Risk for recurrent stroke declines over past 20 years, particularly in women survivors

Recurrent stroke risk has declined over the past 2 decades, with women experiencing a twofold decline compared with men, according to preliminary research presented at the International Stroke Conference.

“Secondary stroke prevention has been successful; however, it has not been as effective among male stroke survivors in recent years,” Chen Chen, MS, lead study author and PhD candidate in epidemiology at the University of Michigan, said in a related release. “We were somewhat surprised that our results showed that in recent years men had similar — or even higher — chances of having a second stroke compared with women.”

With limited data available on sex-specific trends in recurrent strokes, Chen and fellow researchers sought to provide estimates over a 20-year period in South Texas.

Their population-based study included 5,752 individuals with first-ever ischemic strokes (median age, 69 years; 49.9% women) recorded between January 2000 and December 2019 from the Brain Attack Surveillance in Corpus Christi Project. Recurrence interval was measured from time of first ischemic stroke to stroke recurrence, death or Dec. 31, 2019, whichever came first.

Researchers estimated cumulative incidence function (CIF) of recurrence by a multivariable Fine-Gray sub-distribution hazard model, accounting for the competing risk for death. They generated 1- and 5-year sex-specific trends using an interaction between calendar year and sex from the fitted CIF.

Results showed that 786 (13.7%) individuals had stroke recurrences over a median follow-up of 7.6 years, while 2,653 individuals (46.1%) died over a median follow-up of 3.7 years.

Researchers further reported that women had significantly higher adjusted 1- and 5-year risks for recurrence than men in 2000, but 1- and 5-year risks for recurrence declined in both sexes over time. Women experienced greater declines around 2009, making the risks for men and women comparable at that time. However, after 2009, the risks were higher among men.

The largest difference in recurrence between sexes throughout the study was in the 5-year risk in 2000, with women demonstrating a mean 5% (95% CI, 1.5-8.4) higher risk.

“Further research is needed to understand the reasons behind the welcome declining trends in stroke recurrence for both sexes, particularly the reasons for differences over time by sex,” Chen said in the release. “This information will help policymakers understand where to focus efforts that may further improve secondary stroke prevention and reduce or prevent health inequities.”

Reference:

• Recurrent stroke risk decreasing, with twice the decline among women vs. men in South Texas. https://newsroom.heart.org/news/recurrent-stroke-risk-decreasing-with-twice-the-decline-among-women-vs-men-in-south-texas?preview=6734. Published Feb. 2, 2023. Accessed Feb. 8, 2023.