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Irie F, Matsuo R, Mezuki S, Wakisaka Y, Kamouchi M, Kitazono T, Ago T. Effect of smoking status on clinical outcomes after reperfusion therapy for acute ischemic stroke. Sci Rep 2024; 14:9290. [PMID: 38654009 PMCID: PMC11039615 DOI: 10.1038/s41598-024-59508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
Smoking has detrimental effects on the cardiovascular system; however, some studies have reported better clinical outcomes after thrombolysis for ischemic stroke in smokers than in nonsmokers, a phenomenon known as the smoking paradox. Therefore, this study aimed to examine the smoking paradox in patients with ischemic stroke receiving reperfusion therapy. Data were collected from a multicenter hospital-based acute stroke registry in Fukuoka, Japan. The 1148 study patients were categorized into current and noncurrent smokers. The association between smoking and clinical outcomes, including neurological improvement (≥ 4-point decrease in the National Institutes of Health Stroke Scale during hospitalization or 0 points at discharge) and good functional outcomes (modified Rankin Scale score of 0-2) at 3 months, was evaluated using logistic regression analysis and propensity score-matched analysis. Among the participants, 231 (20.1%) were current smokers. The odds ratios (ORs) of favorable outcomes after adjusting for potential confounders were not significantly increased in current smokers (OR 0.85, 95% confidence interval [CI] 0.60-1.22 for neurological improvement; OR 0.95, 95% CI 0.65-1.38 for good functional outcome). No significant association was found in the propensity score-matched cohorts. Smoking cessation is strongly recommended since current smoking was not associated with better outcomes after reperfusion therapy.
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Affiliation(s)
- Fumi Irie
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Satomi Mezuki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
- Emergency and Clinical Care Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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Mehrabi S, Cameron L, Bowman A, Fleet JL, Eng J, Bayley MT, Teasell R. A Systematic Review of Female Participation in Randomized Controlled Trials of Post-Stroke Upper Extremity Rehabilitation in Low- to Middle-Income Countries and High-Income Countries and Regions. Cerebrovasc Dis 2024:1-10. [PMID: 38583429 DOI: 10.1159/000538610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION Female participation is lower than males in both acute stroke and stroke rehabilitation trials. However, less is known about how female participation differs across countries and regions. This study aimed to assess the percentage of female participants in randomized controlled trials (RCTs) of post-stroke rehabilitation of upper extremity (UE) motor disorders in low-middle-income (LMICs) and high-income countries (HICs) as well as different high-income world regions. METHODS CINAHL, Embase, PubMed, Scopus, and Web of Science were searched from 1960 to April 1, 2021. Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English; (2) ≥50% of participants were diagnosed with stroke; 3) included adults ≥18 years old; and (4) applied an intervention to the hemiparetic UE as the primary objective of the study. Countries were divided into HICs and LMICs based on their growth national incomes. The HICs were further divided into the three high-income regions of North America, Europe, and Asia and Oceania. Data analysis was performed using SPSS and RStudio v.4.3.1. RESULTS A total of 1,276 RCTs met inclusion criteria. Of them, 298 RCTs were in LMICs and 978 were in HICs. The percentage of female participants was significantly higher in HICs (39.5%) than LMICs (36.9%). Comparing high-income regions, there was a significant difference in the overall female percentages in favor of RCTs in Europe compared to LMICs but not North America or Asia and Oceania. There was no significant change in the percentage of female participants in all countries and regions over the last 2 decades, with no differences in trends between the groups. CONCLUSIONS Sufficient female representation in clinical trials is required for the generalizability of results. Despite differences in overall percentage of female participation between countries and regions, females have been underrepresented in both HICs and LMICs with no considerable change over 2 decades.
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Affiliation(s)
- Sarvenaz Mehrabi
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada,
| | - Lindsay Cameron
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada
| | - Andrew Bowman
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada
| | - Jamie L Fleet
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
- Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver, British Columbia, Canada
| | - Mark Theodore Bayley
- KITE Research Institute, UHN-Toronto Rehabilitation institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Teasell
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
- Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Liu H, Jin A, Pan Y, Jing J, Meng X, Li H, Li Z, Wang Y. Trends of Sex Differences and Associated Factors in Stroke Outcomes Among Patients With Acute Ischemic Stroke: 2007 to 2018. Neurology 2024; 102:e207818. [PMID: 38165366 PMCID: PMC10834133 DOI: 10.1212/wnl.0000000000207818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Female patients have been shown to experience worse clinical outcomes after acute ischemic stroke (AIS) compared with male patients. We aimed to estimate the temporal trends in the sex differences in stroke outcomes and identify risk factors contributing to the sex differences spanning 10 years in China. METHODS This cohort study was conducted based on data from the China National Stroke Registries (CNSRs, comprising 3 phases, I-III, from 2007 to 2018). Patients with ischemic stroke within 7 days of symptom onset were included. The primary outcome was a 12-month poor functional outcome. Other outcomes included mortality and disability-adjusted life-year (DALY) lost. The sex differences in outcomes and associated factors were estimated using multivariable logistic regression. The sex differences between CNSRs were tested by the interaction of sex and time. RESULTS Among 42,564 patients included, 35.4% were female. The age-adjusted event rate of 12-month poor functional outcome and mortality decreased both in male and female patients after stroke onset (CNSRs I, II, and III, all p varies over time <0.001). There was a decrease in DALY lost for both sexes over the decade (male patients: from 10.1 to 9.3 DALYs; female patients: from 10.9 to 9.6 DALYs). Female patients showed worse 12-month poor functional outcome in CNSRs I and II (odds ratio [OR] with 95% CI: 1.24 [1.10-1.39] and 1.12 [1.01-1.25], respectively) compared with male patients, but the sex difference attenuated in CNSR III (OR with 95% CI: 1.02 [0.89-1.16]), with the temporal trend (p varies over time = 0.004). The sex difference and the temporal trend of the sex difference in mortality from 2007 to 2018 were not found (p varies over time = 0.45). The most important factors attenuating the sex difference in poor functional outcome in CNSRs I and III were education level, socioeconomic deprivation, baseline stroke severity, and current smoking. DISCUSSION This study demonstrated that the sex disparity in poor functional outcome at 12 months was substantially narrowed covering 10 years and completely attenuated in 2015-2018. The findings suggested that female patients have experienced larger improvements in stroke outcomes than male patients over the past decade.
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Affiliation(s)
- Huihui Liu
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Aoming Jin
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Yuesong Pan
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Jing Jing
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Xia Meng
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Hao Li
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Zixiao Li
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, China
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Matsuo R. Registry Studies of Stroke in Japan. J Atheroscler Thromb 2023; 30:1095-1103. [PMID: 37468262 PMCID: PMC10499457 DOI: 10.5551/jat.rv22008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
Recently, the Cerebrovascular and Cardiovascular Disease Control Act was enacted, for which it was necessary to establish a comprehensive and accurate nationwide database and promote rational and economical stroke countermeasures in Japan, thus serving the public interest. Among the many studies on stroke registries, the Fukuoka Stroke Registry, a regional cohort, provides highly accurate information, and the Japanese Stroke Data Bank, a nationwide cohort, is highly comprehensive. The findings of these studies have contributed to the construction of evidence and the establishment of guidelines for stroke management. In the Nationwide survey of Acute Stroke care capacity for Proper dEsignation of Comprehensive stroke CenTer in Japan, research on improving the quality of medical care to close the gap between guidelines and clinical practice was performed using electronic medical records. This has enabled the recommendation of medical policies in Japan by visualizing medical care. In the era of healthcare big data and the Internet of Things, plenty of healthcare information is automatically recorded electronically and incorporated into databases. Thus, the establishment of stroke registries with the effective utilization of these electronic records can contribute to the development of stroke care.
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Affiliation(s)
- Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ohya Y, Matsuo R, Sato N, Irie F, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Modification of the effects of age on clinical outcomes through management of lifestyle-related factors in patients with acute ischemic stroke. J Neurol Sci 2023; 446:120589. [PMID: 36807976 DOI: 10.1016/j.jns.2023.120589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE This study examined the association between age and clinical outcomes after ischemic stroke, and whether the effect of age on post-stroke outcomes can be modified by various factors. METHODS We included 12,171 patients with acute ischemic stroke, who were functionally independent before stroke onset, in a multicenter hospital-based study conducted in Fukuoka, Japan. Patients were categorized into six groups according to age: ≤ 45, 46-55, 56-65, 66-75, 76-85, and > 85 years. Logistic regression analysis was performed to estimate an odds ratio for poor functional outcome (modified Rankin scale score of 3-6 at 3 months) for each age group. Interaction effects of age and various factors were analyzed using a multivariable model. RESULTS The mean age of the patients was 70.3 ± 12.2 years, and 63.9% were men. Neurological deficits at onset were more severe in the older age groups. The odds ratio of poor functional outcome linearly increased (P for trend <0.001), even after adjusting for potential confounders. Sex, body mass index, hypertension, and diabetes mellitus significantly modified the effect of age on the outcome (P < 0.05). The unfavorable effect of older age was greater in female patients and those with low body weight, whereas the protective effect of younger age was smaller in patients with hypertension or diabetes mellitus. CONCLUSIONS Functional outcome worsened with age in patients with acute ischemic stroke, especially in females and those with low body weight, hypertension, or hyperglycemia.
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Affiliation(s)
- Yuichiro Ohya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Noriko Sato
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumi Irie
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Perrier J, Renard M, Pariente A, Bezin J. Systematic review on sex differences for drug use after stroke. Therapie 2023; 78:213-224. [PMID: 36517302 DOI: 10.1016/j.therap.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Systematic reviews and meta-analyses have synthetized the existing knowledge on sex-differences for the risk of stroke, the most recent ones highlighting an increased risk of stroke for women. However, whether there are sex differences in post stroke treatment in real world setting is not known. We therefore conducted a systematic review on this subject. MATERIAL AND METHODS All observational studies on sex-differences in poststroke drug use published until 20/04/2021 were identified from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third resolved disagreements. Data extraction was performed using a standardized form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. RESULTS Of the 604 identified articles, 33 were included. Most were published before 2015 and presented methodological limitations. These limitations differentially affected studies with statistically significant and non-significant results, questioning the reliability of conflicting results. The exploration of sex-differences in drug use varied between therapeutic classes (articles focusing on thrombolytics: 25; antithrombotics: 23; on antihypertensive: 13; lipid-lowering drugs: 9). After stroke, women were found less likely to be prescribed antithrombotics in 48% of the articles investigating this class, and lipid-lowering drugs in 56%. Thirty-one percent of the studies concerning antihypertensive drugs reported the opposite. DISCUSSION/CONCLUSION In women, a lack of use of antithrombotics and lipid-lowering drugs after stroke seem to emerge from this review. Conflicting results regarding sex-differences might relate to methodological limitations in studies with no statistical differences, and advocate for the conduct of newer and more comprehensive research.
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Affiliation(s)
- Julia Perrier
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France.
| | - Mathilde Renard
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France
| | - Antoine Pariente
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
| | - Julien Bezin
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
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Irie F, Matsuo R, Nakamura K, Wakisaka Y, Ago T, Kitazono T, Kamouchi M. Sex Differences in Long-Term Functional Decline after Ischemic Stroke: A Longitudinal Observational Study from the Fukuoka Stroke Registry. Cerebrovasc Dis 2023; 52:409-416. [PMID: 36754022 DOI: 10.1159/000526940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/30/2022] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Data on sex differences in poststroke functional status for a period longer than 1 year based on large cohorts are sparse. This study aimed to determine whether there are sex differences in long-term functional decline after ischemic stroke. METHODS We tracked functional status for 5 years among 3-month survivors of acute ischemic stroke and compared outcomes between women and men using a large-scale hospital-based stroke registry in Fukuoka, Japan. Functional status was assessed using the modified Rankin Scale (mRS). Functional dependency was defined as an mRS score of 3, 4, or 5. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals of outcomes after adjusting for possible confounders. RESULTS A total of 8,446 patients (71.9 ± 12.5 years, 3,377 (40.0%) female patients) were enrolled in this study. Female sex was associated with a higher risk of functional dependency at 5 years poststroke even when adjusting for age, 3-month mRS score, and other confounding factors (multivariable-adjusted OR vs. men, 1.56 [95% confidence interval, 1.26-1.93]). This significant association of female sex with higher dependency at 5 years was also found among patients who were independent at 3 months poststroke. Subgroup analysis showed that increased risk of functional dependency in female patients was more marked in patients aged ≥75 years than in those aged <75 years (p for heterogeneity = 0.02). Conversely, female sex was associated with a lower risk of death. No sex difference was observed in stroke recurrence during 5 years poststroke. DISCUSSION/CONCLUSION This longitudinal observational study suggests that female sex was independently associated with an increased risk of functional decline in the chronic phase of stroke, especially in older patients. There was no sex difference in 5-year stroke recurrence, and thus, other factors might be involved in more significant deterioration of functional status in female survivors of ischemic stroke. Further studies are needed to elucidate underlying causes of sex differences in long-term functional decline after stroke.
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Affiliation(s)
- Fumi Irie
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Shin J, Kim H, Kim Y, Moon J, Lee J, Jung S, Hwang R, Kim MY. Association between Prehospital Visits and Poor Health Outcomes in Korean Acute Stroke Patients: A National Health Insurance Claims Data Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2488. [PMID: 36767860 PMCID: PMC9915235 DOI: 10.3390/ijerph20032488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to determine whether prehospital visits to other medical institutions before admission are associated with prolonged hospital stay, readmission, or mortality rates in acute stroke patients. Using the claims data from the Korean Health Insurance Service, a cross-sectional study was conducted on 58,418 newly diagnosed stroke patients aged ≥ 20 years from 1 January 2019 to 31 December 2019. Extended hospital stay (≥7 days; median value) following initial admission, readmission within 180 days after discharge, and all-cause mortality within 30 days were measured as health outcomes using multiple logistic regression analysis after adjusting for age, sex, income, residential area, and medical history. Stroke patients with a prehospital visit (10,992 patients, 18.8%) had a higher risk of long hospitalization (odds ratio = 1.06; 95% confidence interval = 1.02-1.10), readmission (1.19; 1.14-1.25), and mortality (1.23; 1.13-1.33) compared with patients without a prehospital visit. Female patients and those under 65 years of age had increased unfavorable outcomes (p < 0.05). Prehospital visits were associated with unfavorable health outcomes.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, School of Medicine, Konkuk University, Seoul 05029, Republic of Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul 05029, Republic of Korea
| | - Youngtaek Kim
- Department of Preventive Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Jusun Moon
- Department of Neurology, National Medical Center, Seoul 04564, Republic of Korea
| | - Jeehye Lee
- National Emergency Medical Center, National Medical Center, Seoul 04564, Republic of Korea
| | - Sungwon Jung
- Department of Nursing, Fareast University, Eumseong 27601, Republic of Korea
| | - Rahil Hwang
- Department of Nursing, College of Nursing, Shinhan University, Uijeongbu 11644, Republic of Korea
| | - Mi Young Kim
- Department of Nursing, College of Nursing, Hanyang University, Seoul 15588, Republic of Korea
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Hu S, Ren L, Wang Y, Lei Z, Cai J, Pan S. The association between serum orexin A and short-term neurological improvement in patients with mild to moderate acute ischemic stroke. Brain Behav 2023; 13:e2845. [PMID: 36573700 PMCID: PMC9847589 DOI: 10.1002/brb3.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/20/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The serum orexin A level was significantly lower among patients with acute ischemic stroke (AIS) and negatively related to the volume of the infarction, but the relationship between serum orexin A and prognosis of AIS was still unclear. We aimed to clarify the association between serum orexin A and the short-term neurological improvement in patients with mild to moderate AIS. METHODS We consecutively enrolled patients with first ever mild to moderate AIS admitted to hospital within 48 h from symptom onset in this prospective observational study. The serum orexin A concentrations were determined on the second morning since the admission. The short-term neurological improvement was defined as more than 1 point decrease in the National Institute of Health Stroke Scale score within 7 days after admission. RESULTS We detected increased serum orexin A level in mild to moderate AIS patients with early onset of stroke-related insomnia (33.44 vs 18.66 pg/ml, p = .004) as well as in patients with short-term neurological improvement compared to those without improvement (31.78 vs 16.24 pg/ml, p = .038). The serum orexin A level was positively associated with the short-term neurological improvement after adjusting for sleep condition and other related variables. CONCLUSION Serum orexin A might be a useful biomarker for the assessment of early prognosis in patients with mild to moderate AIS.
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Affiliation(s)
- Shiyu Hu
- Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Lijie Ren
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yang Wang
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Zhihao Lei
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Jingjing Cai
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Suyue Pan
- Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Tram HTH, Tanaka-Mizuno S, Takashima N, Khan K, Arima H, Kadota A, Fujii T, Shitara S, Kitamura A, Miyamatsu N, Kita Y, Urushitani M, Nakagawa Y, Miura K, Nozaki K. Control of Diabetes Mellitus and Long-Term Prognosis in Stroke Patients: The Shiga Stroke and Heart Attack Registry. Cerebrovasc Dis 2023; 52:81-88. [PMID: 35921810 PMCID: PMC9909615 DOI: 10.1159/000525648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The relationship between diabetes control status and long-term prognosis after stroke incidence remains unclear. This study aimed to investigate the effect of diabetes status at admission on long-term survival in patients with first-ever stroke. METHODS A retrospective cohort study was conducted based on the Shiga Stroke and Heart Attack Registry in Japan. Patients were classified according to their diabetes status and glycated hemoglobin (HbA1c) value at hospital admission into the following: (1) free of diabetes (no history of diabetes and HbA1c <6.5%); (2) good control (history of diabetes and HbA1c <7%; free of history and 6.5% ≤HbA1c <7%); and (3) poor control (with or without a history of diabetes and HbA1c ≥7%). Multivariable Cox regression models were used to evaluate the association between diabetes status and long-term survival from stroke onset. Additionally, we also evaluated the association between diabetes status and conditional survival, beginning 29 days after stroke onset. RESULTS A total of 6,331 first-ever stroke patients were eligible for this study. Among study patients, the mean (±SD) age was 72.85 ± 13.19 years, and the mean (±SD) follow-up year was 2.76 ± 1.66 years; additionally, 42.09% of patients were women. Among patients with all strokes, considering the free-of-diabetes group as the reference group, the adjusted hazard ratio (95% confidence interval) for mortality was 1.26 (1.10, 1.44) in the good control group and 1.22 (1.05, 1.41) in the poor control group. Among patients with ischemic stroke, the adjusted hazard ratio was 1.24 (1.06, 1.46) in good control group and 1.27 (1.08, 1.50) in poor control group. After excluding patients who died within 28 days, the adjusted hazard ratio for conditional mortality in the poor control group was 1.31 (1.12, 1.54) among all stroke patients and 1.29 (1.08, 1.54) among ischemic stroke patients. No significant associations were observed between diabetic status and long-term mortality in intracerebral hemorrhage patients. CONCLUSIONS The findings suggest that first-ever stroke patients with diabetes exhibited a higher risk of all-cause mortality than those without diabetes, particularly in the overall stroke and ischemic stroke populations. Additionally, in stroke populations after 28 days of onset, high risk of long-term mortality was stated in stroke patients with poor HbA1c control.
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Affiliation(s)
- Huynh Thi Hong Tram
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan, .,Department of Environmental Heath, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam,
| | - Sachiko Tanaka-Mizuno
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan,Department of Digital Health and Epidemiology, Kyoto University, Kyoto, Kyoto, Japan,*Sachiko Tanaka-Mizuno,
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan,Department of Public Health, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kawser Khan
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Hisatomi Arima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Takako Fujii
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan,Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Satoshi Shitara
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Akihiro Kitamura
- Department of Neurology, Shiga University of Medical Science, Otsu, Japan
| | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Yoshikuni Kita
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan,Tsuruga Nursing University, Tsuruga, Japan
| | - Makoto Urushitani
- Department of Neurology, Shiga University of Medical Science, Otsu, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
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11
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Abdu H, Seyoum G. Sex Differences in Stroke Risk Factors, Clinical Profiles, and In-Hospital Outcomes Among Stroke Patients Admitted to the Medical Ward of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Degener Neurol Neuromuscul Dis 2022; 12:133-144. [PMID: 36304698 PMCID: PMC9595065 DOI: 10.2147/dnnd.s383564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A stroke is a vascular accident that affects both men and women. The threat of stroke and outcome status differ between the sexes. Such data are lacking in Ethiopia. Therefore, this study assessed sex differences in stroke risk factors, clinical profiles, and outcomes in the medical ward of Dessie comprehensive specialized hospital. METHODS A retrospective cross-sectional study was employed among stroke patients. Medical records with complete information and a confirmed diagnosis of stroke using imaging techniques were included in the study. Using simple random sampling, 344 medical records were selected, 312 of which fulfilled the inclusion criteria. Bivariate and multivariate logistic regression analyses and a chi-square test were employed. The frequency, percentage, and mean and standard deviation of the variables were described using descriptive statistics. Findings with a P-value <0.05 were considered statistically significant. RESULTS Most of the patients were above or equal to 45 years old in both sexes. A significantly higher number of male than female patients were aged less than 45 years (p-value-0.001). Younger age (AOR: 2.998, p = 0.000), cigarette smoking (AOR: 2.911, p = 0.009), and Khat chewing (AOR: 3.650, p = 0.001) were risk factors for stroke in males. A higher number of males presented with hemiplegia/hemiparesis 89 (28.5%), aphasia 45 (14.4%), and facial palsy 19 (6.1%). However, more females were unconscious (15.1%). Significant differences were not seen in the stroke outcomes. Furthermore, there were no apparent differences in risk factors for stroke-related mortality. CONCLUSION Males developed stroke at a younger age. Women were older at the time of stroke onset and presented unconscious. More males experienced hemiplegia/hemiparesis, aphasia, and facial palsy. Smoking, drinking, and khat chewing were risk factors for stroke in men. There were no gender differences in the stroke death rate. Therefore, educating the public about stroke risk factors, lifestyle modification, and conducting prospective research is required.
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Affiliation(s)
- Hussen Abdu
- Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia,Correspondence: Hussen Abdu, Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia, Tel +251-910916321, Email
| | - Girma Seyoum
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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12
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Irie F, Matsuo R, Nakamura K, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Sex Differences in the Risk of 30-Day Death After Acute Ischemic Stroke. Neurol Clin Pract 2022; 11:e809-e816. [PMID: 34992963 DOI: 10.1212/cpj.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
Objective To examine sex differences in early stroke deaths according to cause of death. Methods We investigated 30-day deaths in patients with acute ischemic stroke enrolled in a multicenter stroke registry between 2007 and 2019 in Fukuoka, Japan. We estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of cause-specific deaths for women vs men using Cox proportional hazards models and competing risk models. The risk of acute infections during hospitalization and the associated case fatality rates were also compared between the sexes. Results Among 17,956 patients with acute ischemic stroke (women: 41.3%), the crude 30-day death rate after stroke was higher in women than men. However, adjusting for age and stroke severity resulted in a lower risk of death among women (HR [95% CI]: 0.76 [0.62-0.92]). Analyses using competing risk models revealed that women were less likely to die of acute infections (subdistribution HR [95% CI]: 0.33 [0.20-0.54]). Further analyses showed that women were associated with a lower risk of acute infections during hospitalization (OR [95% CI]: 0.62 [0.52-0.74]) and a lower risk of death due to these infections (subdistribution HR [95% CI]: 052 [0.33-0.83]). Conclusions When adjusting for confounders, the female sex was associated with a lower risk of 30-day death after stroke, which could be explained by a female survival advantage in poststroke infections. Sex-specific strategies are needed to reduce early stroke deaths. Classification of Evidence This is a Class I prognostic study because it is a prospective population-based cohort with objective outcomes. Female sex appears to be protective against early stroke deaths and post stroke infections.
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Affiliation(s)
- Fumi Irie
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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13
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Toyoda K, Yoshimura S, Nakai M, Koga M, Sasahara Y, Sonoda K, Kamiyama K, Yazawa Y, Kawada S, Sasaki M, Terasaki T, Miwa K, Koge J, Ishigami A, Wada S, Iwanaga Y, Miyamoto Y, Minematsu K, Kobayashi S. Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes. JAMA Neurol 2021; 79:61-69. [PMID: 34870689 PMCID: PMC8649912 DOI: 10.1001/jamaneurol.2021.4346] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Question Did the initial neurological severity and functional outcomes of patients with stroke change throughout a 20-year period? Findings In this hospital-based, multicenter, prospective registry involving 183 080 patients with acute stroke, initial neurological severity showed a decrease over time in all stroke types. Functional outcome at hospital discharge improved in patients with ischemic stroke but no longer showed improvement after adjustment by reperfusion therapy and others; it did not clearly improve in patients with hemorrhagic stroke. Meaning Twenty-year changes in functional outcomes after ischemic and hemorrhagic strokes showed different trends presumably partly owing to differences in the development of acute therapeutic strategies. Importance Whether recent changes in demographic characteristics and therapeutic technologies have altered stroke outcomes remains unknown. Objective To determine secular changes in initial neurological severity and short-term functional outcomes of patients with acute stroke by sex using a large population. Design, Setting, and Participants This nationwide, hospital-based, multicenter, prospective registry cohort study used the Japan Stroke Data Bank and included patients who developed acute stroke from January 2000 through December 2019. Patients with stroke, including ischemic and hemorrhagic strokes, who registered within 7 days after symptom onset were studied. Modified Rankin Scale scores were assessed at hospital discharge for all patients. Exposure Time. Main Outcomes and Measures Initial severity was assessed by the National Institutes of Health Stroke Scale for ischemic stroke and intracerebral hemorrhage and by the World Federation of Neurological Surgeons grading for subarachnoid hemorrhage. Outcomes were judged as favorable if the modified Rankin Scale score was 0 to 2 and unfavorable if 5 to 6. Results Of 183 080 patients, 135 266 (53 800 women [39.8%]; median [IQR] age, 74 [66-82] years) developed ischemic stroke, 36 014 (15 365 women [42.7%]; median [IQR] age, 70 [59-79] years) developed intracerebral hemorrhage, and 11 800 (7924 women [67.2%]; median [IQR] age, 64 [53-75] years) developed subarachnoid hemorrhage. In all 3 stroke types, median ages at onset increased, and the National Institutes of Health Stroke Scale and World Federation of Neurological Surgeons scores decreased throughout the 20-year period on multivariable analysis. In ischemic stroke, the proportion of favorable outcomes showed an increase over time after age adjustment (odds ratio [OR], 1.020; 95% CI, 1.015-1.024 for women vs OR, 1.015; 95% CI, 1.011-1.018 for men) but then stagnated, or even decreased in men, on multivariate adjustment including reperfusion therapy (OR, 0.997; 95% CI, 0.991-1.003 for women vs OR, 0.990; 95% CI, 0.985-0.994 for men). Unfavorable outcomes and in-hospital deaths decreased in both sexes. In intracerebral hemorrhage, favorable outcomes decreased in both sexes, and unfavorable outcomes and deaths decreased only in women. In subarachnoid hemorrhage, the proportion of favorable outcomes was unchanged, and that of unfavorable outcomes and deaths decreased in both sexes. Conclusions and Relevance In this study, functional outcomes improved in patients with ischemic stroke during the past 20 years in both sexes presumably partly owing to the development of acute reperfusion therapy. The outcomes of patients with hemorrhagic stroke did not clearly improve in the same period.
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yusuke Sasahara
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazutaka Sonoda
- Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan
| | - Sanami Kawada
- Stroke Center, Okayama Kyokuto Hospital, Okayama, Japan
| | - Masahiro Sasaki
- Department of Stroke Science, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Tadashi Terasaki
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akiko Ishigami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichi Wada
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
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14
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MacDonald SL, Hall RE, Bell CM, Cronin S, Jaglal SB. Sex differences in the outcomes of adults admitted to inpatient rehabilitation after stroke. PM R 2021; 14:779-785. [PMID: 34181304 DOI: 10.1002/pmrj.12660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/17/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Several differences have been reported between male and female patients with stroke in clinical and sociodemographic features, treatment, and outcomes. Potential effects in the inpatient rehabilitation population are unclear. OBJECTIVE To evaluate the differences between male and female patients in discharge functional status, length of stay, and discharge home after inpatient rehabilitation for stroke. DESIGN Retrospective, population-based cohort study. SETTING Inpatient rehabilitation centers in Ontario, Canada. PARTICIPANTS Male (N = 10,684) and female (N = 9459) patients discharged from acute care between September 1, 2012 and August 31, 2017, with a diagnosis of stroke and subsequently admitted to inpatient rehabilitation. EXPOSURE VARIABLE Female sex. MAIN OUTCOME MEASURES Discharge Functional Independence Measure (FIM) score, length of stay, and discharge home. RESULTS Female patients had a lower functional status at discharge (mean FIM score 94.1 vs. 97.8, p < .001) and a lower proportion were discharged home (81.1% vs. 82.9%, p = .001). Female and male patients had similar rehabilitation length of stay (mean 31.8 vs. 31.7 days, p = .90). In the adjusted analyses, there was no difference in discharge functional status between male and female patients (FIM score β -.20 [95% confidence interval [CI] -0.64 to 0.25]). Female patients had a mean length of stay 2% shorter (0.98 [95% CI 0.96-0.99]) and a higher odds of discharge home (odds ratio [OR] 1.14 [95% CI 1.05-1.24]). CONCLUSIONS There were no clinically significant sex differences in outcomes after inpatient rehabilitation for stroke. Observed sex disparities in the general stroke population may not be directly applicable to individuals undergoing inpatient rehabilitation.
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Affiliation(s)
- Shannon L MacDonald
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sinai Health, Toronto, Ontario, Canada
| | - Ruth E Hall
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sinai Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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15
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Thomas Q, Crespy V, Duloquin G, Ndiaye M, Sauvant M, Béjot Y, Giroud M. Stroke in women: When gender matters. Rev Neurol (Paris) 2021; 177:881-889. [PMID: 34172293 DOI: 10.1016/j.neurol.2021.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
Stroke in women may be considered as a distinct entity due to numerous differences compared with men, including specific epidemiological, etiological, and outcome features along with unique pathophysiological mechanisms. Stroke is the second cause of death in women worldwide with sex-specific causes of stroke in youger women such as pregnancy, post-partum period, oral contraception and migraine. Substitutive hormone treatment in older women is no more recommended in regard of the increased thromboembolic risk it generates. Venous thrombolysis with rtPA and mechanical thrombectomy are now proven to be as efficacious in women as in men. After a stroke, women present poorer quality of life than men attributable to age, more severe stroke, pre-stroke dependency and depression. Recent data concerning the latest epidemiological surveys reveal a shift in trends with the rise of incidence of strokes in young women (≤55 years and 64 years) contrasting with the stability of incidence rates in older women. As science is unvealing sex-related differences in cardiovascular disorders, health policies need to be adapted accordingly to improve stroke prevention and pre-stroke health in women. In the meantime, therapeutical trials should include more women in order to be able to formulate adequate management.
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Affiliation(s)
- Q Thomas
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France.
| | - V Crespy
- Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - G Duloquin
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Ndiaye
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - M Sauvant
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - Y Béjot
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Giroud
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
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16
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Liu Q, Zhao W, Zou X, Xing Y, Zhou G, Li X. Sex Differences in Outcomes After Spontaneous Intracerebral Hemorrhage Among Patients With Low Total Cholesterol Levels. Am J Med Sci 2021; 362:462-471. [PMID: 33992602 DOI: 10.1016/j.amjms.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/21/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low total cholesterol (TC) levels were shown to be an independent predictor of intracerebral hemorrhagic stroke in previous studies. However, the role of sex in risk and outcome of patients with ICH and low TC levels is unclear. Therefore, the objective of our study was to assess the sex differences in the risk factors and outcomes after spontaneous intracerebral hemorrhage (ICH) in patients with low TC levels in China. METHODS This study recruited consecutive patients diagnosed with ICH who were admitted to the Stroke Registry System in Tianjin between May 2005 and May 2018. Patients with low TC levels (defined as TC<200mg/dl) were analyzed in this study. Sex differences in clinical features, risk factors, and outcomes at hospital discharge, 3 months, and 12 months after ICH were evaluated. RESULTS Of the 824 patients with low TC levels, 610 men (74%) and 214 women (26%). The mean age at ICH onset was younger in men than in women (60.93±12.54 vs. 64.5±12.28, P<0.001), and men were more likely to have higher educational levels than women. There were higher prevalence rates of hypertension, current smoking status, and alcohol consumption in men. Urinary tract infections were more prevalent in women, and hepatic/renal dysfunctions were more prevalent in men. Women had significantly higher neurological function deficits. With lower Barthel indices (BIs) and higher modified Rankin scale (mRS) scores at admission; but there was no significant difference between men and women in National Institutes of Health Stroke Scale (NIHSS) scores. The study showed that there was no significant difference in mortality and dependency rates at hospital discharge, 3 months, and 12 months after ICH. CONCLUSIONS Our study showed that there were no sex differences in clinical outcomes of patients with ICH and low TC levels, which suggests that the effect of low cholesterol as a risk factor for cerebral hemorrhage is the same on patients of different sexs. The possible mechanisms need larger, prospective, multicenter studies to further research.
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Affiliation(s)
- Qian Liu
- The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China.
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xuan Zou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Yonghong Xing
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xin Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
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17
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Kim BG, Kim GY, Cha JK. Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis. BMC Neurol 2021; 21:72. [PMID: 33581738 PMCID: PMC7881609 DOI: 10.1186/s12883-021-02102-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/31/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUNDS Pre-diabetes is an intermediate state between normal glucose metabolism and diabetes. Recent studies suggest that the presence of pre-diabetes is associated with poor outcomes after AIS. However, the results have been controversial. This study examines whether pre-diabetes influences the patients' short and long-term outcomes for AIS using IV thrombolysis. METHODS We enrolled 661 AIS patients with IV thrombolysis. Based on the 2010 ADA guidelines, patients were classified as pre-diabetes, with HbA1c levels of 5.7-6.4%; diabetes, with HbA1c levels more than 6.5%; and NGM (normal glucose metabolism), with HbA1c levels less than 5.7%. We investigated short-term outcomes, including early neurologic deterioration (END), in-hospital death, and poor functional outcomes (mRS > 2) at 90 days. As for long-term outcomes, poor functional outcomes were measured at 1 year. RESULTS Of the 661 AIS patients treated with IV thrombolysis, 197 patients (29.8%) were diagnosed with pre-diabetes, and 210 (31.8%) were diagnosed with diabetes. In a multivariate analysis, pre-diabetes was an independent predictor for END (OR = 2.02; 95% CI 1.12-3.62; p = 0.02) and in-hospital death (OR = 3.12; 95% CI 1.06-9.09; p = 0.04). On the other hand, diabetes was a significant independent factor for poor long-term outcomes (OR = 1.75; 95% CI 1.09-2.78; p = 0.02) after correcting confounding factors. CONCLUSIONS Unlike diabetes, pre-diabetes can be an important predictor of short-term outcomes after AIS. However, a more detailed research is needed to specify the precise mechanisms through which pre-diabetes affects the prognosis of acute ischemic stroke.
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Affiliation(s)
- Byoung-Gwon Kim
- Department of Preventive Medicine, College Of Medicine, Dong-A University, Busan, Korea
| | - Ga Yeon Kim
- Stroke Center, Department of Neurology, College of Medicine, Dong-A University, 1,3Ga, Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, South Korea
| | - Jae-Kwan Cha
- Stroke Center, Department of Neurology, College of Medicine, Dong-A University, 1,3Ga, Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, South Korea.
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Okada T, Uchida K, Sakakibara F, Kageyama H, Yasaka M, Toyoda K, Mori E, Hirano T, Hamasaki T, Yamagami H, Nagao T, Uchiyama S, Minematsu K, Yoshimura S. Sex Differences in Management and Outcomes of Cardioembolic Stroke: Post HOC Analyses of the RELAXED Study. J Stroke Cerebrovasc Dis 2021; 30:105613. [PMID: 33529924 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Experimental models have clearly demonstrated sex differences in the pathophysiology of stroke and prognosis, however clinical evidence remains elusive. In this study, we examined sex differences as a post hoc analysis of RELAXED (Recurrent Embolism Lessened by rivaroxaban, an anti-X agent, of Early Dosing for acute IS and TIA with atrial fibrillation) Study. METHODS We stratified study participants by sex and compared baseline and clinical characteristics as well as clinical outcomes. The primary outcome measure was a good outcome defined as a modified Rankin Scale score of 0-2 at 90 days after stroke. Secondary outcomes were mortality at 90 days, intracranial hemorrhage within 90 days, and recurrence of stroke or transient ischemic attack within 90 days. We constructed a logistic regression model to estimate the adjusted odds ratio of female patients compared with male patients for the primary and secondary outcomes. RESULTS Of 1303 patients, most were male (57.7%) with a mean age of 74.5 years. Female patients were older with a mean age of 80.6 ± 8.9 years and had significantly less frequent anticoagulation therapy before onset of stroke and more severe NIHSS scores. Good outcome was observed in 51.2% and 63.3% of the females and males (p < 0.0001). The adjusted odds ratio of a good outcome in females was 1.12 (95% confidence interval, 0.44-2.87) (p = 0.81). There were no sex differences in secondary outcomes. CONCLUSION Adjusted regression analysis found no sex difference in the treatment outcomes at 90 days after stroke with non-valvular atrial fibrillation.
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Affiliation(s)
- Takashi Okada
- Department of Neurosurgery, Sanda City Hospital, Sanda, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Hiroto Kageyama
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | - Toshimitsu Hamasaki
- The George Washington University Biostatistics Center, Rockville, Maryland, USA
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takehiko Nagao
- Department of Neurology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan
| | - Shinichiro Uchiyama
- Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Medical Center, Tokyo, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
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Dahl S, Hjalmarsson C, Andersson B. Sex differences in risk factors, treatment, and prognosis in acute stroke. ACTA ACUST UNITED AC 2020; 16:1745506520952039. [PMID: 32997605 PMCID: PMC7533936 DOI: 10.1177/1745506520952039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives: Stroke is a major cause of long-term disability and death worldwide. Several studies have shown that women in general have more severe symptoms at arrival to hospital and are less likely to return home and independent living. Our aim with the present study was to update previous results concerning sex differences in baseline characteristics, stroke management, and outcome in a population study from Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: This study included patients with acute ischemic and hemorrhagic stroke in 2014 at Sahlgrenska University Hospital. All data were collected from The Swedish National Stroke Registry (Riksstroke). Results: The study population consisted of 1453 patients, with 46.7% females. Women were 5 years older than men. There was no sex difference in acute stroke severity. Frequency of revascularization was equal between men and women. The stroke mortality rate was the same between the sexes. At 3-months follow-up, women had a worse functional outcome and a higher frequency of depression and post-stroke fatigue. Conclusion: Our results show that there are no sex differences in management of acute stroke. However, the cause of worse functional outcome in women at 3-months follow-up, independent of other risk factors, is not clear and warrants further investigations.
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Affiliation(s)
- Solveig Dahl
- Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hjalmarsson
- Department of Cardiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Andersson
- Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Sex Differences in 28-Day Mortality of Ischemic Stroke in Iran and Its Associated Factors: A Prospective Cohort Study. J Stroke Cerebrovasc Dis 2020; 29:104896. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/27/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022] Open
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Abstract
BACKGROUND In 2009, the window from symptom onset to administration of tissue plasminogen activator for acute ischemic stroke was extended from 3 to 4.5 hours. Yet no systematic review has addressed prehospital delay by sex for stroke symptoms since this change. PURPOSE We aimed to (1) compare prehospital delay times-the time from symptom onset to hospital arrival-between women and men with acute stroke or transient ischemic attack and (2) summarize factors influencing prehospital delay by sex. METHODS The CINAHL, MEDLINE, PubMed, Scopus, and PsycINFO databases were searched using PRISMA guidelines. Inclusion criteria were as follows: (1) quantitative research articles published between May 2008 and April 2019, (2) investigation of prehospital delay among women and men 15 years or older who were given a diagnosis of acute stroke or transient ischemic attack, and (3) English-language publications. The Crowe Critical Appraisal Tool was used to evaluate the quality of studies. RESULTS Fifteen publications (n = 162 856) met inclusion criteria. Most studies (n = 11) showed no sex differences in prehospital delay. Four studies from Asian-Pacific countries and the United States showed that women had significantly longer prehospital delay compared with men. Older age, minority race/ethnicity (black and Mexican American), and underuse of emergency medical services were associated with prolonged prehospital delay in women. CONCLUSIONS Most study authors found no differences in prehospital delay between women and men; however, women delayed longer in some Asian-Pacific and American studies. Findings of sex differences were inconclusive.
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22
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Jiang M, Ma C, Li H, Shen H, Li X, Sun Q, Chen G. Sex Dimorphisms in Ischemic Stroke: From Experimental Studies to Clinic. Front Neurol 2020; 11:504. [PMID: 32636794 PMCID: PMC7318992 DOI: 10.3389/fneur.2020.00504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Sex dimorphisms are important factors that influence the outcomes after ischemic stroke, which include basic health status, cerebrovascular anatomy, hormone levels, and unique factors such as pregnancy and menopause. It is widely recognized that male and female respond differently to stroke. Women aged 45–74 years old showed a lower risk of stroke incidence compared to age-matched man. This kind of protection is lost with aging. Hence, there is increasing requirement to get a more comprehensive understanding of sex-based factors to stroke on stroke incidence, symptoms, and treatments. This review focuses on sex-specific mechanisms in response to stroke based on experimental studies and highlights recent findings in clinical studies including sex-differential evaluation and outcomes of stroke. Sex-based personalized medicine should be promising in stroke therapies.
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Affiliation(s)
- Ming Jiang
- Brain and Nerve Research Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng Ma
- Brain and Nerve Research Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiying Li
- Brain and Nerve Research Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haitao Shen
- Brain and Nerve Research Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Li
- Brain and Nerve Research Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qing Sun
- Brain and Nerve Research Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Brain and Nerve Research Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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23
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Carcel C, Wang X, Sandset EC, Delcourt C, Arima H, Lindley R, Hackett ML, Lavados P, Robinson TG, Muñoz Venturelli P, Olavarría VV, Brunser A, Berge E, Chalmers J, Woodward M, Anderson CS. Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants. Neurology 2019; 93:e2170-e2180. [PMID: 31719135 DOI: 10.1212/wnl.0000000000008615] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/29/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data. METHODS Individual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis. RESULTS There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3-6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06-1.36), and worse quality of life (weighted mean difference -0.07, 95% CI -0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01-1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36-0.93), treated for fever (OR 0.82, 95% CI 0.70-0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74-0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13-1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79-0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78-0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77-0.94). CONCLUSIONS This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.
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Affiliation(s)
- Cheryl Carcel
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
| | - Xia Wang
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Else Charlotte Sandset
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Candice Delcourt
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Hisatomi Arima
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Richard Lindley
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Maree L Hackett
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Pablo Lavados
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Thompson G Robinson
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Paula Muñoz Venturelli
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Verónica V Olavarría
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Alejandro Brunser
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Eivind Berge
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - John Chalmers
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Mark Woodward
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
| | - Craig S Anderson
- From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China
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Zhong C, Wang G, Xu T, Zhu Z, Guo D, Zheng X, Wang A, Bu X, Peng H, Chen J, Xu T, Peng Y, Li Q, Ju Z, Geng D, He J, Zhang Y. Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke. Neurology 2019; 93:e1675-e1685. [PMID: 31551260 DOI: 10.1212/wnl.0000000000008389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To prospectively investigate the relationships between serum tissue inhibitor metalloproteinase-1 (TIMP-1) and clinical outcomes in patients with acute ischemic stroke. METHODS We derived data from the China Antihypertensive Trial in Acute Ischemic Stroke. Baseline serum TIMP-1 concentrations were measured in 3,342 participants. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events. RESULTS A total of 843 participants (25.2%) experienced major disability or died within 3 months. After adjustment for age, sex, admission NIH Stroke Scale score, and other important covariates, odds ratios or hazard ratios (95% confidence intervals) of 1-SD (0.17 ng/mL) higher log-TIMP-1 were 1.17 (1.06-1.29) for the primary outcome, 1.13 (1.02-1.25) for major disability, 1.49 (1.19-1.87) for death, and 1.34 (1.11-1.62) for the composite outcome of death and vascular events. The addition of serum TIMP-1 to conventional risk factors model significantly improved risk prediction of the primary outcome (net reclassification index 9.0%, p = 0.02; integrated discrimination improvement 0.2%, p = 0.03). Participants with both higher TIMP-1 and matrix metalloproteinase-9 levels simultaneously had the highest risk of all study outcomes. CONCLUSIONS Higher TIMP-1 levels were associated with increased risk of mortality and major disability after acute ischemic stroke. Our findings provided evidence supporting the important prognostic role of extracellular matrix biomarkers after acute ischemic stroke.
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Affiliation(s)
- Chongke Zhong
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Guangli Wang
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Tan Xu
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Zhengbao Zhu
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Daoxia Guo
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Xiaowei Zheng
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Aili Wang
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Xiaoqing Bu
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Hao Peng
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Jing Chen
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Tian Xu
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Yanbo Peng
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Qunwei Li
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Zhong Ju
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Deqin Geng
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China
| | - Jiang He
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China.
| | - Yonghong Zhang
- From the Department of Epidemiology (C.Z., G.W., Tan Xu, Z.Z., D. Guo, X.Z., A.W., X.B., H.P., Tian Xu, Y.Z.), School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology (C.Z., J.C., J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Neurology (Y.P.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Epidemiology (Q.L.), School of Public Health, Taishan Medical College, Taian; Department of Neurology (Z.J.), Kerqin District First People's Hospital of Tongliao City; Department of Neurology (D. Geng), Affiliated Hospital of Xuzhou Medical College, China; Department of Medicine (J.C., J.H.), Tulane University School of Medicine, New Orleans, LA; and Department of Neurology (Tian Xu), Affiliated Hospital of Nantong University, China.
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Uchida K, Yoshimura S, Sakai N, Yamagami H, Morimoto T. Sex Differences in Management and Outcomes of Acute Ischemic Stroke With Large Vessel Occlusion. Stroke 2019; 50:1915-1918. [DOI: 10.1161/strokeaha.119.025344] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kazutaka Uchida
- From the Department of Neurosurgery (K.U., S.Y.), Hyogo College of Medicine, Nishinomiya, Japan
- Department of Clinical Epidemiology (K.U., T.M.), Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- From the Department of Neurosurgery (K.U., S.Y.), Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (N.S.)
| | - Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan (H.Y.)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology (K.U., T.M.), Hyogo College of Medicine, Nishinomiya, Japan
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26
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Adeoye AM, Ovbiagele B, Akinyemi JO, Ogah OS, Akinyemi R, Gebregziabher M, Wahab K, Fakunle AG, Akintunde A, Adebayo O, Aje A, Tiwari HK, Arnett D, Agyekum F, Appiah LT, Amusa G, Olunuga TO, Onoja A, Sarfo FS, Akpalu A, Jenkins C, Lackland D, Owolabi L, Komolafe M, Faniyan MM, Arulogun O, Obiako R, Owolabi M. Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study. J Am Heart Assoc 2019; 8:e010814. [PMID: 31142178 PMCID: PMC6585359 DOI: 10.1161/jaha.118.010814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1‐month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1‐month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1‐month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1‐month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.
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Affiliation(s)
- Abiodun M Adeoye
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
| | - Bruce Ovbiagele
- 2 Department of Neurology University of California San Francisco CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mayowa Owolabi
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
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27
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Terai S. [The analysis of the current condition of convalescent rehabilitation for stroke patients - A study in one facility, including a sub-analysis of the elderly]. Nihon Ronen Igakkai Zasshi 2019; 55:259-267. [PMID: 29780095 DOI: 10.3143/geriatrics.55.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To investigate the clinical conditions of convalescent rehabilitation for stroke patients. METHODS We classified 147 stroke patients into 4 groups according to their discharge destination as follows: A, home; B, institution; C, geriatric health services facility; D, nursing home-type unit. A comparative examination was carried out for the following items: age, period from the onset to hospitalization (POH), NIHSS scores (NS), length of stay (LS), quantity of rehabilitation (QR), stroke types, FIM scores at admission and discharge (FS), and motor FIM gains (MFG) and efficiency scores (MFE). In addition, we performed a sub-analysis of 107 elderly patients (≥65) among the 147 total subjects. RESULTS Group A was the youngest on average. The mean values of POH, NS, and LS increased in order from group A to group D. The average QR was the smallest in group A and the largest in group C. There was no marked difference in stroke types among the four groups. The FS revealed a gradual decline from group A to group D. The MFG in groups B and C was higher than in groups A and D. In the elderly patients, the MFG decreased in groups B and C, and a reduction of the MFE was demonstrated in group C. CONCLUSION A relationship was noted between the ADL levels at admission and discharge. It was suggested that MFG and MFE were not predictive factors for the outcome and that elderly patients with a low ADL level tended to have a reduced effect of rehabilitation.
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28
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Pabbidi MR, Kuppusamy M, Didion SP, Sanapureddy P, Reed JT, Sontakke SP. Sex differences in the vascular function and related mechanisms: role of 17β-estradiol. Am J Physiol Heart Circ Physiol 2018; 315:H1499-H1518. [DOI: 10.1152/ajpheart.00194.2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The incidence of cardiovascular disease (CVD) is lower in premenopausal women but increases with age and menopause compared with similarly aged men. Based on the prevalence of CVD in postmenopausal women, sex hormone-dependent mechanisms have been postulated to be the primary factors responsible for the protection from CVD in premenopausal women. Recent Women’s Health Initiative studies, Cochrane Review studies, the Early Versus Late Intervention Trial with Estradiol Study, and the Kronos Early Estrogen Prevention Study have suggested that beneficial effects of hormone replacement therapy (HRT) are seen in women of <60 yr of age and if initiated within <10 yr of menopause. In contrast, the beneficial effects of HRT are not seen in women of >60 yr of age and if commenced after 10 yr of menopause. The higher incidence of CVD and the failure of HRT in postmenopausal aged women could be partly associated with fundamental differences in the vascular structure and function between men and women and in between pre- and postmenopausal women, respectively. In this regard, previous studies from human and animal studies have identified several sex differences in vascular function and associated mechanisms. The female sex hormone 17β-estradiol regulates the majority of these mechanisms. In this review, we summarize the sex differences in vascular structure, myogenic properties, endothelium-dependent and -independent mechanisms, and the role of 17β-estradiol in the regulation of vascular function.
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Affiliation(s)
- Mallikarjuna R. Pabbidi
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Maniselvan Kuppusamy
- Division of Endocrinology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sean P. Didion
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Padmaja Sanapureddy
- Department of Primary Care and Medicine, G. V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi
| | - Joey T. Reed
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sumit P. Sontakke
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
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29
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Kaidonis G, Rao AN, Ouyang YB, Stary CM. Elucidating sex differences in response to cerebral ischemia: immunoregulatory mechanisms and the role of microRNAs. Prog Neurobiol 2018; 176:73-85. [PMID: 30121237 DOI: 10.1016/j.pneurobio.2018.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/04/2018] [Accepted: 08/05/2018] [Indexed: 12/17/2022]
Abstract
Cerebral ischemia remains a major cause of death and disability worldwide, yet therapeutic options remain limited. Differences in sex and age play an important role in the final outcome in response to cerebral ischemia in both experimental and clinical studies: males have a higher risk and worse outcome than females at younger ages and this trend reverses in older ages. Although the molecular mechanisms underlying sex dimorphism are complex and are still not well understood, studies suggest steroid hormones, sex chromosomes, differential cell death and immune pathways, and sex-specific microRNAs may contribute to the outcome following cerebral ischemia. This review focuses on differential effects between males and females on cell death and immunological pathways in response to cerebral ischemia, the central role of innate sex differences in steroid hormone signaling, and upstreamregulation of sexually dimorphic gene expression by microRNAs.
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Affiliation(s)
- Georgia Kaidonis
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative & Pain Medicine, United States; Stanford University School of Medicine, Department of Ophthalmology, United States
| | - Anand N Rao
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative & Pain Medicine, United States
| | - Yi-Bing Ouyang
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative & Pain Medicine, United States
| | - Creed M Stary
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative & Pain Medicine, United States.
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30
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Baptista D, Abreu P, Azevedo E, Magalhães R, Correia M. Sex Differences in Stroke Incidence in a Portuguese Community-Based Study. J Stroke Cerebrovasc Dis 2018; 27:3115-3123. [PMID: 30093196 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/10/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND AIM Stroke is a major health problem. Several studies reported sex differences regarding stroke. We aim to study this issue in an incidence stroke study. METHODS Data were retrieved from a community-based prospective register of patients that had a first ever stroke in a life time between October 2009 and September 2011. We studied sex differences regarding demographic data, vascular risk factors, stroke type, stroke severity (NIHSS), disability at 28days (modified Rankin scale (mRS)), and case fatality at 30 and 90days. RESULTS From 720 stroke patients, 45.3% were men. Women were older (75.0 ± 13.6 versus 67.2 ± 14.9 years), had a worse premorbid mRS (39.3% versus 25.5%, P < .001), and a higher prevalence of hypertension (P = .004) and atrial fibrillation (P < .001). Previous myocardial infarction was more frequent in men (P = .001), as well as smoking habits (P < .001). Ischemic stroke was more common in women than men (87.6% versus 81.3%, P = .038). The 28 days' outcome was worse in women (mRS ≥ 2, 77.2% versus 70.6%, P = .044). No differences were found in initial stroke severity (median NIHSS = 4) and case fatality at 30 and 90days, after adjusting for age and premorbid mRS. CONCLUSION No differences were found in stroke initial severity and mortality at 30 and 90days between men and women, despite the sex differences pertaining to the stroke profile-age, vascular risk factors, stroke type, and outcome. Our results are somewhat discrepant from those described in the literature; more research is needed to understand if this may be due to changes in stroke standard of care.
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Affiliation(s)
- Diana Baptista
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Pedro Abreu
- Faculty of Medicine, University of Porto, Porto, Portugal; Neurology Department, São João Hospital Centre (CHSJ), Porto, Portugal
| | - Elsa Azevedo
- Faculty of Medicine, University of Porto, Porto, Portugal; Neurology Department, São João Hospital Centre (CHSJ), Porto, Portugal
| | - Rui Magalhães
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Manuel Correia
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal; Neurology Department, Santo António Hospital (CHP), Porto, Portugal
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31
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Ischemic stroke across sexes: What is the status quo? Front Neuroendocrinol 2018; 50:3-17. [PMID: 29753797 DOI: 10.1016/j.yfrne.2018.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/11/2018] [Accepted: 05/06/2018] [Indexed: 12/15/2022]
Abstract
Stroke prevalence is expected to increase in the next decades due to the aging of the Western population. Ischemic stroke (IS) shows an age- and sex-dependent distribution in which men represent the most affected population within 65 years of age, being passed by post-menopausal women in older age groups. Furthermore, a sexual dimorphism concerning risk factors, presentation and treatment of IS has been widely recognized. In order to address these phenomena, a number of issue have been raised involving both socio-economical and biological factors. The latter can be either dependent on sex hormones or due to intrinsic factors. Although women have poorer outcomes and are more likely to die after a cerebrovascular event, they are still underrepresented in clinical trials and this is mirrored by the lack of sex-tailored therapies. A greater effort is needed in the future to ensure improved treatment and quality of life to both sexes.
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32
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Gender Gap and Risk Factors for Poor Stroke Outcomes: A Single Hospital-Based Prospective Cohort Study. J Stroke Cerebrovasc Dis 2018; 27:2250-2258. [PMID: 29779883 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/01/2018] [Accepted: 04/11/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study intended to investigate whether etiological stroke subtypes and their corresponding major risk factors have differential effects on outcomes between genders. PATIENTS AND METHODS We enrolled 403 consecutive patients with first-ever acute ischemic stroke (170 women, 233 men), from a referral hospital in Taiwan over a 2-year period. Gender differences in demographics, vascular risk factors, access to health care, etiological stroke subtypes, stroke severity, and outcomes were examined. The primary outcome variable of the study was any unfavorable outcome due to acute ischemic stroke, defined as a modified Rankin Scale score of 3 or higher at 90 days after stroke. Multivariable logistic regression models were used to identify predictors of poor outcomes. RESULTS There were no gender disparities in baseline severity, stroke subtypes, access to health care, and medical comorbidities. Although women had poorer outcomes, female gender was not a predictor of unfavorable outcomes. Important predictors included age of 75years or older (odds ratio [OR] = 2.67; 95% confidence interval [CI], 1.46-4.90), National Institutes of Health Stroke Scale greater than or equal to 8 (OR = 8.38; 95% CI, 4.61-15.2), lack of cohabitation (OR = 2.13; 95% CI, 1.26-3.61), subtypes of cardioembolism (OR = 2.76; 95% CI, 1.29-5.93), and large-artery atherosclerosis (OR = 2.93; 95% CI, 1.47-5.85). In subgroup analyses, the gender-specific independent predictors were cardioembolism (OR = 7.42; 95% CI, 2.21-24.9) or atrial fibrillation (OR = 3.57; 95% CI, 1.31-9.74) in women, and large-artery atherosclerosis (OR = 3.35; 95% CI, 1.30-8.64) or symptomatic large-artery stenosis (OR = 3.42; 95% CI, 1.69-6.96) in men. The differential effects of these predictors according to gender were revealed by interaction tests. CONCLUSION Atrial fibrillation and symptomatic large-artery stenosis are predictors of poor stroke outcomes in women and men, respectively.
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Liberale L, Carbone F, Montecucco F, Gebhard C, Lüscher TF, Wegener S, Camici GG. Ischemic stroke across sexes: what is the status quo? Front Neuroendocrinol 2018:S0091-3022(18)30040-2. [PMID: 29763641 DOI: 10.1016/j.yfrne.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
Stroke prevalence is expected to increase in the next decades due to the aging of the Western population. Ischemic stroke (IS) shows an age- and sex-dependent distribution in which men represent the most affected population within 65 years of age, being passed by post-menopausal women in older age groups. Furthermore, a sexual dimorphism concerning risk factors, presentation and treatment of IS has been widely recognized. In order to address these phenomena, a number of issue have been raised involving both socio-economical and biological factors. The latter can be either dependent on sex hormones or due to intrinsic factors. Although women have poorer outcomes and are more likely to die after a cerebrovascular event, they are still underrepresented in clinical trials and this is mirrored by the lack of sex-tailored therapies. A greater effort is needed in the future to ensure improved treatment and quality of life to both sexes.
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Affiliation(s)
- Luca Liberale
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, CH-8952 Schlieren, Switzerland; First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132 Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy
| | - Cathérine Gebhard
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, CH-8952 Schlieren, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, CH-8952 Schlieren, Switzerland; Cardiology, Royal Brompton and Harefield Hospitals and Imperial College, London, United Kingdom
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, CH-8952 Schlieren, Switzerland.
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Gao H, Sun X, Li W, Gao Q, Zhang J, Zhang Y, Ma Y, Yang X, Kang X, Jiang W. Development and validation of a risk score to predict 30-day mortality in patients with atrial fibrillation-related stroke: GPS-GF score. Neurol Res 2018; 40:532-540. [PMID: 29544401 DOI: 10.1080/01616412.2018.1451431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Hua Gao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaolong Sun
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
- Department of Rehabilitation Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Wen Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Qiong Gao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jing Zhang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yi Zhang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yue Ma
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiai Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaogang Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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Free Radical Damage in Ischemia-Reperfusion Injury: An Obstacle in Acute Ischemic Stroke after Revascularization Therapy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3804979. [PMID: 29770166 PMCID: PMC5892600 DOI: 10.1155/2018/3804979] [Citation(s) in RCA: 284] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/07/2017] [Indexed: 12/16/2022]
Abstract
Acute ischemic stroke is a common cause of morbidity and mortality worldwide. Thrombolysis with recombinant tissue plasminogen activator and endovascular thrombectomy are the main revascularization therapies for acute ischemic stroke. However, ischemia-reperfusion injury after revascularization therapy can result in worsening outcomes. Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury) has been found to play a key role in the process. Free radicals lead to protein dysfunction, DNA damage, and lipid peroxidation, resulting in cell death. Additionally, free radical damage has a strong connection with inducing hemorrhagic transformation and cerebral edema, which are the major complications of revascularization therapy, and mainly influencing neurological outcomes due to the disruption of the blood-brain barrier. In order to get a better clinical prognosis, more and more studies focus on the pharmaceutical and nonpharmaceutical neuroprotective therapies against free radical damage. This review discusses the pathological mechanisms of free radicals in ischemia-reperfusion injury and adjunctive neuroprotective therapies combined with revascularization therapy against free radical damage.
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Mapoure YN, Eyambe NL, Dzudie AT, Ayeah CM, Ba H, Hentchoya R, Luma HN. Gender-Related Differences and Short-Term Outcome of Stroke: Results from a Hospital-Based Registry in Sub-Saharan Africa. Neuroepidemiology 2017; 49:179-188. [PMID: 29190627 DOI: 10.1159/000484319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/16/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Studies suggest that sex differences have an impact on patients with stroke, but existing data in Africa remain inconclusive about this inference. OBJECTIVES To study sex differences in terms of the clinical profile and short-term outcome of stroke in the Douala General Hospital, Cameroon. METHODS A hospital-based prospective cohort study was carried out in a tertiary care hospital over an 8-year period, which included all patients admitted for confirmed acute stroke. Information about the history of stroke with emphasis on clinical profile and outcome was collected. Descriptive statistics, t test, and chi square test were used for comparisons, while the Kaplan-Meier curve was used for survival rate analysis. RESULTS Of the 818 patients included, 455 (55.6%) were male patients. When compared to males, female patients are more likely to experience a stroke at an older age (mean age 62.3 ± 14.1 vs. 58.4 ± 12.9 years, p < 0.001), to be unmarried, to remain unemployed, and to have higher rates of cardio-embolic stroke (p = 0.049), body mass index (p = 0.031), altered levels of consciousness at presentation (p = 0.005), higher mean HDL cholesterol levels (p = 0.001), and in-hospital complications (p = 0.011), especially urinary tract infections (p = 0.018). Males were more likely to have health insurance, to smoke, to consume alcohol (p < 0.001), and to have higher rates of dysarthria (p = 0.004), higher mean uric acid (p = 0.013), and creatinine (p < 0.001) concentrations. Ischemic and hemorrhagic strokes were more prevalent in men (p = 0.003). There are no sex differences in terms of stroke severity, length-of-hospital stay, case fatality, and functional outcome on admission. CONCLUSIONS Sex differences exist in the clinical profile of stroke but not in the outcome. Knowledge of these differences could help influence stroke prevention, thereby improving stroke burden in Africa.
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Affiliation(s)
- Yacouba Njankouo Mapoure
- Department of Clinical Sciences, University of Douala, Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | | | - Anastase Tamdja Dzudie
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Department of Internal Medicine, University of Yaoundé I, Douala, Cameroon
| | - Chia Mark Ayeah
- Department of Clinical Sciences, University of Douala, Douala, Cameroon.,Department of Internal Medicine, Mboppi Baptist Hospital, Douala, Cameroon
| | - Hamadou Ba
- Department of Internal Medicine, University of Yaoundé I, Douala, Cameroon
| | - Romuald Hentchoya
- Service of Intensive Care Unit, Douala General Hospital, Douala, Cameroon
| | - Henry Namme Luma
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Department of Internal Medicine, University of Yaoundé I, Douala, Cameroon
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Ong CT, Wong YS, Sung SF, Wu CS, Hsu YC, Su YH, Hung LC. Sex-related differences in the risk factors for in-hospital mortality and outcomes of ischemic stroke patients in rural areas of Taiwan. PLoS One 2017; 12:e0185361. [PMID: 28934363 PMCID: PMC5608367 DOI: 10.1371/journal.pone.0185361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Sex-related differences in the clinical presentation and outcomes of stroke patients are issues that have attracted increased interest from the scientific community. The present study aimed to investigate sex-related differences in the risk factors for in-hospital mortality and outcome in ischemic stroke patients. Methods A total of 4278 acute ischemic stroke patients admitted to a stroke unit between January 1, 2007 and December 31, 2014 were included in the study. We considered demographic characteristics, clinical characteristics, co-morbidities, and complications, among others, as factors that may affect clinical presentation and in-hospital mortality. Good and poor outcomes were defined as modified Ranking Score (mRS)≦2 and mRS>2. Neurological deterioration (ND) was defined as an increase of National Institutes of Health Stroke Score (NIHSS) ≥ 4 points. Hemorrhagic transformation (HT) was defined as signs of hemorrhage in cranial CT or MRI scans. Transtentorial herniation was defined by brain edema, as seen in cranial CT or MRI scans, associated with the onset of acute unilateral or bilateral papillary dilation, loss of reactivity to light, and decline of ≥ 2 points in the Glasgow coma scale score. Results Of 4278 ischemic stroke patients (women 1757, 41.1%), 269 (6.3%) received thrombolytic therapy. The in hospital mortality rate was 3.35% (139/4278) [4.45% (80/1757) for women and 2.34% (59/2521) for men, p < 0.01]. At discharge, 41.2% (1761/4278) of the patients showed good outcomes [35.4% (622/1757) for women and 45.2% (1139/2521) for men]. Six months after stroke, 56.1% (1813/3231) showed good outcomes [47.4% (629/1328) for women and 62.2% (1184/1903) for men, p < 0.01]. Atrial fibrillation (AF), diabetes mellitus, stroke history, and old age were factors contributing to poor outcomes in men and women. Hypertension was associated with poor outcomes in women but not in men in comparison with patients without hypertension. Stroke severity and increased intracranial pressure were associated with increased in-hospital mortality in men and women. AF was associated with increased in-hospital mortality in women but not in men compared with patients without AF. Conclusion The in-hospital mortality rate was not significantly different between women and men. Functional outcomes at discharge and six months after stroke were poorer in women than in men. Hypertension is an independent factor causing poorer outcomes in women than in men. AF is an independent factor affecting sex differences in hospital mortality in women.
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Affiliation(s)
- Cheung-Ter Ong
- Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chia-Yi, Taiwan
- * E-mail:
| | - Yi-Sin Wong
- Department of Family Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Sheng-Feng Sung
- Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chi-Shun Wu
- Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yung-Chu Hsu
- Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yu-Hsiang Su
- Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Ling-Chien Hung
- Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
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Sex differences in ischaemic stroke: potential cellular mechanisms. Clin Sci (Lond) 2017; 131:533-552. [PMID: 28302915 DOI: 10.1042/cs20160841] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 12/12/2022]
Abstract
Stroke remains a leading cause of mortality and disability worldwide. More women than men have strokes each year, in part because women live longer. Women have poorer functional outcomes, are more likely to need nursing home care and have higher rates of recurrent stroke compared with men. Despite continued advancements in primary prevention, innovative acute therapies and ongoing developments in neurorehabilitation, stroke incidence and mortality continue to increase due to the aging of the U.S. POPULATION Sex chromosomes (XX compared with XY), sex hormones (oestrogen and androgen), epigenetic regulation and environmental factors all contribute to sex differences. Ischaemic sensitivity varies over the lifespan, with females having an "ischaemia resistant" phenotype that wanes after menopause, which has recently been modelled in the laboratory. Pharmacological therapies for acute ischaemic stroke are limited. The only pharmacological treatment for stroke approved by the Food and Drug Administration (FDA) is tissue plasminogen activator (tPA), which must be used within hours of stroke onset and has a number of contraindications. Pre-clinical studies have identified a number of potentially efficacious neuroprotective agents; however, nothing has been effectively translated into therapy in clinical practice. This may be due, in part, to the overwhelming use of young male rodents in pre-clinical research, as well as lack of sex-specific design and analysis in clinical trials. The review will summarize the current clinical evidence for sex differences in ischaemic stroke, and will discuss sex differences in the cellular mechanisms of acute ischaemic injury, highlighting cell death and immune/inflammatory pathways that may contribute to these clinical differences.
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Hofstad H, Naess H, Gjelsvik BEB, Eide GE, Skouen JS. Subjective health complaints predict functional outcome six months after stroke. Acta Neurol Scand 2017; 135:161-169. [PMID: 27345529 PMCID: PMC5216442 DOI: 10.1111/ane.12624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cerebrovascular stroke is a main cause of lasting disability in older age, and initial stroke severity has been established as a main determinant for the degree of functional loss. In this study, we searched for other predictors of functional outcome in a cohort of stroke patients participating in an early supported discharge randomised controlled trial. METHODS Thirty candidate variables related either to premorbid history or to the acute stroke were examined by ordered logistic regression in 229 stroke patients. Dependent variables were modified Rankin Scale (mRS) at 6 months and mRS change from baseline to 6 months. RESULTS For mRS at 6 months, Barthel Index at stable baseline post-stroke was the main predictor, with sex, age, previous cerebrovascular disease, previous peripheral artery disease and the necessity for tube feeding in the acute phase also contributing to the final model. For mRS change, only age and previous cerebrovascular disease were significant predictors. Prestroke subjective health complaints added significantly to all final models concurrently with sex losing its predictive power. CONCLUSIONS Initial stroke severity was the main predictor of functional outcome. Subjective health complaints score was a potent predictor for both outcome and improvement from baseline to 6 months and at the same time ameliorated the predictive impact of sex. The poorer functional prognosis for women after stroke may therefore be related to their higher load of subjective health complaints rather than to their sex itself. Treating these complaints may possibly improve the functional prognosis.
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Affiliation(s)
- H. Hofstad
- Department of Physical Medicine and Rehabilitation; Haukeland University Hospital; Bergen Norway
- Department of Global Public Health and Primary Care; Physiotherapy Research Group; University of Bergen; Bergen Norway
| | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre for Age-related Medicine; Stavanger University Hospital; Stavanger Norway
- Institute of Clinical Medicine; University of Bergen; Bergen Norway
| | - B. E. B. Gjelsvik
- Department of Global Public Health and Primary Care; Physiotherapy Research Group; University of Bergen; Bergen Norway
- Department of Physiotherapy; Haukeland University Hospital; Bergen Norway
| | - G. E. Eide
- Centre for Clinical Research; Haukeland University Hospital; Bergen Norway
- Department of Global Public Health and Primary Care; Lifestyle Epidemiology Research Group; University of Bergen; Bergen Norway
| | - J. S. Skouen
- Department of Physical Medicine and Rehabilitation; Haukeland University Hospital; Bergen Norway
- Department of Global Public Health and Primary Care; Physiotherapy Research Group; University of Bergen; Bergen Norway
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El Husseini N, Fonarow GC, Smith EE, Ju C, Schwamm LH, Hernandez AF, Schulte PJ, Xian Y, Goldstein LB. Renal Dysfunction Is Associated With Poststroke Discharge Disposition and In-Hospital Mortality: Findings From Get With The Guidelines-Stroke. Stroke 2016; 48:327-334. [PMID: 28034963 DOI: 10.1161/strokeaha.116.014601] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Kidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with poststroke in-hospital mortality or discharge disposition. METHODS In this cohort study, data from ischemic stroke patients in Get With The Guidelines-Stroke linked to fee-for-service Medicare data were analyzed. The Modification of Diet in Renal Disease study equation was used to calculate the eGFR (mL/min/1.73 m2). Dialysis was identified by International Classification of Diseases, Ninth Revision codes. Adjusted multivariable Cox proportional hazards models were used to determine the independent associations of eGFR with discharge disposition and in-hospital mortality. Adjusted individual models also examined whether the association of clinical and demographic factors with outcomes varied by eGFR level. RESULTS Of 232 236 patients, 47.3% had an eGFR ≥60, 26.6% an eGFR 45 to 59, 16.8% an eGFR 30 to 44, 5.6% an eGFR 15 to 29, 0.7% an eGFR<15 without dialysis, and 2.8% were receiving dialysis. Of the total cohort, 11.8% died during the hospitalization or were discharged to hospice, and 38.6% were discharged home. After adjusting for other relevant variables, renal dysfunction was independently associated with an increased risk of in-hospital mortality that was highest among those with eGFR <15 without dialysis (odds ratio, 2.52; 95% confidence interval, 2.07-3.07). An eGFR 15 to 29 (odds ratio, 0.82; 95% confidence interval, 0.78-0.87), eGFR <15 (odds ratio, 0.72; 95% confidence interval, 0.61-0.86), and dialysis (odds ratio, 0.86; 95% confidence interval, 0.79-0.94) remained associated with lower odds of being discharged home. In addition, the associations of several clinical and demographic factors with outcomes varied by eGFR level. CONCLUSIONS eGFR on admission is an important predictor of poststroke short-term outcomes.
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Affiliation(s)
- Nada El Husseini
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.).
| | - Gregg C Fonarow
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Eric E Smith
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Christine Ju
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Lee H Schwamm
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Adrian F Hernandez
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Phillip J Schulte
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Ying Xian
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
| | - Larry B Goldstein
- From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.)
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Faber JE, Moore SM, Lucitti JL, Aghajanian A, Zhang H. Sex Differences in the Cerebral Collateral Circulation. Transl Stroke Res 2016; 8:273-283. [PMID: 27844273 DOI: 10.1007/s12975-016-0508-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022]
Abstract
Premenopausal women and intact female rodents sustain smaller cerebral infarctions than males. Several sex-dependent differences have been identified as potential contributors, but many questions remain unanswered. Mice exhibit wide variation in native collateral number and diameter (collateral extent) that is dependent on differences in genetic background, aging, and other comorbidities and that contributes to their also-wide differences in infarct volume. Likewise, variation in infarct volume correlates with differences in collateral-dependent blood flow in patients with acute ischemic stroke. We examined whether extent of pial collateral arterioles and posterior communicating collateral arteries (PComAs) differ depending on sex in young, aged, obese, hypertensive, and genetically different mice. We combined new data with meta-analysis of our previously published data. Females of C57BL/6J (B6) and BALB/cByJ (BC) strains sustained smaller infarctions than males after permanent MCA occlusion. This protection was unchanged in BC mice after introgression of the B6 allele of Dce1, the major genetic determinant of variation in pial collaterals among mouse strains. Consistent with this, collateral extent in these and other strains did not differ with sex. Extent of PComAs and primary cerebral arteries also did not vary with sex. No dimorphism was evident for loss of pial collateral number and/or diameter (collateral rarefaction) caused by aging, obesity, and hypertension, nor for collateral remodeling after pMCAO. However, rarefaction was greater in females with long-standing hypertension. We conclude that smaller infarct volume in female mice is not due to greater collateral extent, greater remodeling, or less rarefaction caused by aging, obesity, or hypertension.
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Affiliation(s)
- James E Faber
- Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Scott M Moore
- Department of Surgery, University of Colorado, Denver, CO, USA
| | - Jennifer L Lucitti
- Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Amir Aghajanian
- Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Hua Zhang
- Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, 27599, USA
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Fredwall M, Sternberg S, Blackhurst D, Lee A, Leacock R, Nathaniel TI. Gender Differences in Exclusion Criteria for Recombinant Tissue-Type Plasminogen Activator. J Stroke Cerebrovasc Dis 2016; 25:2569-2574. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 04/06/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022] Open
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Mochmann HC, Scheitz JF, Petzold GC, Haeusler KG, Audebert HJ, Laufs U, Schneider C, Landmesser U, Werner N, Endres M, Witzenbichler B, Nolte CH. Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin: The Troponin Elevation in Acute Ischemic Stroke (TRELAS) Study. Circulation 2016; 133:1264-71. [PMID: 26933082 DOI: 10.1161/circulationaha.115.018547] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/28/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND A relevant proportion of patients with acute ischemic stroke (AIS) have elevated levels of cardiac troponins (cTn). However, the frequency of coronary ischemia as the cause of elevated cTn is unknown. The aim of our study was to analyze coronary vessel status in AIS patients with elevated cTn compared with patients presenting with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). METHODS AND RESULTS Among 2123 consecutive patients with AIS prospectively screened at 2 tertiary hospitals, 13.7% had cTn elevation (>50 ng/L). According to a prespecified sample size estimation, 29 patients with AIS (median age, 76 years [first-third quartiles, 70-82 years]; 52% male) underwent conventional coronary angiography and were compared with age- and sex-matched patients with NSTE-ACS. The primary end point was presence of coronary culprit lesions on coronary angiograms as analyzed by independent interventional cardiologists blinded for clinical data. Median cTn on presentation did not differ between patients with AIS or NSTE-ACS (95 versus 94 ng/L; P=0.70). Compared with patients with NSTE-ACS, patients with AIS were less likely to have coronary culprit lesions (7 of 29 versus 23 of 29; P<0.001) or any obstructive coronary artery disease (15 of 29 versus 25 of 29; P=0.02; median number of vessels with >50% stenosis, 1 [first-third quartiles, 0-2] versus 2 [first-third quartiles, 1-3]; P<0.01). CONCLUSIONS Coronary culprit lesions are significantly less frequent in AIS patients compared with age- and sex-matched patients with NSTE-ACS despite similar baseline cTn levels. Half of all AIS patients had no angiographic evidence of coronary artery disease. Further studies are needed to clinically identify the minority of patients with AIS and angiographic evidence of a culprit lesion. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01263964.
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Affiliation(s)
- Hans-Christian Mochmann
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Jan F Scheitz
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Gabor C Petzold
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Karl Georg Haeusler
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Heinrich J Audebert
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Ulrich Laufs
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Christine Schneider
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Ulf Landmesser
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Nikos Werner
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Matthias Endres
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Bernhard Witzenbichler
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.)
| | - Christian H Nolte
- From Klinik für Kardiologie (H.-C.M., U.L.) and Klinik für Neurologie (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.) and ExcellenceCluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases and Department of Neurology(G.C.P., C.S.) and Department of Internal Medicine II (N.W.), University of Bonn, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie undInternistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.); German Center for Neurodegenerative Diseases, Berlin,Germany (M.E.); Berlin Institute of Health, Germany (M.E.); and Klinik für Kardiologie und Pneumologie, Helios Amper-Klinikum Dachau, Germany (B.W.).
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Ahnstedt H, McCullough LD, Cipolla MJ. The Importance of Considering Sex Differences in Translational Stroke Research. Transl Stroke Res 2016; 7:261-73. [PMID: 26830778 DOI: 10.1007/s12975-016-0450-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Abstract
Stroke is the second leading cause of death worldwide, and differences between men and women have been documented in incidence, prevalence, and outcome. Here, we reviewed the literature on sex differences in stroke severity, mortality, functional outcome, and response to therapies after ischemic stroke. Many of the sex differences in stroke severity and mortality are explained by differences in baseline demographics such as older age in women. However, women account for more stroke deaths, consistently suffer from worse stroke outcomes, and are more often institutionalized and permanently disabled than men. These sex differences in functional outcome are equalized after treatment with tissue plasminogen activator (tPA) and women may benefit more from treatment than men. However, this may depend on race, as African-American women have less of a response to tPA than other groups. Regarding endovascular treatments, the few existing studies that have investigated sex differences in stroke outcome point to equal benefit in both sexes; however, many clinical trials are relatively underpowered to detect sex differences. Further, we considered sex-specific effects in animal models of stroke and present recommendations for the performance of stroke studies in female animals. The male-biased use of research animals is distinguished from the clinical situation where there is a disproportionate and growing female stroke population. Stroke in women is greatly understudied, and including both sexes is especially important in both preclinical and clinical studies that evaluate potential stroke therapies.
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Affiliation(s)
- Hilda Ahnstedt
- Department of Neurological Sciences, University of Vermont, 149 Beaumont Ave., HSRF 416A, Burlington, VT, 05405, USA
| | - Louise D McCullough
- Department of Neurology, University of Texas Health Science Center, Houston, TX, USA
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont, 149 Beaumont Ave., HSRF 416A, Burlington, VT, 05405, USA. .,Department of Pharmacology, University of Vermont, Burlington, VT, USA.
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Endo M, Sairenchi T, Kojimahara N, Haruyama Y, Sato Y, Kato R, Yamaguchi N. Sickness absence and return to work among Japanese stroke survivors: a 365-day cohort study. BMJ Open 2016; 6:e009682. [PMID: 26729388 PMCID: PMC4716216 DOI: 10.1136/bmjopen-2015-009682] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate the cumulative return to work (RTW) rate and to clarify the predictors of the time to full-time RTW (full RTW) and resignation among Japanese stroke survivors, within the 365-day period following their initial day of sickness absence due to stroke. SETTING This study was based on tertiary prevention of occupational health in large-scaled Japanese companies of various industries. PARTICIPANTS The participants in this study were 382 Japanese workers who experienced an episode of sickness leave due to clinically certified stroke diagnosed between 1 January 2000 and 31 December 2011. Data were obtained from an occupational health register. Participants were followed up for 365 days after the start day of the first sickness absence. The cumulative RTW rates by Kaplan-Meier estimates and predictors for time to full RTW and resignation by Cox regression were calculated. RESULTS A total of 382 employees had their first sickness absence due to stroke during the 12-year follow-up period. The cumulative full RTW rates at 60, 120, 180 and 365 days were 15.1%, 33.6%, 43.5% and 62.4%, respectively. Employees who took sick leave due to cerebral haemorrhage had a longer time to full RTW (HR, 0.50; 95% CI 0.36 to 0.69) than those with cerebral infarction. Older employees (over 50 years of age) demonstrated a shorter time to resignation than younger employees (HR, 3.30; 95% CI 1.17 to 9.33). Manual workers had a longer time to resignation than non-manual workers (HR, 0.24; 95% CI 0.07 to 0.78). CONCLUSIONS Cumulative RTW rates depended on the subtype of stroke, and older age was a predictor of resignation.
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Affiliation(s)
- Motoki Endo
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University, Mibu Town, Japan
| | - Noriko Kojimahara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University, Mibu Town, Japan
| | - Yasuto Sato
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Rika Kato
- Oyama Health Management Center, Health Promotion Center, Komatsu Ltd, Oyama City, Japan
| | - Naohito Yamaguchi
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
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Tomita H, Hagii J, Metoki N, Saito S, Shiroto H, Hitomi H, Kamada T, Seino S, Takahashi K, Baba Y, Sasaki S, Uchizawa T, Iwata M, Matsumoto S, Shoji Y, Tanno T, Osanai T, Yasujima M, Okumura K. Impact of Sex Difference on Severity and Functional Outcome in Patients with Cardioembolic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2613-8. [PMID: 26341732 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/21/2015] [Accepted: 07/16/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Female sex is a risk factor for thromboembolic events in Caucasian, but not in Japanese, patients with nonvalvular atrial fibrillation. However, it remains unclear whether the female sex is also a risk factor for severe stroke and unfavorable functional outcome in patients with cardioembolic (CE) stroke. METHODS Three hundred fifty-five consecutive patients with CE stroke within 48 hours after onset and with a modified Rankin Scale (mRS) score of 1 or lower before onset were studied. We compared basic characteristics, stroke severity, and functional outcome between female (n = 157) and male (n = 198) patients. RESULTS The mean age was higher in female than in male patients (80 ± 8 versus 75 ± 9 years, P < .00001). The congestive heart failure, hypertension, age [≥ 75 years], diabetes, stroke/transient ischemic attack [TIA] (CHADS2) score before onset was similar between the two groups (median, 3 [2-4] in both groups). Stroke severity on admission, assessed by the National Institutes of Health Stroke Scale (NIHSS), was higher in female than in male patients (13 [5-20] versus 8 [3-16], P = .0009). Functional outcome at discharge, assessed by mRS, was unfavorable in female than in male patients (3 [1-5] versus 2 [1-4], P = .005). An mRS score of 3 or higher at discharge was found more in female than in male patients (59% versus 39%, P = .0001). Multivariate analyses confirmed that female sex was a significant determinant of severe stroke (NIHSS ≥ 8) on admission (odds ratio [OR] to male = 1.97; 95% confidence interval [CI]; 1.24-3.15, P = .004) and for the mRS score of 3 or higher at discharge (OR = 1.83; 95% CI, 1.16-2.89; P = .01). Similar results were obtained by propensity-score matching analysis. CONCLUSIONS Female sex is a risk factor for severe stroke on admission and unfavorable functional outcome at discharge in Japanese patients with CE stroke.
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Affiliation(s)
- Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Norifumi Metoki
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Shin Saito
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Hiroshi Shiroto
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Hiroyasu Hitomi
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Takaatsu Kamada
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Satoshi Seino
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Koki Takahashi
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Yoshiko Baba
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Satoko Sasaki
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | | | - Manabu Iwata
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Shigeo Matsumoto
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Yoshihiro Shoji
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Tomohiro Tanno
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Tomohiro Osanai
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan; Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Minoru Yasujima
- Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan; Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
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Llull L, Laredo C, Renú A, Pérez B, Vila E, Obach V, Urra X, Planas A, Amaro S, Chamorro Á. Uric Acid Therapy Improves Clinical Outcome in Women With Acute Ischemic Stroke. Stroke 2015; 46:2162-7. [PMID: 26159792 DOI: 10.1161/strokeaha.115.009960] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/21/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE It is unknown whether women and men with acute ischemic stroke respond similar to an antioxidant regimen administered in combination with thrombolysis. Here, we investigated the independent effect of sex on the response to uric acid (UA) therapy in patients with acute stroke treated with alteplase. METHODS In the Efficacy Study of Combined Treatment With Uric Acid and rtPA in Acute Ischemic Stroke (URICO-ICTUS) trial, 206 women and 205 men were randomized to UA 1000 mg or placebo. In this reanalysis of the trial, the primary outcome was the rate of excellent outcome at 90 days (modified Rankin Scale, 0-1, or 2, if premorbid score of 2) in women and men using regression models adjusted for confounders associated with sex. The interaction of UA levels by treatment on infarct growth was assessed in selected patients. RESULTS Excellent outcome occurred in 47 of 111 (42%) women treated with UA, and 28 of 95 (29%) treated with placebo, and in 36 of 100 (36%) men treated with UA and 38 of 105 (34%) treated with placebo. Treatment and sex interacted significantly with excellent outcome (P=0.045). Thus, UA therapy doubled the effect of placebo to attain an excellent outcome in women (odd ratio [95% confidence interval], 2.088 [1.050-4.150]; P=0.036), but not in men (odd ratio [95% confidence interval], 0.999 [0.516-1.934]; P=0.997). The interactions between treatment and serum UA levels (P<0.001) or allantoin/UA ratio (P<0.001) on infarct growth were significant only in women. CONCLUSIONS In women with acute ischemic stroke treated with alteplase, the administration of UA reduced infarct growth in selected patients and was better than placebo to reach excellent outcome. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT00860366.
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Affiliation(s)
- Laura Llull
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Carlos Laredo
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Arturo Renú
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Belén Pérez
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Elisabet Vila
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Víctor Obach
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Xabier Urra
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Anna Planas
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Sergio Amaro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.)
| | - Ángel Chamorro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain (L.L., C.L., A.R., V.O., X.U., S.A., Á.C.); Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain (B.P., E.V.); Department of Brain Ischemia and Neurodegeneration, Institute for Biomedical Research of Barcelona, Spanish Research Council, Barcelona, Spain (A.P.); and Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain (A.P.).
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48
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Abstract
Stroke is the leading cause of acquired disability and the third leading cause of death in women worldwide. Sex differences in risk factors, treatment response and quality of life after stroke complicate stroke management in women. Women have an increased lifetime incidence of stroke compared to men, largely due to a sharp increase in stroke risk in older postmenopausal women. Women also have an increased lifetime prevalence of stroke risk factors, including hypertension and atrial fibrillation in postmenopausal women, as well as abdominal obesity and metabolic syndrome in middle-aged women. Controversy continues over the risks of oral contraceptives, hormone therapy and surgical intervention for carotid stenosis in women. Pregnancy and the postpartum period represent a time of increased risk, presenting challenges to stroke management. Recognition of these issues is critical to improving acute care and functional recovery after stroke in women.
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Affiliation(s)
- Matthew D Howe
- Department of Neuroscience, The University of Connecticut Health Center, Farmington, CT 06030, USA
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