Sex, Ethnicity, and Stroke

T he social and economic costs of stroke in minority populations are projected to have an enormous increase over the next decades.1 In this issue of the American Journal of Hypertension, Lisabeth et al. evaluated the burden of stroke in Mexican-American (MA) and nonHispanic white (NHW) women in the Brain Attack Surveillance in Corpus Christi Project.2 Although an excess of stroke risk in MAs has previously been reported as part of the same Project,3 data on sex-specific stroke risk in this ethnic group are scarce. Lisabeth et al. found that MA women with stroke were significantly younger than NHW cases. Stroke severity was comparable between the two groups, but MA women carried a significantly increased risk of total and ischemic stroke between ages of 45 and 74 years, without major differences in the older age group. Among the main stroke risk factors, hypertension and diabetes were significantly more frequent in MA women. For hypertension, figures were significantly higher only in the younger age group (45–59 years). The frequency of diabetes, as well as the association of hypertension and diabetes, in MA female stroke patients was more than twofold that observed in NHW patients. MA women seemed to be more aware of their hypertensive state, and they reported use of antihypertensive drugs more frequently than their white counterparts. This information, however, was available only in a subset of patients, and the study did not report on the frequency of hypertension awareness and treatment by age group, while the evaluation of these figures in younger patients, i.e., those with major differences for both stroke risk and hypertension, would have been of interest. Likewise, no information was available on duration of hypertension and diabetes, frequency of diabetes by age group, and efficacy of blood pressure or glycemic control in the two study populations. As stated by the authors, education was not included in multivariate models, therefore a possible confounding effect could not be assessed. The study is of interest for focusing on women and ethnicity. Considering the longer life-expectancy of women, and the direct relationship between stroke and age, female patients will be those bearing the major burden of the disease, both in terms of absolute numbers, severity, and residual disability. In spite of these evidences, studies found that diagnostic tools such as