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Student-led research yields important discovery about clinical stroke trials

Two Michigan State University students – one an undergraduate, the other in her second year of medical school – analyzed a decade’s worth of stroke studies and found a glaring flaw: women patients were significantly underrepresented.

That two students made such an important finding is impressive enough. Even more is that their study was published in JAMA Neurology, a prestigious journal of the American Medical Association.

Headshot of Brent Strong
Brent Strong, an MSU Honors College senior majoring in physiology, was lead author of a stroke study published in JAMA Neurology, a prestigous journal of the American Medical Association. Courtesy photo

“I would say it hasn’t quite sunk in with me yet,” said Brent Strong, an Honors College senior majoring in physiology in the MSU College of Natural Science and the study's lead author.

His co-author, second-year College of Human Medicine student Julia Pudar, called the study’s acceptance by JAMA Neurology a huge honor.

"It was quite a bit of work, but it was so rewarding," Pudar said. "Honestly, I had so much fun doing this.”

Mathew Reeves, Ph.D., a professor of epidemiology and biostatistics at MSU, suggested the two team up to study whether women stroke patients were under-enrolled in randomized, controlled trials of stroke treatments.

Their meta-analysis of 115 studies conducted all over the world, including in the United States, Canada, Asia, and Europe found that relative to their numbers among stroke patients in the general population, women were underrepresented by five percentage points. One significant reason, they found, is that many studies used an upper age limit of 80 years, which excluded many women because they tend to suffer strokes an average of five years later than men.

Headshot of Jullia Pudar
Julia Pudar, a second-year medical student in the MSU College of Human Medicine and study co-author, teamed up with Strong to do a meta-analysis of 115 studies from all over the world--an analysis that found women were underrepresented in stroke treatment trials. Courtesy photo

By excluding stroke patients over age 80, the studies “undermined the generalizability of their findings,” Strong said. “Hopefully, this at least engenders an awareness of the issue.”

“If enough women aren’t being enrolled in the trials, how can we be sure of how the treatments are going to affect them?” Pudar asked.

"It’s an honor that the work we’ve done is going out into the world and hopefully will have an impact,” she added.

Due to the pandemic, Pudar and Strong met only once in person, instead conferring frequently online with Zoom, communicating by email, and sharing drafts through Dropbox.

Before enrolling in medical school, Pudar earned bachelor’s degrees in computer science and biomedical engineering.

“Ultimately, I decided I like working with people more than with computers,” she said, although her experience allowed her to write a program to assist in extracting data from the studies they analyzed. In the fall, she will begin her third year of medical school at the Southeast Michigan campus in Southfield.

Strong, awarded a highly competitive Marshall Scholarship, will begin graduate studies at the University of Glasgow in Scotland, followed by further studies at the University of Edinburgh. He plans to work toward graduate degrees in statistics and population health sciences.

“Right now,” he said, “my thought is to become an epidemiologist doing what Dr. Reeves does.”

Having their paper published in such a prestigious medical journal is a remarkable achievement for the two students, Reeves said.

“It’s really exciting to me to see young people come onto a research team who want to learn and get ahead,” he said. “Both of these students are unbelievably competent. I’m awestruck at how good they are.”

While Reeves is listed as a co-author, he said most of the credit goes to Strong and Pudar.

“I just guided them,” he said. 


Banner image: An MSU student-led study recently published in JAMA Neurology, found that, relative to their numbers among stroke patients in the general population, women were underrepresented by five percentage points due to age limits in stroke treatment trials. Photo courtesy of University Communications