Introduction: Hematoma Expansion (HE) is a modifiable cause of disability and death after intracerebral hemorrhage (ICH). Hemostatic biomarkers have the potential to predict HE and identify specific mechanisms of hemostasis for therapeutic intervention; however, many biomarkers, like the International Normalized Ratio (INR), are limited in scope to patients taking warfarin or with hepatic failure. Thromboelastography (TEG) is a rapid, bedside test of clot strength and platelet activity. We prospectively tested the hypothesis that TEG would predict HE and disability outcomes in a large, multi-center cohort, potentially identifying patients for targeted treatment. Methods: We enrolled spontaneous ICH patients at six medical centers across the U.S. between 2019 and 2023. Global hemostasis of whole blood samples was analyzed with TEG. All patients had two CT scans for HE calculation, and a blood draw that occurred prior to follow-up imaging. Patients treated with desmopressin or other interventions that impact coagulation were excluded. Correlations between continuous numerical variables (HE and hemostatic biomarkers) were calculated using Spearman’s correlation. Correlations between the three-month modified Rankin Scale (mRS) and biomarkers were calculated using Kendall’s correlation. Results: We enrolled 82 patients (34.1% women) with a mean age of 61 +/- 13.3 years. None took pre-ICH anticoagulants, and INR was normal. Symptom onset occurred within a median time of 1.8 [1.15 – 4.48] hours before first CT scan imaging, and 5.8 [4.45 – 7.57] hours before blood draw. TEG K, a measure of fibrinogen dependent clot strength, was associated with subsequent HE (rho = 0.19, P =0.048) and the mRS at three months (tau = 0.28, P =0.04). Additionally, TEG MA (tau = -0.32, P = 0.02), a measure of clot strength dependent on platelets, and HE (tau = 0.35, P =0.01) were associated with the mRS at three months. Fibrinogen levels were in the normal range, excluding hypofibrinogenemia as a potential confounder of the association between TEG, hematoma expansion, and outcomes. Conclusions: Hemostatic biomarkers from TEG, particularly related to clot strength and fibrin generation, were associated with subsequent HE and the mRS at three months.

Background: Cancer survivors are at greater risk of cardiovascular disease compared to individuals without cancer in the general population. Despite this increased risk, it is unknown the extent to which this population is aware of symptoms of myocardial infarction (MI) and stroke, and whether disparities in awareness exist. Methods: We used data from the cross-sectional 2014 and 2017 National Health Interview Surveys and included individuals aged ≥18 years with self-reported cancer and complete data on awareness of MI and stroke symptoms. The MI symptoms included 1) chest pain/discomfort, 2) shortness of breath, 3) pain/discomfort in arms/shoulders, 4) feeling weak, lightheaded, or faint, and 5) jaw, neck, or back pain. Stroke symptoms included 1) numbness of face/arm/leg, 2) confusion/trouble speaking, 3) difficulty walking/dizziness/loss of balance, 4) trouble seeing in one/both eyes, and 5) severe headache. Awareness of and response to symptoms (i.e., calling 9-1-1 or emergency medical services [EMS]) were assessed using multivariable logistic regression with adjustment for sociodemographic characteristics. Results: Among 4,312 cancer survivors (median age: 67.0 years), representing 14.3 million survivors annually, 37.4% and 21.0% were unaware of all MI and stroke symptoms, respectively. Those who were of Hispanic ethnicity (MI: aOR [adjusted odds ratio], 1.55 [95% CI, 1.17-2.05]; stroke: 1.54 [95% CI, 1.13-2.09]), had lower level of education (MI: aOR, 1.32 [95% CI, 1.14-1.52]; stroke: aOR, 1.41 [95% CI, 1.20-1.66]), and were of non-US-born immigrant status (MI: aOR, 1.82 [95% CI, 1.37-2.42]; stroke: aOR, 1.41 [95% CI, 1.03-1.92]) had an increased likelihood of being unaware of all MI and stroke symptoms. Hispanic (MI: aOR, 2.10 [95% CI, 1.12-3.93]) and non-Hispanic Asian individuals (MI: aOR, 2.70 [95% CI, 1.11-6.59]) and those with a lower level of education (MI: aOR, 1.54 [95% CI, 1.06-2.24]) were more likely to not be aware of any MI symptoms. Adults with a lower level of education (MI: aOR, 1.42 [95% CI, 1.05-1.92]) and those with a lower income (stroke: aOR, 1.77 [95% CI, 1.19-2.62]) were significantly more likely not to call EMS in response to MI and stroke symptoms, respectively. Conclusions: Despite having an increased cardiovascular risk, many cancer survivors are not aware of MI and stroke symptoms. Increasing education of common symptoms, particularly among cancer survivors experiencing disparities, could potentially reduce these inequities.

Introduction: A nation-wide stroke surveillance system is not available in the US, limiting analyses to identify subgroups at disproportionate risk for ischemic stroke (IS). These data are needed to help inform targeted interventions to improve primary stroke prevention in high-risk populations. We assessed trends in IS hospitalizations and risk factor prevalence by age, sex, and racial/ethnic subgroups using data from GWTG-Stroke. Methods: The sample included patients discharged from GWTG-Stroke participating hospitals in 2010-2021 with a final diagnosis of IS. We conducted a stratified analysis to determine the proportionate composition and temporal trends in IS hospitalizations by race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, or Other), sex (women, men), and age (18-44, 45-64, 65+ y). We then used logistic regression to calculate the unadjusted prevalence odds for 10 stroke risk factors for the different race/ethnic, sex, and age groups. Results: There were 4,229,981 IS hospitalizations (mean age 70.1±14.4 y, 49.8% women) from 2,771 hospitals. The Hispanic and Other groups comprised an increasingly greater proportion of total IS hospitalizations over the study period in both women and men and in all age groups (P for trend <0.001; Figure 1 ). Within each racial/ethnic group, hospitalizations for IS were particularly high for younger (i.e., age <65 y) NHB men (53% of hospitalizations), Hispanic men (47% of hospitalizations), and NHB women (43% of hospitalizations), as compared to NHW women and men (25% and 35% of hospitalizations, respectively; Figure 2 ). The prevalence odds of common stroke risk factors including hypertension, diabetes, and overweight/obesity were higher for NHB vs NHW subgroups (e.g., NHB women 18-44 y OR 2.71 [95% CI 2.63-2.79] for hypertension, 1.90 [1.83-1.96] for diabetes, 1.24 [1.20-1.28] for overweight/obesity; NHB men 18-44 y OR 2.33 [2.26-2.40] for hypertension, 1.71 [1.65-1.77] for diabetes, 1.09 [1.05-1.13] for obesity/overweight) and Hispanic vs NHW subgroups (e.g., Hispanic women 18-44 y OR 1.22 [1.17-1.28] for hypertension, 1.69 [1.61-1.77] for diabetes; Hispanic men 18-44 y OR 1.22 [1.18-1.27] for hypertension, 1.83 [1.75-1.92] for diabetes; Figure 3 ). Conclusions: Stroke prevention efforts particularly targeting hypertension, diabetes, and overweight/obesity in younger NHB and Hispanic women and men may provide an opportunity to address their disproportionately high hospitalizations for IS.

Background:Proactive blood pressure (BP) management is particularly beneficial for younger Veterans, who have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. It is unknown what proportion of younger Veterans achieve and maintain BP control after hypertension onset and if BP control differs by demographics and social deprivation. Methods:Electronic health records were merged from Veterans who enrolled in VA care 10/1/2001-9/30/2017 and met criteria for hypertension - first diagnosis or antihypertensive fill. BP control (140/90 mmHg), was estimated 1, 2, and 5 years post-hypertension documentation, and characterized by sex, race, and ethnicity. Adjusted logistic regressions assessed likelihood of BP control by these demographics and with the Social Deprivation Index (SDI). Results:Overall, 17% patients met criteria for hypertension (n=198,367; 11% of women, median age 41). One year later, 59% of men and 65% of women achieved BP control. After adjustment, women had a 72% greater odds of BP control than men, with minimal change over 5 years. Black adults had a 22% lower odds of BP control than White adults. SDI did not significantly change these results. Conclusions:In the largest study of hypertension in younger Veterans, 41% of men and 35% of women did not have BP control after 1 year, and BP control was consistently better for women through 5 years. Thus, the first year of hypertension management portends future, long-term BP control. As social deprivation did not affect BP control, the VA system may protect against disadvantages observed in the general U.S. population.

OBJECTIVES: Low hemoglobin concentration impairs clinical hemostasis across several diseases. It is unclear whether hemoglobin impacts laboratory functional coagulation assessments. We evaluated the relationship of hemoglobin concentration on viscoelastic hemostatic assays in intracerebral hemorrhage (ICH) and perioperative patients admitted to an ICU. DESIGN: Observational cohort study and separate in vitro laboratory study. SETTING: Multicenter tertiary referral ICUs. PATIENTS: Two acute ICH cohorts receiving distinct testing modalities: rotational thromboelastometry (ROTEM) and thromboelastography (TEG), and a third surgical ICU cohort receiving ROTEM were evaluated to assess the generalizability of findings across disease processes and testing platforms. A separate in vitro ROTEM laboratory study was performed utilizing ICH patient blood samples. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Relationships between baseline hemoglobin and ROTEM/TEG results were separately assessed across patient cohorts using Spearman correlations and linear regression models. A separate in vitro study assessed ROTEM tracing changes after serial hemoglobin modifications from ICH patient blood samples. In both our ROTEM ( n = 34) and TEG ( n = 239) ICH cohorts, hemoglobin concentrations directly correlated with coagulation kinetics (ROTEM r : 0.46; p = 0.01; TEG r : 0.49; p < 0.0001) and inversely correlated with clot strength (ROTEM r : –0.52, p = 0.002; TEG r : –0.40, p < 0.0001). Similar relationships were identified in perioperative ICU admitted patients ( n = 121). We continued to identify these relationships in linear regression models. When manipulating ICH patient blood samples to achieve lower hemoglobin concentrations in vitro, we similarly identified that lower hemoglobin concentrations resulted in progressively faster coagulation kinetics and greater clot strength on ROTEM tracings. CONCLUSIONS: Lower hemoglobin concentrations have a consistent, measurable impact on ROTEM/TEG testing in ICU admitted patients, which appear to be artifactual. It is possible that patients with low hemoglobin may appear to have normal viscoelastic parameters when, in fact, they have a mild hypocoagulable state. Further work is required to determine if these tests should be corrected for a patient’s hemoglobin concentration.

Background: Veteran status (~6% of U.S. population) is an independent risk factor for cardiovascular disease (CVD). High blood pressure (BP) increases CVD risk for older Veterans. Less is known about BP levels and trajectories for younger Veterans. Objective: Assess sex- and racial/ethnic differences in longitudinal BP trajectories for young Veterans accessing the Veterans Affairs (VA) healthcare system. Methods: We used national 2001-2016 Veterans Health Administration data for Veterans who served in conflicts in Afghanistan and Iraq. Systolic (SBP) and diastolic (DBP) BP were collected from the first to most recent outpatient visit. Linear mixed effects models estimated annual rate of change in BP. Models adjusted for sociodemographic, behavioral, and clinical factors included a time*sex, time*race/ethnicity interaction term. Results: We included 764,652 Veterans (13% women; median age 29.5 years) with 14,788,864 BP measurements over a mean of 6.1 years. There was a significant interaction by sex and race/ethnicity ( P <0.0001). In sex-stratified models, women vs. men had lower initial SBP (113.3 vs 120.9) and DBP (70.1 vs 73.0), but women had a markedly rapid BP increase over time (SBP rate of change= 0.36 vs 0.10 mmHg/year; DBP = 0.46 vs 0.31; Figure ). For women, Non-Hispanic (NH) Black women had the highest initial BP and annual rate of change (SBP/DBP: 0.46/0.50). Conclusion: Younger Veterans’ have normal BP when ending military service, but there are sex, racial, and ethnic differences in BP patterns over time. NH Black women Veterans show the greatest rate of BP increase. Targeted interventions may be needed to reduce disparities in trajectories to reduce future CVD risk.

Aneurysmal subarachnoid hemorrhage and intracerebral hemorrhage are devastating injuries causing significant morbidity and mortality. However, advancements made over decades have improved outcomes. This review summarizes a systematic approach to stabilize and treat these patient populations.

Transparency and Openness Promotion Guidelines and data is available upon reasonable request. a prospective observational study. Thromboelastography indices included R, K, maximum ampli-tude (MA), G, and alpha angle. These were correlated to DCI and 3-month modified Rankin Scale (mRS). Samples were col-lected at predetermined time points: < 24 hours (T 1 ), 24 to 48 hours (T 2 ), 3 to 5 days (T 3 ), 6 to 9 days (T 4 ), and ≥ 10 days (T 5 ). A univariable analysis was conducted to determine vari-ables associated with poor outcomes and DCI. These were validated in a multivariable analysis which included age, Hunt-Hess grade, Fisher scale, and comorbidities. Receiver operating characteristics were performed to determine predictive poten-tial. For expanded methods, see the Supplemental Material.

Coagulopathy is the loss of balance between hemostatic and fibrinolytic processes resulting in excessive bleeding, intravascular thrombosis, or abnormalities in coagulation testing. It is frequently encountered in the neurocritical care unit and can contribute to poor outcomes. Coagulopathies present unique challenges to the neurointensivist, where early recognition and appropriate management are key. In this chapter, we will discuss techniques to assess coagulopathies as well as treatment strategies for the brain-injured patient.

Background: Hypertension increases the risk of cardiovascular disease. Literature describing associations between depression and blood pressure is inconsistent, potentially due to differing associations by sex. Veterans have high burdens of both depression and hypertension, respectively, and thus are a critical population in which to understand possible individual differences. Thus, among Veterans, we estimated the association between depression and hypertension and determined if this differs by sex. Methods: We used 2001-2017 nationwide Veterans Health Administration data from Veterans who served in support of conflicts in Afghanistan and Iraq. Major depressive disorder (MDD), mild depression, or no depression (reference group) were defined based on ICD-9/ICD-10-CM codes. Multivariable logistic regression models tested if depression status (independent variable) affected the risk of hypertension (dependent variable; defined as ≥2 blood pressure readings ≥140 systolic or ≥90 diastolic), controlling for sociodemographic factors, smoking, and comorbid mental health conditions. The adjusted model was also stratified by sex. Results: Among 761,627 Veterans (13.0% women; median age [interquartile range]= 29.5 [25.2-39.2] years), 24.1% had MDD, 18.8% mild depression, and 57.1% no depression. MDD was more prevalent for women than men (32.4% vs. 22.8%; p <0.001). Hypertension was more common among Veterans with MDD (48.6%), compared to those with mild depression (40.7%) or no depression (28.0%; p <0.001). In adjusted analyses, those with MDD had a 2.46xgreater risk of hypertension (95% CI, 2.43-2.49) and those with mild depression had 1.76xgreater risk (95% CI, 1.73-1.78) vs. those with no depression. In sex-stratified analyses, adjusted odds ratios were similar for women and men (MDD: 2.43 for women, 2.46 for men; mild depression: 1.74 for women, 1.75 for men). Conclusion: Both major and minor depression are associated with an increased risk of hypertension, with similar risk observed for women and men. Given the high burden of both depression and hypertension in this younger population, the potential long-term health implications of these conditions may warrant targeted intervention to prevent cardiovascular disease.

Background: AHA/ASA guidelines recommend statins in appropriate patients to reduce the risk of recurrent stroke. Previous studies have found disproportionately high stroke readmission rates in the Stroke Belt (SB) region in the southern portion of the United States. There is limited information about contemporary post-stroke statin use in SB residents and how this compares to other regions of the country. Methods: Stroke patients residing in or outside the SB who had a history of hyperlipidemia were identified from the nationally representative 2017 and 2019 Behavioral Risk Factor Surveillance System surveys. Current statin use (Yes/No) was ascertained. Survey-weighted estimates of overall and sex- and age-specific statin use were determined by SB resident status. Logistic regression with survey weighting was applied to calculate odds ratios of statin use without and with adjustment for stroke-related sociodemographic covariates. Results: The sample included 21,006 stroke survivors (16% SB residents). SB residence (80.8% vs. 78.9% in non-SB residents, Figure) was not associated with higher odds of post-stroke statin use without or with confounder adjustment. In sex- and age-specific analyses, SB residents were more likely than non-SB residents to use statins following a stroke in all subgroups, with this difference being most pronounced in those age 18-44y. Conclusions: Overall statin use was similar between stroke survivors residing in SB and non-SB states but was lowest among those aged 18-44 years regardless of residence. Our findings suggest other factors related to post-discharge care may more greatly impact recurrent stroke rates in rural US areas than statin medication use and warrant additional study.

BACKGROUND:Spontaneous intracerebral hemorrhage (ICH) is the second most prevalent subtype of stroke and has high mortality and morbidity. The utility of radiographic features to predict secondary brain injury related to hematoma expansion (HE) or increased intracranial pressure has been highlighted in patients with ICH, including the computed tomographic angiography (CTA) spot sign and intraventricular hemorrhage (IVH). Understanding the pathophysiology of spot sign and IVH may help identify optimal therapeutic strategies. We examined factors related to the spot sign and IVH, including coagulation status, hematoma size, and location, and evaluated their prognostic value in patients with ICH.METHODS:Prospectively collected data from a single center between 2012 and 2015 were analyzed. Patients who underwent thromboelastography within 24 h of symptom onset and completed follow-up brain imaging and CTA within 48 h after onset were included for analysis. Multivariate logistic regression analyses were performed to identify determinants of the spot sign and IVH and their predictive value for HE, early neurological deterioration (END), in-hospital mortality, and functional outcome at discharge.RESULTS:Of 161 patients, 50 (31.1%) had a spot sign and 93 (57.8%) had IVH. In multivariable analysis, the spot sign was associated with greater hematoma volume (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03), decreased white blood cell count (OR 0.88; 95% CI 0.79-0.98), and prolonged activated partial thromboplastin time (OR 1.14; 95% CI 1.06-1.23). IVH was associated with greater hematoma volume (OR 1.02; 95% CI 1.01-1.04) and nonlobar location of hematoma (OR 0.23; 95% CI 0.09-0.61). The spot sign was associated with greater risk of all adverse outcomes. IVH was associated with an increased risk of END and reduced HE, without significant impact on mortality or functional outcome.CONCLUSIONS:The spot sign and IVH are associated with specific hematoma characteristics, such as size and location, but are related differently to coagulation status and clinical course. A combined analysis of the spot sign and IVH can improve the understanding of pathophysiology and risk stratification after ICH.

Background Relatively greater increases in hypertension prevalence among US rural residents may contribute to geographic disparities in recurrent stroke. There is limited US information on poststroke antihypertensive medication use by rural/urban residence. We assessed antihypertensive use and lifestyle characteristics for US rural compared with urban stroke survivors and residence‐based trends in use between 2005 and 2019. Methods and Results US stroke survivors with hypertension were identified in the 2005 to 2019 national Behavioral Risk Factor Surveillance System surveys. We ascertained the survey‐weighted prevalence of reported antihypertensive use and lifestyle characteristics (ie, physical activity, diabetes, cholesterol, body mass index, and smoking) among respondents with hypertension in odd years over this period by rural/urban residence. Separate trend analyses were used to detect changes in use over time. Survey‐weighted logistic regression was used to calculate unadjusted and adjusted (sociodemographic and lifestyle factors) odds ratios for antihypertensive use by year. Our study included 82 175 individuals (36.4% rural residents). Lifestyle characteristics were similar between rural and urban residents except for higher smoking prevalence among rural residents. Antihypertensive use was similar between rural and urban stroke survivors in unadjusted and adjusted analyses (>90% in both populations). Trend analyses showed a small but significant increase in antihypertensive use over time among urban ( P =0.033) but not rural stroke survivors ( P =0.587). Conclusions Our findings indicate that poststroke antihypertensive use is comparable in rural and urban residents with a reported history of hypertension, but additional work is merited to identify reasons for a trend for increased use of these drugs among urban residents.

Introduction: Myocardial dysfunction is a well-documented feature of post-cardiac arrest syndrome. The natural history of left ventricular systolic dysfunction (LVSD) remains largely unknown. We sought to characterize the change in left ventricular systolic function after return of spontaneous circulation (ROSC). Methods: This is a retrospective review of cardiac arrest patients at a single tertiary center between 2015 and 2020. We included patients with a transthoracic echocardiogram (TTE) documenting left ventricular ejection fraction (EF) within 1 day of ROSC and at least one follow-up TTE within 6 months after cardiac arrest. LVSD was defined as EF <40% on TTE. Patients with known LVSD preceding cardiac arrest were excluded. Using paired t-test, we compared initial (within 1 day of ROSC) and follow up TTEs, stratified by shockable rhythm status. Recovery of LVSD was defined as improvement in EF to >50%. Results: Of 477 cardiac arrest patients, 89 (18.7%) patients met the inclusion criterion. 28 (31.5%) had a baseline TTE on file; 5 patients had LVSD prior to arrest and were excluded, leaving a cohort of 84 patients. Thirty-one (36.9%) patients had LVSD on TTE after ROSC, of which 16 (51.6%) had recovery of EF on follow up TTE. The figure shows the timeline of EF recovery for the whole cohort. In-hospital follow up TTE (n=84) was done at a median (IQR) of 7 (4,16) days and post-discharge follow up (n=26) at 63 (29, 115) days. In patients with shockable rhythm arrest, EF improved from ROSC to inpatient follow up TTE [mean (SD) 36% (2.6) to 50% (2.5), P <0.001]. Patients with non-shockable rhythm arrest had a higher baseline EF with a non-significant change at follow up [50% (2.6) to 56% (2.5), p=0.072]. Conclusion: Among survivors of cardiac arrest, significant recovery of LVSD was common. Further work is necessary to elucidate predictors of myocardial recovery and to determine optimal timing for repeat echocardiography.

Introduction: Post-resuscitative transthoracic echocardiography (TTE) in cardiac arrest survivors has led to increased identification of left ventricular systolic dysfunction (LVSD). We sought to evaluate the association between LVSD and in-hospital outcomes. Methods: This is a retrospective review of all cardiac arrest patients with TTE documenting left ventricular systolic function during admission to a single tertiary care center between 2015 and 2020. We used a multivariable logistic regression adjusted for age, sex, race, cardiac arrest location, witnessed arrest, initial rhythm, etiology, and Charlson Comorbidity Index to evaluate the association between LVSD and in-hospital outcomes. LVSD was defined as ejection fraction (EF) < 40% on TTE. Good neurologic outcome was defined as Cerebral Performance Categories 1-2. High vasopressor need was defined as peak norepinephrine-equivalent dose > 1mcg/kg/min within 72 hours of arrest. Use of antiarrhythmic was defined as any dose of amiodarone, esmolol, or lidocaine within 72 hours of arrest. Results: Of 477 cardiac arrest patients, 321 (67.3%) met inclusion and were included in the analysis. Mean age was 60.4 ± 16.9 years with most being male (n= 192, 59.8%) and Caucasian (n=203, 63.2%). The majority had out-of-hospital cardiac arrest (n=212, 66%) and presented with a non-shockable rhythm (n=220, 68.5%). LVSD was more common in patients with shockable rhythm (48.5% (n =49) vs 22.6% (n= 49), p<0.001). There was no difference in survival to hospital discharge, good neurologic outcome, or progression to brain death for patients with LVSD compared to those without (OR [95% CI] 1.04 [0.57-1.86], 0.87 [0.46-1.62], and 1.84 [0.70-4.79], respectively). LVSD was associated with increased use of antiarrhythmics (OR 2.85 [1.55-5.26]) and high vasopressor requirement (OR 1.81 [1.08-3.05]). Conclusion: LVSD was common in cardiac arrest patients, particularly those with shockable rhythm arrest, and was associated with increased vasopressor or antiarrhythmic use. There was no association between LVSD and survival to hospital discharge, functional neurologic outcome, or progression to brain death.

Background: The relationship between cardiovascular disease risk factors (CVD-RFs) and health care utilization may differ by sex. We determined whether having more CVD-RFs was associated with all-cause emergency department (ED) visits and all-cause hospitalizations for women and men with prior stroke/transient ischemic attack (TIA). Materials and Methods: In this cross-sectional study, we used nationally representative Medical Expenditure Panel Survey (2012-2015) data for persons aged ≥18 years with a prior stroke/TIA. CVD-RF summary scores include six self-reported factors (hypertension, diabetes, high cholesterol, physical inactivity, smoking, and obesity). Sex-specific covariate-adjusted logistic regression models assessed associations between CVD-RF scores and having one or more all-cause ED visits and one or more all-cause hospitalizations. Results: The weighted sample represents 9.1 million individuals (mean age 66.6 years; 54.3% women). Prevalence of low (0-1 risk factors), intermediate (2-3), and high (4-6) CVD-RF scores was 19.4%, 60.5%, and 20.1% for women and 14.6%, 60.2%, and 25.2% for men, respectively. Women having intermediate and high scores had a 1.58-fold (95% confidence interval [CI], 1.14-2.18) and 2.21-fold (95% CI, 1.50-3.25) increased odds of ED visits compared with women with low scores. Women with high CVD-RF scores had a 2.18-fold (95% CI, 1.42-3.34) increased odds of hospitalizations, but there was no association for women with intermediate CVD-RF profiles. There was no association between CVD-RF scores and either outcome for men. Conclusions: Women, but not men, with high and intermediate CVD-RF profiles had increased odds of all-cause ED visits; women with high CVD-RF profiles had increased odds of all-cause hospitalizations. The burden of CVD-RFs may be a sex-specific predictor of higher health care utilization in women with a history of stroke/TIA.