Racial Differences in the Association between Parity and Incident Stroke: Results from the REasons for Geographic and Racial Differences in Stroke Study

Sex and stroke risk factors: A review of differences and impact

OBJECTIVES

There is an increase in stroke incidence risk over the lifetime of women, given their longer life expectancy. However, an alarming trend for sex disparities, particularly in certain stroke risk factors, shows a concerning need for focus on sex differences in stroke prevention and treatment for women. In this article, we are addressing sex differences in both traditional and sex-specific stroke risk factors.

METHODS

We searched PubMed from inception to December 2022 for articles related to sex differences and risk factors for stroke. We reviewed full-text articles for relevance and ultimately included 152 articles for this focused review.

RESULTS

Women are at increased risk for stroke from both traditional and non-traditional stroke risk factors. As women age, they have a higher disease burden of atrial fibrillation, increased risk of stroke related to diabetes, worsening lipid profiles, and higher prevalence of hypertension and obesity compared to men. Further, women carry sex hormone-specific risk factors for stroke, including the age of menarche, menopause, pregnancy, and its complications, as well as hormonal therapy. Men have a higher prevalence of tobacco use and atrial fibrillation, as well as an increased risk for stroke related to hyperlipidemia. Additionally, men have sex-specific risks related to low testosterone levels.

CONCLUSIONS

By identifying biological sex-specific risk factors for stroke, developing robust collaborations, researching, and applying the knowledge for risk reduction strategies, we can begin to tailor prevention and reduce the global burden of stroke morbidity and mortality.

The Impact of Sex and Gender on Stroke

Women face a disproportionate burden of stroke mortality and disability. Biologic sex and sociocultural gender both contribute to differences in stroke risk factors, assessment, treatment, and outcomes. There are substantial differences in the strength of association of stroke risk factors, as well as female-specific risk factors. Moreover, there are differences in presentation, response to treatment, and stroke outcomes in women. This review outlines current knowledge of impact of sex and gender on stroke, as well as delineates research gaps and areas for future inquiry.

Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: results of over 15 years of follow-up

Background

Most previous studies conducted in non-Middle Eastern populations have suggested that an increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women.

Methods

In this population-based cohort study, which included 3929 women and 2571 men aged ≥30 years, data for the number of parity/live birth(s) were obtained by a standard questionnaire. Participants were then annually followed for CVD events. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors.

Results

During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with two live births. Among women in multivariable analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01–1.10), and having ≥4 parity was associated with a HR of 1.86 (0.97–3.56, p-value = 0.061). Among men, in comparison with participants who had 1 child, multivariable HRs of having 2, 3, and ≥ 4 children were 1.97 (1.24–3.12), 2.08 (1.31–3.31), and 2.08 (1.30–3.34), respectively.

Conclusion

To the best of our knowledge, the current study is the first report on this issue in the Middle East and North Africa region, a region with a high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03499-2.

Gender differences in aphasia outcomes: evidence from the AphasiaBank

BACKGROUND

Stroke is one of the leading causes of death in the United States. Aphasia is a language impairment which results as a consequence of stroke. Gender differences are reported in underlying mechanisms of stroke, however, gender differences in aphasia type and severity remain unclear.

AIMS

To examine gender differences in aphasia impairment based on data from AphasiaBank, a research repository of data obtained from studies of aphasia.

METHODS & PROCEDURES

The data were collected from AphasiaBank for 294 persons with aphasia (PWA) (172 men, 122 women). Baseline comparisons by gender groups were completed using independent samples t-tests and Pearson Chi square statistics. Univariate comparisons of the total Western Aphasia Battery-Revised (WAB-R) -AQ and -R subtests' scores were compared between the two groups using independent samples t-tests. Multivariate comparisons were completed by using multivariate analysis of variance (MANOVA).

OUTCOMES & RESULTS

Gender differences were observed in the severity of aphasia with men exhibiting more severe aphasia than women. Analyses of WAB-R indicated greater impairment among men based on AQ and greater impairment was observed in individual subtest performance. Men exhibited statistically significantly lower WAB-R AQs than women (67.4 versus 75.6). Lower WAB-R AQs were derived from lower scores among men on individual subtests; information content, fluency, repetition, sentence completion, responsive speech and tests of comprehension (yes/no, auditory word recognition and sequential commands).

CONCLUSIONS & IMPLICATIONS

This study offers evidence of gender differences in aphasia severity, global communication impairment and lower scores on individual subtests used to derive the WAB-R AQ. The limitations of the study with suggestions for future directions are presented.