Women may be more likely than men to skip medications to prevent a second stroke

Women who have had strokes may be more likely than men to skip doses of medications that could help prevent a second stroke, according to new research.

The study, published Wednesday in the Journal of the American Heart Association, found women – who are already known to face a higher risk of recurrent strokes – were more likely than men to report not taking all of their prescribed cholesterol-lowering or blood-thinning medications. The gap in nonadherence was most pronounced for cholesterol-lowering medications, where it was largest between Mexican American women and men.

While the study did not examine why participants skipped taking medications, its authors said in a news release that numerous factors could be contributing to the disparities.

"Women in general and Mexican American women in particular are more likely to be caregivers for other family members," lead researcher Chen Chen said in a news release. Chen is a doctoral candidate in epidemiology at the University of Michigan in Ann Arbor. "As a result, they may be less able to prioritize and manage their own health, which may contribute to a higher likelihood of medication nonadherence."

Another reason women may skip doses of cholesterol-lowering medications, or statins, could be due to negative side effects, such as muscle pain and weakness, the researchers suggested.

Senior study author Dr. Lynda Lisabeth said in the news release that "clinicians might consider screening for these factors and discussing the importance of not missing doses when prescribing these medications to patients to help reduce their risk of having another stroke." Lisabeth is a professor of neurology and epidemiology at the University of Michigan.

Researchers analyzed self-reported medication adherence data for 1,324 people who were an average 66 years old and who had a first ischemic stroke between 2008 and 2019. An ischemic stroke is caused by a blood clot or plaque in the arteries blocking blood flow to the brain. The analysis used data from the Brain Attack Surveillance in Corpus Christi Project, which recruited participants from Nueces County, Texas. Nearly half of participants were women, and 58% self-identified as Mexican American.

Participants were asked about their adherence to four types of stroke prevention medication: cholesterol-lowering, blood pressure-lowering, and antiplatelets and anticoagulants, taken to prevent blood clots. They were considered adherent if they reported never or rarely missing a dose and nonadherent if they reported occasionally, often or very often skipping a dose, or if they said they discontinued or did not fill their prescriptions.

Within three months of having a stroke, 11.5% of participants reported not taking their medication as prescribed. Compared to men, women were 80% more likely to report missing doses of cholesterol-lowering drugs and 53% more likely to skip antiplatelet medications, but there was no difference in adherence to medications to lower blood pressure.

Among Mexican American participants, women were three times as likely as men to skip a dose of cholesterol-lowering medications. Compared to men overall, women who were older or married also were more likely to miss doses of prescribed medications.

"The results of this study align well with previous observations from national databases and longitudinal population-based studies, which showed a higher frequency of nonadherence to secondary stroke prevention among females," Dr. Fernando D. Testai said in the news release. Testai, who was not involved in the research, is a professor in the department of neurology and rehabilitation at the University of Illinois College of Medicine in Chicago.

"The incremental value of this study lies in its examination of adherence during the critical few months after acute stroke, a period when the risk of experiencing a second stroke is highest," he said. "Addressing factors that contribute to sex-associated disparities in stroke care, particularly among racial and ethnic minorities, should be a top priority for a society that seeks to eliminate social inequalities and inequities."