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Jewish World Review May 1, 2001 / 8 Iyar, 5761

Lee Bowman

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Consumer Reports

Women more likely to suffer stroke after heart surgery -- WOMEN are one-and-a-half times more likely than men to suffer a stroke after heart surgery, and the strokes are also more likely to prove fatal, researchers say.

The study, published Tuesday in Circulation: The Journal of the American Heart Association, followed more than 416,000 men and women who had heart surgery in 1996 or 1997.

"There seems to be something about being a woman that predisposes a patient to a higher risk for stroke after heart surgery,'' said Dr. Charles Hogue, chief of cardiothoracic anesthesiology at Washington University School of Medicine in St. Louis and senior co-author of the study.

The researchers found that among the 32 percent of patients who were women, 3.8 percent suffered some type of neurological problem - stroke, transient ischemic attack or coma in the first few days following surgery. Among men, 2.4 percent had such problems, so the risk was 1.6 times greater for the women.

In addition, the death rate after surgery was higher for women, 5.7 percent as opposed to 3.5 percent for men. Among those suffering strokes, the death rate was 32 percent for women, 28 percent for men.

And when investigators made statistical adjustments to control for risk factors like high blood pressure, diabetes and smoking, women were still at about 21 percent increased risk over men. "Female gender is an independent risk factor for stroke after heart surgery,'' Hogue said.

While the gender difference is notable, heart operations, particularly coronary bypass surgery, have become relatively safe. Death rates for the surgery have not increased appreciably in the past 10 years, even though procedures are being done on patients who are older and sicker.

It has long been known that women who have heart surgery tend to fare worse than men, but the role of stroke as a contributor to poor outcomes hadn't been determined.

"Postoperative stroke is a devastating complication for both men and women. It is associated with significant suffering for patients and their families, and results in high health-care costs,'' said Dr. Victor Davila-Romain, senior co-author of the study and director of the Washington University Cardiovascular Imaging and Clinical Research Lab. "Our challenge is to identify the causes of strokes and to devise aggressive strategies to prevent them.''

Davila-Romain and Hogue suggest that decreased levels of the hormone estrogen may contribute to the elevated risk. Most female heart patients are operated on 10 to 15 years after they go through menopause.

Estrogen is thought to help protect women from heart disease before menopause and some research also indicates the brain chemical protects against damage to cells in the brain.

Men have less estrogen in their bodies than women, but they do make some by converting part of the male hormone, androgen, into estrogen. This allows men to maintain some level of hormone throughout life. But once women undergo menopause, estrogen levels plummet to virtually immeasurable concentrations.

"Unfortunately, the data from the Society of Thoracic Surgeons Database we used did not show which women were using hormone replacement therapy,'' Hogue said. "But when we looked at our own data at Barnes-Jewish Hospital in St. Louis, we found that fewer than 10 percent of the women who came in for heart surgery were taking estrogen at that time.''

The researchers are now doing a comparative study to determine if women given estrogen therapy just before heart surgery fare better than those not given such therapy.

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