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(Stroke. 2009;40:2116.)
© 2009 American Heart Association, Inc.

Original Contributions

Elderly Women Have Lower Rates of Stroke, Cardiovascular Events, and Mortality After Hospitalization for Transient Ischemic Attack

Judith H. Lichtman, PhD; Sara B. Jones, MPH; Emi Watanabe, MPH; Norrina B. Allen, MPH; Yun Wang, PhD; Virginia J. Howard, PhD Larry B. Goldstein, MD

From the Section of Chronic Disease Epidemiology (J.H.L., S.B.J., E.W., N.B.A., Y.W.), Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn; the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham, Birmingham, Ala; and the Department of Medicine (Neurology; L.B.G.), Duke Stroke Center, Center for Clinical Health Policy Research, Duke University and Durham VAMC, Durham, NC.

Correspondence to Judith H. Lichtman, PhD, Yale University School of Medicine, PO Box 208034, New Haven, CT 06520-8034. E-mail Judith.Lichtman{at}yale.edu

Background and Purpose— Patients with transient ischemic attack (TIA) are at increased risk for stroke, cardiovascular events, and death, yet little is known about whether these risks differ for men and women. We determined whether there are sex-based differences in these outcomes 30 days and 1 year after TIA using a national sample of elderly patients.

Methods— Rates of 30-day and 1-year hospitalization for TIA (International Classification of Diseases, 9th Revision Code 435), stroke (International Classification of Diseases, 9th Revision Codes 433, 434, and 436), coronary artery disease (International Classification of Diseases, 9th Revision Codes 410 to 414), all-cause readmission, and mortality were determined for fee-for-service Medicare patients 65 years of age discharged with a TIA in 2002. Cox proportional hazards models and random-effects logistic models compared outcomes with risk adjustment for demographics, medical history, comorbidities, and prior hospitalizations.

Results— The study included 122063 TIA hospitalizations (mean age, 79.0±7.6 years; 62% women; 86% white). Men were younger but had higher rates of cardiac comorbidities than women. Women had lower unadjusted rates of stroke, coronary artery disease, and mortality at 30 days and 1 year after TIA admission. These relationships persisted in risk-adjusted analyses at 30 days for stroke (hazard ratio, 0.70; 95% CI, 0.64 to 0.77), coronary artery disease (hazard ratio, 0.86; 0.74 to 1.00), and mortality (odds ratio, 0.74; 0.68 to 0.82) as well as at 1 year for stroke (hazard ratio, 0.85; 0.81 to 0.89), coronary artery disease (hazard ratio, 0.81; 0.77 to 0.86), and mortality (odds ratio, 0.78; 0.75 to 0.81).

Conclusion— These data suggest that women have a better prognosis than men within the first year after hospital discharge for a TIA. Additional research is needed to identify factors that may explain these sex-related differences in outcomes.

Key Words: sex • transient ischemic attack (TIA) outcome