title: Assessment of Vascular Disease Prevention Practices in Urban Women.
abstract: Women suffer higher rates of death due to stroke compared to men. In addition, previous studies suggest that women are treated less aggressively for vascular risk factors compared to men. We assessed the quality of primary and secondary vascular prevention at multiple primary care sites within a single region.
  
  
  
  Women more than age of 40 years were eligible for the study. Data from the electronic medical record at multiple primary care locations (internal medicine, family medicine, and geriatrics) were analyzed to assess quality of vascular preventative care. Specific attention was devoted to use of antithrombotic agents, statins, and estrogen.
  
  
  
  1,815 women with a mean age of 61 years were reviewed. Seventy-five percent were African American. Patients in the urban practices had higher rates of vascular risk factors and existing vascular disease (heart disease or stroke) compared to the suburban locations. Seventy-one percent of patients with diabetes were receiving statins. For patients with previous stroke/transient ischemic attack (TIA), the use of antiplatelet agents or statins was <70%. Patients >70 years were more likely to receive antiplatelet agents (51% vs. 30%, p < 0.0001) and statins (p < 0.001).
  
  
  
  Urban women have higher rates of vascular risk factors and overt vascular disease compared to suburban women. The use of proven secondary prevention medications for patients with prior stroke/TIA was suboptimal. Both primary and secondary prevention should be intensified for urban women.
authors.affiliation: 1 Stroke Program, Department of Neurology, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Seemant
authors.initials: S
authors.lastname: Chaturvedi
authors.affiliation: 2 Department of Continuing Medical Education, Wayne State University School of Medicine , Detroit, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Pieper
authors.affiliation: 3 Department of Internal Medicine, Wayne State University School of Medicine , Detroit, Michigan.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Levine
authors.affiliation: 3 Department of Internal Medicine, Wayne State University School of Medicine , Detroit, Michigan.
authors.forename: Neeli
authors.initials: N
authors.lastname: Thati
authors.affiliation: 4 Department of Neurology, Wayne State University School of Medicine , Detroit, Michigan.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Madhavan
authors.affiliation: 5 Department of Family Medicine, Wayne State University School of Medicine , Detroit, Michigan.
authors.forename: Maribeth
authors.initials: M
authors.lastname: Mateo
authors.affiliation: 3 Department of Internal Medicine, Wayne State University School of Medicine , Detroit, Michigan.
authors.forename: Lavoisier
authors.initials: L
authors.lastname: Cardozo
authors.affiliation: 3 Department of Internal Medicine, Wayne State University School of Medicine , Detroit, Michigan.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Lepczyk
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011787:Quality of Health Care; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013383:Suburban Population; D016896:Treatment Outcome; D014505:Urban Population; D014652:Vascular Diseases / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin