addressed. 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

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