1
|
Huo S, Rivier CA, Clocchiatti-Tuozzo S, Renedo D, Sunmonu NA, de Havenon A, Sarpong DF, Rosendale N, Sheth KN, Falcone GJ. Brain Health Outcomes in Sexual and Gender Minority Groups: Results From the All of Us Research Program. Neurology 2024; 103:e209863. [PMID: 39321407 DOI: 10.1212/wnl.0000000000209863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Sexual and gender minority (SGM) groups have been historically underrepresented in neurologic research, and their brain health disparities are unknown. We aim to evaluate whether SGM persons are at higher risk of adverse brain health outcomes compared with cisgender straight (non-SGM) individuals. METHODS We conducted a cross-sectional study in the All of Us Research Program, a US population-based study, including all participants with information on gender identity and sexual orientation. We used baseline questionnaires to identify sexual minority (lesbian, gay, bisexual, diverse sexual orientation; nonstraight sexual orientation) and gender minority (gender diverse and transgender; gender identity different from sex assigned at birth) participants. The primary outcome was a composite of stroke, dementia, and late-life depression, assessed using electronic health record data and self-report. Secondarily, we evaluated each disease separately. Furthermore, we evaluated all subgroups of gender and sexual minorities stratified by sex assigned at birth. We used multivariable logistic regression (adjusted for age, sex assigned at birth, race/ethnicity, cardiovascular risk factors, other relevant comorbidities, and neighborhood deprivation index) to assess the relationship between SGM groups and the outcomes. RESULTS Of 413,457 US adults enrolled between May 31, 2017, and June 30, 2022, we included 393,041 participants with available information on sexual orientation and gender identity (mean age 51 [SD 17] years), of whom 39,632 (10%) belonged to SGM groups. Of them, 38,528 (97%) belonged to a sexual minority and 4,431 (11%) to a gender minority. Compared with non-SGM, SGM persons had 15% higher odds of the brain health composite outcome (odds ratio [OR] 1.15, 95% CI 1.08-1.22). In secondary analyses, these results persisted across sexual and gender minorities separately (all 95% CIs > 1). Assessing individual diseases, all SGM groups had higher odds of dementia (SGM vs non-SGM: OR 1.14, 95% CI 1.00-1.29) and late-life depression (SGM vs non-SGM: OR 1.27, 95% CI 1.17-1.38) and transgender women had higher odds of stroke (OR 1.68, 95% CI 1.04-2.70). DISCUSSION In a large US population study, SGM persons had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurologic care.
Collapse
Affiliation(s)
- Shufan Huo
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Cyprien A Rivier
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Santiago Clocchiatti-Tuozzo
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Daniela Renedo
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - N Abimbola Sunmonu
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Adam de Havenon
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Daniel F Sarpong
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Nicole Rosendale
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Kevin N Sheth
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| | - Guido J Falcone
- From the Department of Neurology (S.H., C.A.R., S.C.-T., D.R., N.A.S., A.d.H., K.N.S., G.J.F.), Yale Center for Brain and Mind Health (S.H., C.A.R., S.C.-T., D.R., A.d.H., K.N.S., G.J.F.), Department of Internal Medicine (S.C.-T.), Department of Neurosurgery (D.R.), and Office of Health Equity Research (D.F.S.), Yale University School of Medicine, New Haven, CT; and Weill Institute for Neurosciences (N.R.), Department of Neurology, University of California San Francisco
| |
Collapse
|
2
|
Colsch R, Onweni-Eze M, Byrd EM, Damush TM, Olney CM, Reardon EE, Hadidi NN. Women Veterans' Stroke Risk Factors: Identified Prevention Methods and Knowledge Gaps. Mil Med 2024:usae445. [PMID: 39325564 DOI: 10.1093/milmed/usae445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/01/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
INTRODUCTION Stroke is a significant health burden for veterans and the fifth leading cause of death for women. Compared to civilian women, women veterans have significant multimorbid physical and mental health conditions contributing to their stroke risk. This scoping review aimed to synthesize evidence on the stroke risk factors specific to U.S. women veterans and identify any association between risk factors and a delay in prevention and treatment for women veterans. MATERIALS AND METHODS This study was approved by the organizational Institutional Review Board. The search strategy was run across 6 databases: MEDLINE and EMBASE via Ovid, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. A total of 1218 records were uploaded to Covidence for screening. Criteria for included studies were peer-reviewed primary research articles written in English about women veterans and cardiovascular disease and stroke risk factors. No restrictions were placed on publication date. RESULTS Fourteen articles met the inclusion criteria. Cohorts were 30 years and older. Data originated from national and individual Veterans Affairs studies. Women veterans starting at age 30 have a steadily increasing positive curvilinear association with stroke risk, indicating a need to screen earlier than the recommended age of 45 years. Stroke incidence was higher in veterans with post-traumatic stress disorder, insomnia, restless leg syndrome, traumatic brain injury, constipation with laxative use, egg consumption (2-4 eggs/wk), frailty, and systemic sclerosis. When comparing White veterans and civilian counterparts, Black veterans had a higher incidence of stroke. Ten studies addressed prevention methods. The clinicians should screen and treat women veterans for post-traumatic stress disorder and constipation and consider alternative treatment methods for constipation. CONCLUSIONS Empirical literature on this matter is lacking. Examining and understanding the differences in sex, gender, and veteran status, and their association with stroke risk, is warranted. Screening women veterans for post-traumatic stress disorder and for stroke early, at 30 years of age, is recommended.
Collapse
Affiliation(s)
- Renee Colsch
- Education, Minneapolis VAMC, Minneapolis, MN 55417, USA
| | | | - Elizabeth M Byrd
- Acute, Chronic, and Continuing Care, UAB, The University of Alabama at Birmingham, Birmingham, AL 35294-1210, USA
| | - Teresa M Damush
- Center for Health Information and Communication, Indianapolis VAMC, Indianapolis, IN 46202, USA
| | | | - Erin E Reardon
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA 30322, USA
| | - Niloufar N Hadidi
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| |
Collapse
|
3
|
de Souza OF, Araújo ACB, Vieira LB, Bachur JA, Lopez AGP, Gonçalves TG, de Abreu LC. Sex Disparity in Stroke Mortality among Adults: A Time Series Analysis in the Greater Vitoria Region, Brazil (2000-2021). EPIDEMIOLOGIA 2024; 5:402-410. [PMID: 39051209 PMCID: PMC11270260 DOI: 10.3390/epidemiologia5030029] [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: 05/19/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
The disparity between the sexes in stroke mortality has been demonstrated in people from different locations. The objective of this study was to analyze the disparity between sexes in stroke mortality in adults in the metropolitan area of Greater Vitoria between 2000 and 2021. Ecological time series design was conducted with a database of the Brazilian Health System Informatics Department. The annual percentage change and average annual percentage change were calculated through joinpoint regression. Pairwise comparisons using parallelism and coincidence tests were applied to compare temporal trends between men and women. Men had higher mortality rates in most years between 2000 and 2021. In contrast, women had higher proportional mortality values in all years evaluated from 2000 to 2021. The paired comparison revealed a disparity between the sexes in the proportional mortality time series (parallelism test: p = 0.003; coincidence test: p < 0.001). However, the time series of the mortality rates showed no disparity between the sexes (parallelism test: p = 0.114; coincidence test: p = 0.093). From 2000 to 2021, there was a disparity in proportional mortality from stroke between the sexes of the population in the metropolitan area of Greater Vitoria, Brazil. However, the time series of mortality rates between the sexes did not reveal any disparity in the study period.
Collapse
Affiliation(s)
- Orivaldo Florencio de Souza
- Postgraduate Program in Nutrition and Health, Federal University of Espírito Santo, Vitoria 29043-900, Brazil;
- Postgraduate Program in Health Sciences, Federal University of Acre, Rio Branco 69915-900, Brazil
| | | | - Lorenna Baião Vieira
- Postgraduate Program in Public Health, Federal University of Espírito Santo Vitoria 29043-900, Brazil
| | | | | | - Thiago Gomes Gonçalves
- Postgraduate Program in Health Sciences, Federal University of Acre, Rio Branco 69915-900, Brazil
| | - Luiz Carlos de Abreu
- Postgraduate Program in Medical Sciences, University of Sao Paulo, São Paulo 01246-903, Brazil
| |
Collapse
|
4
|
Mikkola U, Rissanen I, Kivelä M, Rusanen H, Kajantie E, Miettunen J, Paananen M. Overweight in Adolescence and Young Adulthood in Association With Adult Cerebrovascular Disease: The NFBC1966 Study. Stroke 2024; 55:1857-1865. [PMID: 38841866 PMCID: PMC11268552 DOI: 10.1161/strokeaha.123.045444] [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: 10/06/2023] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Risk factors for cerebrovascular disease in adulthood are well known. However, research on individuals' risk factors throughout their life span has been limited. This prospective cohort study aims to determine the effect of body mass index (BMI) and its changes in adolescence and young adulthood on early onset cerebrovascular disease. METHODS This study includes 10 491 people (5185 women) from the Northern Finland Birth Cohort 1966. Height, weight, and BMI were measured at ages 14 and 31 years. Sex- and age-specific BMI ranges were used to define overweight and obesity. Data on ischemic and hemorrhagic cerebrovascular diseases between ages 14 and 54 years were extracted from national hospital and death registers. Cox proportion hazard models (95% CI) were used to estimate associations between BMI or its changes and cerebrovascular disease, while adjusting for sex, smoking, educational level, BMI at the other time point, and age at menarche for women. Additionally, sex-BMI interactions were calculated. RESULTS A total of 452 individuals (4.7%) experienced cerebrovascular disease during the follow-up. The risk of ischemic cerebrovascular disease was increased for overweight women at ages 14 years (hazard ratio [HR], 2.49 [95% CI, 1.44-4.31]) and 31 years (HR, 2.13 [95% CI, 1.14-3.97]), as well as for obese women at ages 14 years (HR, 1.87 [95% CI, 0.76-4.58) and 31 years (HR, 2.67 [95% CI, 1.26-5.65]), with normal weight as the reference. These results were independent of earlier or later BMI. Similar associations were not found among men. The risk of hemorrhagic cerebrovascular disease was increased at age 31 years both among obese women (HR, 3.49 [95% CI, 1.13-10.7) and obese men (HR, 5.75 [95% CI, 1.43-23.1). The risk of any cerebrovascular disease related to overweight at age 14 years was 2.09× higher among girls than boys (95% CI, 1.06-4.15). The risk of ischemic cerebrovascular disease related to obesity at age 31 years was 6.96× higher among women than men (95% CI, 1.36-35.7). CONCLUSIONS Among women, being overweight in adolescence or young adulthood increases the risk of cerebrovascular disease, especially ischemic, independent of their earlier or later BMI.
Collapse
Affiliation(s)
- Ursula Mikkola
- Research Unit of Population Health (U.M., I.R., M.K., J.M., M.P.), University of Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland (U.M., I.R., M.K., H.R., E.K., J.M.)
| | - Ina Rissanen
- Research Unit of Population Health (U.M., I.R., M.K., J.M., M.P.), University of Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland (U.M., I.R., M.K., H.R., E.K., J.M.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands (I.R.)
| | - Milja Kivelä
- Research Unit of Population Health (U.M., I.R., M.K., J.M., M.P.), University of Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland (U.M., I.R., M.K., H.R., E.K., J.M.)
| | - Harri Rusanen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland (U.M., I.R., M.K., H.R., E.K., J.M.)
- Department of Neurology, Oulu University Hospital, Finland (H.R.)
| | - Eero Kajantie
- Clinical Medicine Research Unit (E.K.), University of Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland (U.M., I.R., M.K., H.R., E.K., J.M.)
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland (E.K.)
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway (E.K.)
| | - Jouko Miettunen
- Research Unit of Population Health (U.M., I.R., M.K., J.M., M.P.), University of Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland (U.M., I.R., M.K., H.R., E.K., J.M.)
| | - Markus Paananen
- Research Unit of Population Health (U.M., I.R., M.K., J.M., M.P.), University of Oulu, Finland
- Social and Health Care Services, Western Uusimaa Wellbeing Services County, Helsinki, Finland (M.P.)
| |
Collapse
|
5
|
Han Y, Zhang B, Qi X, Yuan G, Li X, Hao G, Liang G. Comparison of sex differences on outcomes after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis. BMC Neurol 2024; 24:153. [PMID: 38704548 PMCID: PMC11069223 DOI: 10.1186/s12883-024-03659-3] [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: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE Sex differences in outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain controversial. Therefore, the aim of this study was to investigate the sex differences in the prognosis of patients with aSAH. METHODS This study retrospectively analyzed the clinical data of aSAH patients admitted to the Department of Neurosurgery of General Hospital of Northern Theater Command, from April 2020 to January 2022. The modified Rankin Scale (mRS) was used to evaluate outcomes at 3-month post-discharge. Baseline characteristics, in-hospital complications and outcomes were compared after 1:1 propensity score matching (PSM). RESULTS A total of 665 patients were included and the majority (63.8%) were female. Female patients were significantly older than male patients (59.3 ± 10.9 years vs. 55.1 ± 10.9 years, P < 0.001). After PSM, 141 male and 141 female patients were compared. Comparing postoperative complications and mRS scores, the incidence of delayed cerebral ischemia (DCI) and hydrocephalus and mRS ≥ 2 at 3-month were significantly higher in female patients than in male patients. After adjustment, the analysis of risk factors for unfavorable prognosis at 3-month showed that age, sex, smoking, high Hunt Hess grade, high mFisher score, DCI, and hydrocephalus were independent risk factors. CONCLUSION Female patients with aSAH have a worse prognosis than male patients, and this difference may be because females are more vulnerable to DCI and hydrocephalus.
Collapse
Affiliation(s)
- Yuwei Han
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Bingying Zhang
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Xin Qi
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Guanqian Yuan
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Xiaoming Li
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China.
| | - Guangzhi Hao
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China.
| | - Guobiao Liang
- Department of Neurology, General Hospital of Northern Theater Command, NO.83, Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China.
| |
Collapse
|
6
|
Peycheva M, Padlina G, Genceviciute K, Krasteva MP, Boronylo A, Goeldlin MB, Müller M, Wenz ES, Müller MD, Hammer H, Bücke P, Bigi S, Simonetti BG, Hoffmann A, Umarova RM, Pilgram-Pastor S, Gralla J, Mordasini P, Antonenko K, Heldner MR. Baseline characteristics and outcome of stroke patients after endovascular therapy according to previous symptomatic vascular disease and sex. Front Neurol 2024; 15:1293905. [PMID: 38694775 PMCID: PMC11061446 DOI: 10.3389/fneur.2024.1293905] [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: 09/22/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Aim The aim of this study was to investigate baseline characteristics and outcome of patients after endovascular therapy (EVT) for acute large vessel occlusion (LVO) in relation to their history of symptomatic vascular disease and sex. Methods Consecutive EVT-eligible patients with LVO in the anterior circulation admitted to our stroke center between 04/2015 and 04/2020 were included in this observational cohort study. All patients were treated according to a standardized acute ischaemic stroke (AIS) protocol. Baseline characteristics and successful reperfusion, recurrent/progressive in-hospital ischaemic stroke, symptomatic in-hospital intracranial hemorrhage, death at discharge and at 3 months, and functional outcome at 3 months were analyzed according to previous symptomatic vascular disease and sex. Results 995 patients with LVO in the anterior circulation (49.4% women, median age 76 years, median admission NIHSS score 14) were included. Patients with multiple vs. no previous vascular events showed higher mortality at discharge (20% vs. 9.3%, age/sex - adjustedOR = 1.43, p = 0.030) and less independency at 3 months (28.8% vs. 48.8%, age/sex - adjustedOR = 0.72, p = 0.020). All patients and men alone with one or multiple vs. patients and men with no previous vascular events showed more recurrent/progressive in-hospital ischaemic strokes (19.9% vs. 6.4% in all patients, age/sex - adjustedOR = 1.76, p = 0.028) (16.7% vs. 5.8% in men, age-adjustedOR = 2.20, p = 0.035). Men vs. women showed more in-hospital symptomatic intracranial hemorrhage among patients with one or multiple vs. no previous vascular events (23.7% vs. 6.6% in men and 15.4% vs. 5.5% in women, OR = 2.32, p = 0.035/age - adjustedOR = 2.36, p = 0.035). Conclusions Previous vascular events increased the risk of in-hospital complications and poorer outcome in the analyzed patients with EVT-eligible LVO-AIS. Our findings may support risk assessment in these stroke patients and could contribute to the design of future studies.
Collapse
Affiliation(s)
- Marieta Peycheva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology and Research Institute, Medical University Plovdiv, Plovdiv, Bulgaria
| | - Giovanna Padlina
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Clinica Luganese, Mancucco, Lugano, Switzerland
| | - Kotryna Genceviciute
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marina P. Krasteva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Queen Giovanna, Sofia, Bulgaria
| | - Anna Boronylo
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Madlaine Müller
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Elena S. Wenz
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mandy D. Müller
- Department of Neurosurgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sandra Bigi
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Paediatric Neurology, Department of Paediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Barbara Goeggel Simonetti
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Neuropaediatrics, Istituto Pediatrico della Svizzera Italiana IPSI EOC, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Angelika Hoffmann
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Roza M. Umarova
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sara Pilgram-Pastor
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Netzwerk Radiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
7
|
Egle M, Wang WC, Fann YC, Johansen MC, Lee JT, Yeh CH, Jason Lin CH, Jeng JS, Sun Y, Lien LM, Gottesman RF. Sex Differences in the Role of Multimorbidity on Poststroke Disability: The Taiwan Stroke Registry. Neurology 2024; 102:e209140. [PMID: 38330286 PMCID: PMC11067697 DOI: 10.1212/wnl.0000000000209140] [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: 07/31/2023] [Accepted: 11/28/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Multimorbidity is common in patients who experience stroke. Less is known about the effect of specific multimorbidity patterns on long-term disability in patients with stroke. Furthermore, given the increased poststroke disability frequently seen in female vs male patients, it is unknown whether multimorbidity has a similar association with disability in both sexes. We assessed whether specific multimorbidity clusters were associated with greater long-term poststroke disability burden overall and by sex. METHODS In the Taiwan Stroke Registry, an ongoing nationwide prospective registry, patients with first-ever ischemic stroke were enrolled; this analysis is restricted to those individuals surviving to at least 6 months poststroke. Using a hierarchical clustering approach, clusters of prestroke multimorbidity were generated based on 16 risk factors; the algorithm identified 5 distinct clusters. The association between clusters and 12-month poststroke disability, defined using the modified Rankin Scale (mRS), was determined using logistic regression models, with additional models stratified by sex. The longitudinal association between multimorbidity and functional status change was assessed using mixed-effects models. RESULTS Nine-thousand eight hundred eighteen patients with first-ever ischemic stroke were included. The cluster with no risk factors was the reference, "healthier" risk group (N = 1,373). Patients with a cluster profile of diabetes, peripheral artery disease (PAD), and chronic kidney disease (CKD) (N = 1882) had significantly greater disability (mRS ≥ 3) at 1 month (OR [95% CI] = 1.36 [1.13-1.63]), 3 months (OR [95% CI] = 1.27 [1.04-1.55]), and 6 months (OR [95% CI] = 1.30 [1.06-1.59]) but not at 12 months (OR [95% CI] = 1.16 [0.95-1.42]) than patients with a healthier risk factor profile. In the sex-stratified analysis, the associations with this risk cluster remained consistent in male patients (OR [95% CI] = 1.42 [1.06-1.89]) at 12 months, who also had a higher comorbidity burden, but not in female patients (OR [95% CI] = 0.95 [0.71-1.26]), who had higher proportions of severe strokes and severe disability (p-interaction = 0.04). DISCUSSION Taiwanese patients with multimorbidity, specifically the concurrent presence of diabetes, PAD, and CKD, had higher odds of a worse functional outcome in the first 6 months poststroke. Clusters of multimorbidity may be less informative for long-term disability in female patients. Further studies should evaluate other mechanisms for worse disability in female patients poststroke.
Collapse
Affiliation(s)
- Marco Egle
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wei-Chun Wang
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yang C Fann
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Michelle C Johansen
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jiunn-Tay Lee
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Hsin Yeh
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chih-Hao Jason Lin
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yu Sun
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Li-Ming Lien
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Rebecca F Gottesman
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
8
|
Ebrahimi R, Dennis PA, Alvarez CA, Shroyer AL, Beckham JC, Sumner JA. Posttraumatic Stress Disorder Is Associated With Elevated Risk of Incident Stroke and Transient Ischemic Attack in Women Veterans. J Am Heart Assoc 2024; 13:e033032. [PMID: 38410963 PMCID: PMC10944021 DOI: 10.1161/jaha.123.033032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/06/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been associated with ischemic heart disease in women veterans, but evidence for associations with other cardiovascular disorders remains limited in this population. This retrospective longitudinal cohort study evaluated the association of PTSD with incident stroke/transient ischemic attack (TIA) in women veterans. METHODS AND RESULTS Veterans Health Administration electronic health records were used to identify women veterans aged ≥18 years engaged with Veterans Health Administration health care from January 1, 2000 to December 31, 2019. We identified women veterans with and without PTSD without a history of stroke or TIA at start of follow-up. Propensity score matching was used to match groups on age, race or ethnicity, traditional cardiovascular risk factors, female-specific risk factors, a range of mental and physical health conditions, and number of prior health care visits. PTSD, stroke, TIA, and risk factors used in propensity score matching were based on diagnostic codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for associations of PTSD with an incident stroke/TIA composite. Subanalyses considered stroke and TIA separately, plus age- and race- or ethnicity-stratified analyses were carried out. The analytic sample included 208 092 women veterans (104 046 with and 104 046 without PTSD). PTSD was associated with a greater rate of developing stroke/TIA (HR, 1.33 [95% CI, 1.25-1.42], P<0.001). This elevated risk was especially pronounced in women <50 years old and in Hispanic/Latina women. CONCLUSIONS Findings indicate a strong association of PTSD with incident stroke/TIA in women veterans. Research is needed to determine whether addressing PTSD and its downstream consequences can offset this risk.
Collapse
Affiliation(s)
- Ramin Ebrahimi
- Department of MedicineUniversity of CaliforniaLos AngelesCAUSA
- Department of MedicineVeterans Affairs (VA) Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - Paul A. Dennis
- Department of Population Health SciencesDuke University School of MedicineDurhamNCUSA
- Durham VA Medical CenterDurhamNCUSA
| | - Carlos A. Alvarez
- Department of Pharmacy PracticeTexas Tech University Health Science CenterLubbockTXUSA
- Department of ResearchVA North Texas Health Care SystemDallasTXUSA
| | - A. Laurie Shroyer
- Department of Surgery, Renaissance School of MedicineStony Brook UniversityStony BrookNYUSA
- Northport VA Medical CenterNorthportNYUSA
| | - Jean C. Beckham
- Durham VA Medical CenterDurhamNCUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | | |
Collapse
|
9
|
Ye J, Yang Y, Tang L, He L, Zhou M. Recurrent stroke in a reproductive age women with patent foramen ovale. BMC Womens Health 2024; 24:70. [PMID: 38273311 PMCID: PMC10809491 DOI: 10.1186/s12905-024-02909-3] [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: 05/23/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) is a known cause of ischemic stroke in young adults and combined oral contraceptives (COCs) are widely used by women of reproductive age. If young women with PFO are taking COCs, they may be subjected to a synergistic increase in the occurrence of stroke, though reports of ischemic stroke in this population are rare. We report a woman of reproductive age who was taking COC suffered repetitive ischemic strokes before a patent foramen ovale (PFO) was detected and closed, which may raise concerns in this field. CASE PRESENTATION A 31-year-old woman presented to the emergency department with sudden-onset right upper- and lower-limb weakness and dysarthria for 1 hour, whose only risk factor of stroke was oral contraceptive use. On admission, she was alert with left gaze deviation, dysarthria, and right-sided hemiplegia. Her symptoms improved after receiving the revascularization therapy. About 24 hours later, her left eye experienced sudden painless vision loss. Then the PFO with a substantial right-to-left shunt was detected and then she received a trans-catheter closure of the defect. Over 3 months of follow-up, there were no signs of stroke, but visual loss persisted. CONCLUSION This case of disabling stroke raises concerns regarding optimal management in primary and secondary prevention of stroke in young women on COCs with additional risk factors of stroke.
Collapse
Affiliation(s)
- Jing Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yujia Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Tang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
10
|
Liu R, Cao S, Cai Y, Zhou M, Gou X, Huang Y. Brain and serum metabolomic studies reveal therapeutic effects of san hua decoction in rats with ischemic stroke. Front Endocrinol (Lausanne) 2023; 14:1289558. [PMID: 38098862 PMCID: PMC10720749 DOI: 10.3389/fendo.2023.1289558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
San Hua Decoction (SHD) is a traditional four-herbal formula that has long been used to treat stroke. Our study used a traditional pharmacodynamic approach combined with systematic and untargeted metabolomics analyses to further investigate the therapeutic effects and potential mechanisms of SHD on ischemic stroke (IS). Male Sprague-Dawley rats were randomly divided into control, sham-operated, middle cerebral artery occlusion reperfusion (MCAO/R) model and SHD groups. The SHD group was provided with SHD (7.2 g/kg, i.g.) and the other three groups were provided with equal amounts of purified water once a day in the morning for 10 consecutive days. Our results showed that cerebral infarct volumes were reduced in the SHD group compared with the model group. Besides, SHD enhanced the activity of SOD and decreased MDA level in MCAO/R rats. Meanwhile, SHD could ameliorate pathological abnormalities by reducing neuronal damage, improving the structure of damaged neurons and reducing inflammatory cell infiltration. Metabolomic analysis of brain and serum samples with GC-MS techniques revealed 55 differential metabolites between the sham and model groups. Among them, the levels of 12 metabolites were restored after treatment with SHD. Metabolic pathway analysis showed that SHD improved the levels of 12 metabolites related to amino acid metabolism and carbohydrate metabolism, 9 of which were significantly associated with disease. SHD attenuated brain inflammation after ischemia-reperfusion. The mechanisms underlying the therapeutic effects of SHD in MCAO/R rats are related to amino acid and carbohydrate metabolism.
Collapse
Affiliation(s)
- Ruisi Liu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shengxuan Cao
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Research of Chinese Medicine on Prevention and Treatment for Major Diseases, Beijing, China
| | - Yufeng Cai
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Research of Chinese Medicine on Prevention and Treatment for Major Diseases, Beijing, China
| | - Mingmei Zhou
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Frontiers Science Center of TCM Chemical Biology, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojun Gou
- Central Laboratory, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Huang
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Research of Chinese Medicine on Prevention and Treatment for Major Diseases, Beijing, China
| |
Collapse
|
11
|
Svyatova G, Mirzakhmetova D, Berezina G, Murtazaliyeva A. Candidate genes related to acute cerebral circulatory disorders in Preeclampsia in the Kazakh Population. J Stroke Cerebrovasc Dis 2023; 32:107392. [PMID: 37776726 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107392] [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: 04/26/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to conduct a comparative analysis of the population frequencies of alleles and genotypes of polymorphic variants of coagulation and fibrinolysis genes SERPINE1 rs1799889, ITGA2 rs1126643, THBD rs1042580, FII rs1799963, FV rs6025, FVII rs6046, angiogenesis and endothelial dysfunction PGF rs12411, FLT1 rs4769612, KDR rs2071559, ACE rs4340, GWAS associated with the development of acute cerebral circulatory disorders in preeclampsia, in an ethnically homogeneous population of Kazakhs with previously studied populations of the world. METHODS The genomic database was analysed based on the results of genotyping of 1800 conditionally healthy individuals of Kazakh nationality ∼2.5 million SNPs using OmniChip 2.5 M Illumina chips at the DECODE Iceland Genomic Center as part of the joint implementation of the project "Genetic Studies of Preeclampsia in Populations of Central Asia and Europe" (InterPregGen) within the 7th Framework Programme of the European Commission under Grant Agreement No. 282540. RESULT The study discovered a significantly higher population frequency of carrying the unfavorable rs1126643 allele of the ITGA2 gene polymorphism when compared with European populations. The population frequencies of carrying minor alleles of the SERPINE1 (rs179988) and KDR (rs2071559) genes in the Kazakh population were significantly lower when compared with the previously studied populations of Europe and Asia. An intermediate frequency of unfavorable minor alleles between European and Asian populations was found in Kazakhs for gene polymorphisms: FV rs6025, PGF rs12411, and ACE rs4340. The genomic analysis determined the choice of polymorphisms for their further replicative genotyping in patients with ACCD in PE in the Kazakh population. CONCLUSION The obtained results will serve as a basis for the development of effective methods of early diagnosis and treatment of PE in pregnant women, carriers of unfavorable genotypes.
Collapse
Affiliation(s)
- Gulnara Svyatova
- Republican Medical Genetic Consultation, Scientific Center of Obstetrics, Gynecology and Perinatology, 050020, 125 Dostyk Ave., Almaty, Kazakhstan
| | - Dinara Mirzakhmetova
- Scientific Center of Obstetrics, Gynecology and Perinatology, 050020, 125 Dostyk Ave., Almaty, Kazakhstan.
| | - Galina Berezina
- Republican Medical Genetic Consultation, Scientific Center of Obstetrics, Gynecology and Perinatology, 050020, 125 Dostyk Ave., Almaty, Kazakhstan
| | - Alexandra Murtazaliyeva
- Republican Medical Genetic Consultation, Scientific Center of Obstetrics, Gynecology and Perinatology, 050020, 125 Dostyk Ave., Almaty, Kazakhstan
| |
Collapse
|
12
|
Zou X, Wang L, Wang S, Zhang L. Mendelian randomization study and meta-analysis exploring the causality of age at menarche and the risk of intracerebral hemorrhage and ischemic stroke. CNS Neurosci Ther 2023; 29:3043-3052. [PMID: 37170723 PMCID: PMC10493675 DOI: 10.1111/cns.14245] [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: 01/31/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The relationship between the age at menarche (AAM) and the risk of intracerebral hemorrhage (ICH) and ischemic stroke (IS) is still up for debate. The purpose of this study was to investigate potential causal connections between them. METHODS Genome-wide association analysis (GWAS) of AAM conducted by the MRC-IEU consortium was utilized for association analyses of ICH and IS by two-sample Mendelian randomization (MR) study. AAM data of the within-family GWAS consortium were used as replication phase data to verify the causal relationship between each other. Inverse variance weighting (IVW) method was the primary method used in this MR study. For additional proof, the weighted median estimation, MR-Egger regression, MR-PRESSO test, and MR-Robust Adjusted Profile Score evaluation were performed. The Cochran's Q test and the MR-PRESSO global test were used, respectively, to examine the sensitivity and pleiotropy. Random effects meta-analysis was utilized to analyze the causal data from the two consortiums to further explore the causality between AAM and ICH, IS. RESULTS We found that the AAM was causally linked with the risk of ICH (OR = 0.48, 95% CI: 0.28-0.80, p = 0.006). On the contrary, the causal effect from AAM to IS (OR = 0.98, 95% CI: 0.91-1.06, p = 0.64) has not been confirmed. For all subtypes of ICH, we found that nonlobar intracerebral hemorrhage (NLICH, OR = 0.41, 95% CI: 0.23-0.75, p = 0.004) but not lobar intracerebral hemorrhage (LICH, OR = 0.65, 95% CI: 0.34-1.24, p = 0.19) was associated with AAM without surprise. Similarly, we used the within-family GWAS consortium data to explore causality and found that AAM may reduce the risk of ICH (OR = 0.78, 95% CI: 0.72-0.86, p = 9.5 × 10-8 ) and NLICH (OR = 0.68, 95% CI: 0.61-0.75, p = 3.4 × 10-13 ) by IVW methods, but is not related to IS (OR = 0.97, 95% CI: 0.93-1.02, p = 0.26). These findings are further supported by the meta-analysis. Both Cochran's Q test and the MR-PRESSO global test failed to detect the presence of sensitivity. CONCLUSION AAM and ICH, particularly NLICH, are causally related, but not LICH, IS, or its subtypes in European population.
Collapse
Affiliation(s)
- Xuelun Zou
- Department of NeurologyXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Leiyun Wang
- Department of PharmacyWuhan First HospitalWuhanChina
| | - Sai Wang
- Department of NeurologyXiangya Hospital, Central South UniversityChangshaHunanChina
| | - Le Zhang
- Department of NeurologyXiangya Hospital, Central South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Multi‐Modal Monitoring Technology for Severe Cerebrovascular Disease of Human Engineering Research Center, Xiangya HospitalCentral South UniversityChangshaHunanChina
| |
Collapse
|
13
|
Khoromi S. Secondary headaches in pregnancy and the puerperium. Front Neurol 2023; 14:1239078. [PMID: 37840942 PMCID: PMC10569305 DOI: 10.3389/fneur.2023.1239078] [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: 06/12/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Headache during pregnancy can be due to primary causes such as migraine but can also be a presenting symptom of secondary causes including life threatening conditions. This is a minireview of secondary causes of headache during pregnancy and the puerperium. Unique alterations in physiological and vascular functions as well as in the coagulation pathway which occur during pregnancy increase the risk of most of these secondary conditions which include preeclampsia, eclampsia, hemorrhagic stroke, cerebral venous, sinus thrombosis, reversible cerebral vascular syndrome, and posterior reversible encephalopathy. Marked increase in progesterone level in pregnancy is also associated with the growth of tumors such as meningiomas, as 70% of these tumors are positive for progesterone receptors and increase in size can lead to headache along with other neurological symptoms. Hemodynamic changes can lead to the growth of meningiomas as well. Although hormone producing pituitary tumors are usually not conducing to pregnancy, women with known pituitary tumors who do get pregnant may become symptomatic during pregnancy and develop secondary headache. Another rare cause of secondary headache during pregnancy is pituitary apoplexy. Although its occurrence is uncommon, it needs to be properly recognized and treated to avoid endocrine and visual complications. Other rare entities with increased incidence during the puerperium such postdural puncture headache will be also discussed. In summary, new onset headache during pregnancy deserves special attention because in the absence of proper recognition and treatment, secondary headache disorders can endanger the life of the mother and the fetus.
Collapse
Affiliation(s)
- Suzan Khoromi
- University of California, San Diego, La Jolla, CA, United States
| |
Collapse
|
14
|
Harrison CH, Taquet M, Harrison PJ, Watkinson PJ, Rowland MJ. Sex and age effects on risk of non-traumatic subarachnoid hemorrhage: Retrospective cohort study of 124,234 cases using electronic health records. J Stroke Cerebrovasc Dis 2023; 32:107196. [PMID: 37230056 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107196] [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: 02/25/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES The epidemiology of non-traumatic subarachnoid hemorrhage (SAH) is unclear. This study describes the antecedent characteristics of SAH patients, compares the risk of SAH between women and men, and explores if this changes with age. MATERIALS AND METHODS Retrospective cohort study using an electronic health records network based in the USA (TriNetX). All patients aged 18-90y with at least one healthcare visit were included. Antecedent characteristics of SAH patients (ICD-10 code I60) were measured. The incidence proportion and the relative risk between women and men, were estimated overall, in the 55-90y age group, and in five-year age categories. RESULTS Of 58.9 million eligible patients, with 190.8 million person-years of observations, 124,234 (0.21%; 63,467 female, 60,671 male) had a first SAH, with a mean age of 56.8 (S.D. 16.8) y (women: 58.2 [16.2] y, men 55.3 [17.2] y). 9,758 SAH cases (7.8%) occurred in people aged 18-30y. Prior to the SAH, an intracranial aneurysm had been diagnosed in 4.1% (women: 5.8% men: 2.5%), hypertension in 25.1% and nicotine dependence in 9.1%. Overall, women had a lower risk of SAH compared to men (RR 0.83, 95% CI 0.83-0.84), with a progressive increase in risk ratio across age groups: from RR 0.36 (0.35-0.37) in people aged 18-24y, to RR 1.07 (1.01-1.13) aged 85-90y. CONCLUSIONS Men are at greater risk of SAH than women overall, driven by younger adult age groups. Women are at greater risk than men only in the over 75-year age groups. The excess of SAH in young men merits investigation.
Collapse
Affiliation(s)
- Charlotte H Harrison
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| | - Maxime Taquet
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK; Oxford Critical Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Matthew J Rowland
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| |
Collapse
|
15
|
Gao D, Wang H, Wang Y, Ma S, Zou Z. Association between Diet Quality and Stroke among Chinese Adults: Results from China Health and Nutrition Survey 2011. Nutrients 2023; 15:3229. [PMID: 37513647 PMCID: PMC10384737 DOI: 10.3390/nu15143229] [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: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
The low-burden Diet Quality Questionnaire (DQQ) is a standardized tool to collect indicators of dietary adequacy as well as indicators of the protection of health against noncommunicable diseases (NCDs) within the framework of the global diet quality project. Stroke is the leading cause of the cardiovascular disease burden in China, with poor diet being one of the major risk factors. In this study, we aimed to understand the association of several indicators of diet quality derived from the DQQ with stroke among Chinese adults and, further, to examine the gender differences using the 2011 wave of the China Health and Nutrition Survey. Multivariable logistic regression was used to examine the associations of the NCD-Protect score, NCD-Risk score, and global dietary recommendations score (GDR) score with stroke. There were 192 stroke cases (121 in men and 71 in women) of 12,051 adults. The continuous NCD-Risk score was positively associated with stroke in women (odds ratio (OR) = 1.52, 95% confidence interval (CI): 1.13-2.06). When compared with women with an NCD-Risk score of 0 points, those with an NCD-Risk score ≥2 points had a higher risk of stroke (OR = 2.71, 95% CI: 1.35-5.43). In addition, compared with women with a GDR score ≤0, those with a GDR score ≥2 points had lower odds of stroke (OR = 0.42, 95% CI: 0.22-0.77). Poor diet quality, as reflected by the NCD-Risk score, was associated with an increased risk of stroke in Chinese women, but not in men. Our findings provided evidence that an optimal diet quality could be conducive to preventing stroke for Chinese women and suggested a diverse diet characterized by the limited consumption of unhealthy foods, such as red meat, processed meat, sweets, soft drinks (sodas), and packaged ultra-processed salty snacks.
Collapse
Affiliation(s)
- Disi Gao
- School of Health Humanities, Peking University, Beijing 100191, China; (D.G.); (Y.W.)
| | - Huan Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (H.W.); (S.M.)
| | - Yue Wang
- School of Health Humanities, Peking University, Beijing 100191, China; (D.G.); (Y.W.)
| | - Sheng Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (H.W.); (S.M.)
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (H.W.); (S.M.)
| |
Collapse
|
16
|
Deshmukh A, Alharbi NF, Alwadai MM, Katsanos AH, Ng K, van Adel B. Direct MT without tPA in the Second Trimester of Pregnancy with LVO. Neurol India 2023; 71:804-806. [PMID: 37635532 DOI: 10.4103/0028-3886.383835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Aviraj Deshmukh
- Stroke and Interventional Neurologist, Northern Ontario School of Medicine, Health Sciences North, Sudbury, ON, Canada
| | - Naif Faisal Alharbi
- King Fahad General Hospital, Ministry of Health Al Mustashfa Al Am, Al Andalus, Jeddah, Saudi Arabia
| | - Mohammed Mesfer Alwadai
- King Fahad General Hospital, Ministry of Health Al Mustashfa Al Am, Al Andalus, Jeddah, Saudi Arabia
| | - Aris H Katsanos
- Division of Neurology, Hamilton General Hospital, McMaster University, 237 Barton St E, Hamilton, ON L8L 2X2, Canada
| | - Kelvin Ng
- Division of Neurology, Hamilton General Hospital, McMaster University, 237 Barton St E, Hamilton, ON L8L 2X2, Canada
| | - Brian van Adel
- Department of Neurointervention, Hamilton General Hospital, McMaster University, 237 Barton St E, Hamilton, ON L8L 2X2, Canada
| |
Collapse
|
17
|
Datta A, Saha C, Godse P, Sharma M, Sarmah D, Bhattacharya P. Neuroendocrine regulation in stroke. Trends Endocrinol Metab 2023; 34:260-277. [PMID: 36922255 DOI: 10.1016/j.tem.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
The neuroendocrine system, a crosstalk between the central nervous system and endocrine glands, balances and controls hormone secretion and their functions. Neuroendocrine pathways and mechanisms often get dysregulated following stroke, leading to altered hormone secretion and aberrant receptor expression. Dysregulation of the hypothalamus-pituitary-thyroid (HPT) axis and hypothalamus-pituitary-adrenal (HPA) axis often led to severe stroke outcomes. Post-stroke complications such as cognitive impairment, depression, infection etc. are directly or indirectly influenced by the altered neuroendocrine activity that plays a crucial role in stroke vulnerability and susceptibility. Therefore, it is imperative to explore various neurohormonal inter-relationships in regulating stroke, its outcome, and prognosis. Here, we review the biology of different hormones associated with stroke and explore their regulation with a view towards prospective therapeutics.
Collapse
Affiliation(s)
- Aishika Datta
- Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat-382355, India
| | - Chandrima Saha
- Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat-382355, India
| | - Pratiksha Godse
- Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat-382355, India
| | - Muskaan Sharma
- Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat-382355, India
| | - Deepaneeta Sarmah
- Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat-382355, India
| | - Pallab Bhattacharya
- Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat-382355, India.
| |
Collapse
|
18
|
Hemorrhagic Stroke in Pregnancy. Clin Obstet Gynecol 2023; 66:223-230. [PMID: 36044629 DOI: 10.1097/grf.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hemorrhagic stroke carries a high risk of disability and mortality. The obstetrical population is at increased risk. Prompt diagnosis and maternal stabilization with a multidisciplinary approach are the mainstays in management. Computed tomography head is the diagnostic imaging of choice and is considered safe in pregnancy. Fetal status optimization before neurosurgery and delivery should be considered if the fetus is viable or if worsening maternal condition. Obstetric indications guide the mode of delivery. Cesarean delivery may be indicated to reduce increasing intracranial pressure. Neuraxial anesthesia should be considered to minimize catecholamine surges, reduce sedation, and control blood pressures.
Collapse
|
19
|
Chung JY, Lee BN, Kim YS, Shin BS, Kang HG. Sex differences and risk factors in recurrent ischemic stroke. Front Neurol 2023; 14:1028431. [PMID: 36779056 PMCID: PMC9909397 DOI: 10.3389/fneur.2023.1028431] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Recurrent ischemic stroke (RIS) is associated with increased mortality and poor outcomes. Therefore, secondary prevention is critical for reducing the risk of recurrent stroke. Previous studies have found sex differences in risk factors in patients with first-ever stroke; however, the results have been inconsistent for recurrent stroke. Therefore, this study aimed to investigate whether there are significant sex differences in the clinical characteristics and risk factors for recurrent ischemic stroke. Methods We retrospectively studied 787 patients with recurrent ischemic stroke after first-ever stroke confirmation using magnetic resonance imaging (MRI) after visiting a regional tertiary hospital between 2014 and 2020. Demographic characteristics, laboratory findings, and risk factors were compared between the male and female patients. In addition, multivariate logistic regression was performed to identify the independent factors associated with stroke recurrence in male patients. Results Among the 787 patients, 466 (59.2%) were males. Males were younger than females (67.6 vs. 71.9 years). Females had higher rates of hypertension, diabetes mellitus, dyslipidemia, and overweight than those of males. However, the alcohol drinking and smoking rate were significantly higher in males than that in females. There were no statistically significant sex-based differences in the laboratory findings. Among males, hypertension, alcohol drinking, smoking and dyslipidemia was a significant risk factor for ischemic stroke recurrence. Conclusion Hypertension and dyslipidemia were significant risk factors of recurrent ischemic stroke in both genders. Smoking and alcohol drinking were significant risk factors associated with ischemic stroke recurrence in males. Therefore, smoking cessation and alcohol abstinence are recommended after the first stroke to prevent recurrent ischemic stroke especially for males. Diabetes was a significant risk factor of ischemic stroke recurrence in females. More extensive studies are needed to understand the causal relationship of each factors with ischemic stroke recurrence according to sex differences and specification of preventive management is needed.
Collapse
Affiliation(s)
- Ji Yeon Chung
- Department of Neurology, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Bit Na Lee
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Young Seo Kim
- Department of Neurology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Byoung-Soo Shin
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hyun Goo Kang
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea,*Correspondence: Hyun Goo Kang ✉
| |
Collapse
|
20
|
Ospel J, Singh N, Ganesh A, Goyal M. Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care. J Stroke 2023; 25:16-25. [PMID: 36746379 PMCID: PMC9911850 DOI: 10.5853/jos.2022.04077] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023] Open
Abstract
There are several controversies regarding the role of sex and gender in the pathophysiology and management of acute stroke. Assessing the role of sex, i.e., biological/pathophysiological factors, and gender, i.e., sociocultural factors, in isolation is often not possible since they are closely intertwined with each other. To complicate matters even more, the functional baseline status of women and men at the time of their first stroke is substantially different, whereby women have, on average, a poorer reported/ascertained baseline function compared to men. These differences in baseline variables account for a large part of the differences in post-stroke outcomes between women and men. Adjusting for these baseline differences is difficult, and in many cases, residual confounding cannot be excluded. Despite these obstacles, a better understanding of how patient sex and gender differences influence acute stroke and stroke care pathways is crucial to avoid biases and allow us to provide the best possible care for all acute stroke patients. Disregarding patient sex and gender on one hand and ignoring potential confounding factors in sex- and gender-stratified analyses on the other hand, may cause researchers to come to erroneous conclusions and physicians to provide suboptimal care. This review outlines sex- and gender-related factors in key aspects of acute stroke, including acute stroke epidemiology, diagnosis, access to care, treatment outcomes, and post-acute care. We also attempt to outline knowledge gaps, which deserve to be studied in further detail, and practical implications for physicians treating acute stroke patients in their daily practice.
Collapse
Affiliation(s)
- Johanna Ospel
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada,Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Nishita Singh
- Department of Neurology, University of Manitoba, Winnipeg, MB, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada,Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada,Correspondence: Mayank Goyal Departments of Radiology and Clinical Neurosciences, Foothills Medical Center, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada Tel: +1-403-9443379 E-mail:
| |
Collapse
|
21
|
Yan Y, Zhang X, Zhong D, Wang A, Wu S, Wu B. Adenomyosis-Associated Ischemic Stroke: Pathophysiology, Detection and Management. Brain Sci 2022; 12:1410. [PMID: 36291343 PMCID: PMC9599589 DOI: 10.3390/brainsci12101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 03/18/2024] Open
Abstract
Female-specific risk factors for stroke have gradually received attention. The relationship between ischemic stroke and adenomyosis, a benign uterine disorder commonly present in parous women, is underrecognized. We aimed to provide an overview of the epidemiology, pathophysiological mechanisms, clinical characteristics, diagnostic considerations, and potential therapeutic strategies of adenomyosis-associated ischemic stroke. We shared our experience with the diagnosis and management of a patient, and summarized current findings and knowledge gaps of this disease based on previous literature. The relevant studies were searched in English and Chinese databases up to April 2022 using the keywords "ischemic stroke", "cerebral infarction" and "adenomyosis". Then, we provided a narrative review of the retrieved articles. Finally, the data of 32 cases were analyzed. We found that increased levels of carbohydrate antigen 125 and D-dimer and decreased level of hemoglobin are biomarkers of adenomyosis-associated ischemic stroke. In addition, hypercoagulability might be a key mechanism leading to thromboembolism in the cerebrovascular system. Additional studies are needed to find optimal prevention strategies for the disease. A better understanding of this "rare" pathogenesis of ischemic stroke may inform a more precise diagnosis and effective prevention strategy in middle-aged women with embolic stroke of undetermined source.
Collapse
Affiliation(s)
| | | | | | | | | | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
22
|
Yang B, Glenn AJ, Liu Q, Madsen T, Allison MA, Shikany JM, Manson JE, Chan KHK, Wu WC, Li J, Liu S, Lo K. Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women's Health Initiative and a Network Meta-Analysis of Prospective Studies. Nutrients 2022; 14:4226. [PMID: 36296910 PMCID: PMC9609206 DOI: 10.3390/nu14204226] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/05/2022] Open
Abstract
Much remains unknown about the role of added sugar in relation to cardiovascular disease (CVD) and the relative contributions of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) to CVD risk. Among the 109,034 women who participated in Women's Health Initiative, we assessed average intakes of added sugar, SSB and ASB, and conducted Cox regression to estimate the hazard ratios (HRs) and their 95% confidence intervals for CVD risk. The consistency of findings was compared to a network meta-analysis of all available cohorts. During an average of 17.4 years of follow-up, 11,597 cases of total CVD (nonfatal myocardial infarction, coronary heart disease (CHD) death, stroke, coronary revascularization, and/or incident heart failure) were confirmed. Added sugar as % energy intake daily (%EAS) at ≥15.0% was positively associated with total CVD (HR = 1.08 [1.01, 1.15]) and CHD (HR = 1.20 [1.09, 1.32]). There was also a higher risk of total CVD associated with ≥1 serving of SSB intake per day (HR = 1.29 [1.17, 1.42]), CHD (1.35 [1.16, 1.57]), and total stroke (1.30 [1.10, 1.53]). Similarly, ASB intake was associated with an increased risk of CVD (1.14 [1.03, 1.26]) and stroke (1.24 [1.04, 1.48]). According to the network meta-analysis, there was a large amount of heterogeneity across studies, showing no consistent pattern implicating added sugar, ASB, or SSB in CVD outcomes. A diet containing %EAS ≥15.0% and consuming ≥1 serving of SSB or ASB may be associated with a higher CVD incidence. The relative contribution of added sugar, SSB, and ASB to CVD risk warrants further investigation.
Collapse
Affiliation(s)
- Bo Yang
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Andrea J. Glenn
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Qing Liu
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Tracy Madsen
- Department of Emergency Medicine, Brown University, Providence, RI 02912, USA
| | - Matthew A. Allison
- Department of Family Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - James M. Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Kei Hang Katie Chan
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
- Department of Biomedical Sciences, Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China
| | - Wen-Chih Wu
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Jie Li
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Simin Liu
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Kenneth Lo
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| |
Collapse
|
23
|
Reddy V, Wurtz M, Patel SH, McCarthy M, Raval AP. Oral contraceptives and stroke: Foes or friends. Front Neuroendocrinol 2022; 67:101016. [PMID: 35870646 DOI: 10.1016/j.yfrne.2022.101016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023]
Abstract
Incidents of strokes are increased in young women relative to young men, suggesting that oral contraceptive (OC) use is one of the causes of stroke among young women. Long-term exposures to the varying combinations of estrogen and progestogen found in OCs affect blood clotting, lipid and lipoprotein metabolism, endothelial function, and de novo synthesis of neurosteroids, especially brain-derived 17β-estradiol. The latter is essential for neuroprotection, memory, sexual differentiation, synaptic transmission, and behavior. Deleterious effects of OCs may be exacerbated due to comorbidities like polycystic ovary syndrome, sickle cell anemia, COVID-19, exposures to endocrine disrupting chemicals, and conventional or electronic cigarette smoking. The goal of the current review is to revisit the available literature regarding the impact of OC use on stroke, to explain possible underlying mechanisms, and to identify gaps in our understanding to promote future research to reduce and cure stroke in OC users.
Collapse
Affiliation(s)
- Varun Reddy
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA; Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA
| | - Megan Wurtz
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA; Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA
| | - Shahil H Patel
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA; Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA
| | - Micheline McCarthy
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA
| | - Ami P Raval
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA; Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami Florida 33136, USA; Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.
| |
Collapse
|
24
|
Farland LV, Degnan WJ, Bell ML, Kasner SE, Liberman AL, Shah DK, Rexrode KM, Missmer SA. Laparoscopically Confirmed Endometriosis and Risk of Incident Stroke: A Prospective Cohort Study. Stroke 2022; 53:3116-3122. [PMID: 35861076 PMCID: PMC9529799 DOI: 10.1161/strokeaha.122.039250] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior research suggests that women with endometriosis are at greater risk of coronary heart disease. Therefore, our objective was to prospectively investigate the association between laparoscopically confirmed endometriosis and risk of incident stroke during 28 years of follow-up. METHODS Participants in the NHSII cohort study (Nurses' Health Study II) were followed from 1989 when they were between the ages of 25 to 42 until 2017 for development of incident stroke (ischemic and hemorrhagic). Cox proportional hazard models were used to calculate hazard ratios and 95% CI, with adjustment for potential confounding variables (alcohol intake, body mass index at age 18, current body mass index, age at menarche, menstrual cycle pattern in adolescence, current menstrual cycle pattern, parity, oral contraceptive use history, smoking history, diet quality, physical activity, NSAID use, aspirin use, race/ethnicity, and income). We estimated the proportion of the total association mediated by history of hypertension, hypercholesterolemia, hysterectomy/oophorectomy, and hormone therapy. We also tested for effect modification by age (<50, ≥50 years), infertility history, body mass index (<25, ≥25 kg/m2), and menopausal status. RESULTS We documented 893 incident cases of stroke during 2 770 152 person-years of follow-up. Women with laparoscopically confirmed endometriosis had a 34% greater risk of stroke in multivariable-adjusted models (hazard ratio, 1.34 [95% CI, 1.10-1.62]), compared to those without a history of endometriosis. Of the total association of endometriosis with risk of stroke, the largest proportion was attributed to hysterectomy/oophorectomy (39% mediated [95% CI, 14%-71%]) and hormone therapy (16% mediated [95% CI, 5%-40%]). We observed no differences in the relationship between endometriosis and stroke by age, infertility history, body mass index, or menopausal status. CONCLUSIONS We observed that women with endometriosis were at elevated risk of stroke. Women and their health care providers should be aware of endometriosis history, maximize primary cardiovascular prevention, and discuss signs and symptoms of cardiovascular disease.
Collapse
Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics (L.V.F., W.J.D., M.L.B.), University of Arizona, Tucson
- Mel and Enid Zuckerman College of Public Health, and Department of Obstetrics and Gynecology, College of Medicine-Tucson (L.V.F.), University of Arizona, Tucson
| | - William J Degnan
- Department of Epidemiology and Biostatistics (L.V.F., W.J.D., M.L.B.), University of Arizona, Tucson
- Department of Community, Environment, and Policy (W.J.D.), University of Arizona, Tucson
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics (L.V.F., W.J.D., M.L.B.), University of Arizona, Tucson
| | - Scott E Kasner
- Department of Neurology (S.E.K.), University of Pennsylvania, Philadelphia
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine (A.L.L.)
| | - Divya K Shah
- Department of Obstetrics and Gynecology (D.K.S.), University of Pennsylvania, Philadelphia
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (K.M.R.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (K.M.R., S.A.M.)
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (K.M.R., S.A.M.)
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.)
| |
Collapse
|
25
|
Sullivan-Baca E, Modiano YA, Choudhury TK, Tierney SM, Kellogg E. Promoting gender-informed mentorship in neuropsychology: Reflections and suggestions from early career women. J Clin Exp Neuropsychol 2022; 44:398-408. [PMID: 35906731 DOI: 10.1080/13803395.2022.2107184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION While women now represent a majority of neuropsychology trainees, men remain prominent in senior positions. As such, female mentees are often paired with senior male mentors, a practice referred to as "cross-gender mentorship." Although cross-gender mentoring dynamics have inherent potential for missteps due to implicit power differentials, when approached through a gender-informed lens, they can be optimized and lead to personal and professional growth for women neuropsychologists. The present article provides a framework for promoting gender-informed mentorship by cataloging first-hand accounts of early career women and discussing resultant lessons and concrete suggestions for mentorship. METHOD The authors provide first-hand accounts of experiences related to cross-gender mentorship across a variety of settings and professional contexts. From these accounts, the following steps offer a framework to encourage effective mentorship: 1) Set appropriate expectations and boundaries, 2) Address challenging clinical interactions through a gender-informed lens, 3) Foster personal and professional development, 4) Understand the intersection between gender and multicultural traits, 5) Advocate for advancement of women in the field, and 6) Maintain knowledge of women's issues. CONCLUSIONS Providing effective mentorship for women in neuropsychology is crucial to promote ascension of women to leadership positions and close long-established disparities in the field. The authors hope that our shared experiences can serve as useful tools for both women trainees and their mentors as they embark on mentoring relationships. Practically, we envision that mentoring dyads may discuss this article at the outset of their relationship to understand potential challenges and collaboratively establish a groundwork for optimal mentoring.
Collapse
Affiliation(s)
| | - Yosefa A Modiano
- Neurosciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Tabina K Choudhury
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Mental Health Care Line, Houston, TX, USA
| | - Savanna M Tierney
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Mental Health Care Line, Houston, TX, USA
| | - Emily Kellogg
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Mental Health Care Line, Houston, TX, USA.,Neurology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
26
|
Liang C, Chung HF, Dobson AJ, Hayashi K, van der Schouw YT, Kuh D, Hardy R, Derby CA, El Khoudary SR, Janssen I, Sandin S, Weiderpass E, Mishra GD. Infertility, recurrent pregnancy loss, and risk of stroke: pooled analysis of individual patient data of 618 851 women. BMJ 2022; 377:e070603. [PMID: 35732311 PMCID: PMC9214882 DOI: 10.1136/bmj-2022-070603] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the associations of infertility, recurrent miscarriage, and stillbirth with the risk of first non-fatal and fatal stroke, further stratified by stroke subtypes. DESIGN Individual participant pooled analysis of eight prospective cohort studies. SETTING Cohort studies across seven countries (Australia, China, Japan, Netherlands, Sweden, the United Kingdom, and the United States) participating in the InterLACE (International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events) consortium, which was established in June 2012. PARTICIPANTS 618 851 women aged 32.0-73.0 years at baseline with data on infertility, miscarriage, or stillbirth, at least one outcome event (non-fatal or fatal stroke), and information on covariates were included; 93 119 women were excluded. Of the participants, 275 863 had data on non-fatal and fatal stroke, 54 716 only had data on non-fatal stroke, and 288 272 only had data on fatal stroke. MAIN OUTCOME AND MEASURES Non-fatal strokes were identified through self-reported questionnaires, linked hospital data, or national patient registers. Fatal strokes were identified through death registry data. RESULTS The median follow-up for non-fatal stroke and fatal stroke was 13.0 years (interquartile range 12.0-14.0) and 9.4 years (7.6-13.0), respectively. A first non-fatal stroke was experienced by 9265 (2.8%) women and 4003 (0.7%) experienced a fatal stroke. Hazard ratios for non-fatal or fatal stroke were stratified by hypertension and adjusted for race or ethnicity, body mass index, smoking status, education level, and study. Infertility was associated with an increased risk of non-fatal stroke (hazard ratio 1.14, 95% confidence interval 1.08 to 1.20). Recurrent miscarriage (at least three) was associated with higher risk of non-fatal and fatal stroke (1.35, 1.27 to 1.44, and 1.82, 1.58 to 2.10, respectively). Women with stillbirth were at 31% higher risk of non-fatal stroke (1.31, 1.10 to 1.57) and women with recurrent stillbirth were at 26% higher risk of fatal stroke (1.26, 1.15 to 1.39). The increased risk of stroke (non-fatal or fatal) associated with infertility or recurrent stillbirths was mainly driven by a single stroke subtype (non-fatal ischaemic stroke and fatal haemorrhagic stroke), while the increased risk of stroke (non-fatal or fatal) associated with recurrent miscarriages was driven by both subtypes. CONCLUSION A history of recurrent miscarriages and death or loss of a baby before or during birth could be considered a female specific risk factor for stroke, with differences in risk according to stroke subtypes. These findings could contribute to improved monitoring and stroke prevention for women with such a history.
Collapse
Affiliation(s)
- Chen Liang
- University of Queensland, School of Public Health, Queensland, Australia
| | - Hsin-Fang Chung
- University of Queensland, School of Public Health, Queensland, Australia
| | - Annette J Dobson
- University of Queensland, School of Public Health, Queensland, Australia
| | | | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Carol A Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Gita D Mishra
- University of Queensland, School of Public Health, Queensland, Australia
| |
Collapse
|
27
|
Bays HE, Kulkarni A, German C, Satish P, Iluyomade A, Dudum R, Thakkar A, Rifai MA, Mehta A, Thobani A, Al-Saiegh Y, Nelson AJ, Sheth S, Toth PP. Ten things to know about ten cardiovascular disease risk factors - 2022. Am J Prev Cardiol 2022; 10:100342. [PMID: 35517870 PMCID: PMC9061634 DOI: 10.1016/j.ajpc.2022.100342] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
The American Society for Preventive Cardiology (ASPC) "Ten things to know about ten cardiovascular disease risk factors - 2022" is a summary document regarding cardiovascular disease (CVD) risk factors. This 2022 update provides summary tables of ten things to know about 10 CVD risk factors and builds upon the foundation of prior annual versions of "Ten things to know about ten cardiovascular disease risk factors" published since 2020. This 2022 version provides the perspective of ASPC members and includes updated sentinel references (i.e., applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful dietary intake, physical inactivity, dyslipidemia, pre-diabetes/diabetes, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis (with smoking as a potential contributor to thrombosis), kidney dysfunction and genetics/familial hypercholesterolemia. Other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the ASPC "Ten things to know about ten cardiovascular disease risk factors - 2022" to provide a tabular overview of things to know about ten of the most common CVD risk factors applicable to preventive cardiology and provide ready access to applicable guidelines and sentinel reviews.
Collapse
Affiliation(s)
- Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville KY 40213
| | - Anandita Kulkarni
- Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701
| | - Charles German
- University of Chicago, Section of Cardiology, 5841 South Maryland Ave, MC 6080, Chicago, IL 60637
| | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA 77030
| | - Adedapo Iluyomade
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL 33176
| | - Ramzi Dudum
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Aarti Thakkar
- Osler Medicine Program, Johns Hopkins Hospital, Baltimore MD
| | | | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Aneesha Thobani
- Emory University School of Medicine | Department of Cardiology, 101 Woodruff Circle, WMB 2125, Atlanta, GA 30322
| | - Yousif Al-Saiegh
- Lankenau Medical Center – Mainline Health, Department of Cardiovascular Disease, 100 E Lancaster Ave, Wynnewood, PA 19096
| | - Adam J Nelson
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX 75093
| | - Samip Sheth
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
28
|
Lai PMR, Jimenez M, Du R, Rexrode K. Association of Reproductive Life Span and Age at Menopause With the Risk of Aneurysmal Subarachnoid Hemorrhage. Neurology 2022; 98:e2005-e2012. [PMID: 35351793 PMCID: PMC9162048 DOI: 10.1212/wnl.0000000000200222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Subarachnoid hemorrhage from cerebral aneurysm remains a devastating disease with high mortality and morbidity. Cerebral aneurysm and its rupture are more prevalent in postmenopausal women and have been postulated to be hormonally influenced. The goal of this study was to investigate the associations of female-specific factors, including reproductive life span, age at menarche, and age at menopause, with the incidence of aneurysmal subarachnoid hemorrhage (aSAH) in women. METHODS Participants in the Nurses' Health Study were followed up from 1980 or the time of reaching menopause until 2018. Only women with natural menopause or surgical menopause due to bilateral oophorectomy were included. Reproductive life span was defined by subtracting the age at menarche from the age at menopause. Multivariable-stratified proportional hazards models were used to study reproductive life span, age at menarche, and age at menopause with the incidence of aSAH. Multivariable models were adjusted for age, race, smoking, hysterectomy, hypertension, hyperlipidemia, body mass index, hormone therapy use, oral contraceptive use, and parity. RESULTS A total of 97,398 postmenopausal women with reproductive life span data were included; 138 participants developed aSAH, which was confirmed on medical record review by a physician. A shorter reproductive life span (≤35 years) was associated with a 2-fold higher incidence of aSAH after multivariable adjustment (hazard ratio [HR] 2.0 [95% CI 1.4-2.8]). Early age at menopause (age <45 years) was similarly associated with a higher risk of aSAH (HR 2.1 [95% CI 1.4-3.1]), but age at menarche was not. Use of oral contraceptives and postmenopausal hormone therapy was not associated with the incidence of aSAH. DISCUSSION An earlier age at menopause and a shorter reproductive life span duration (≤35 years) were associated with a higher risk of incident aSAH in women. No associations were noted for age at menarche, parity, oral contraceptive use, or postmenopausal therapy use.
Collapse
Affiliation(s)
- Pui Man Rosalind Lai
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
| | - Monik Jimenez
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
| | - Rose Du
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
| | - Kathryn Rexrode
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
| |
Collapse
|
29
|
Cai Y, Liu Z, Jia C, Zhao J, Chai S, Li Z, Xu C, Zhang T, Ma Y, Ma C, Chen X, Jiang P, Zhao W, Chen J, Xiong N. Comparison of Sex Differences in Outcomes of Patients With Aneurysmal Subarachnoid Hemorrhage: A Single-Center Retrospective Study. Front Neurol 2022; 13:853513. [PMID: 35572942 PMCID: PMC9103686 DOI: 10.3389/fneur.2022.853513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/09/2022] [Indexed: 01/29/2023] Open
Abstract
Background Sex differences in the outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain controversial. The aim of this study was to evaluate sex differences in the outcomes of patients with aSAH. Method This study retrospectively analyzed the clinical data of consecutive patients with aSAH, admitted to the Department of Neurosurgery, Wuhan University Zhongnan Hospital, from May 1, 2020 to December 31, 2020. The modified Rankin Scale (mRS) score was used to evaluate the prognosis of patients at discharge. Outcome indicators included cerebral ischemia, hydrocephalus, and mRS ≥ 2 at discharge. Results The majority (65%) of the 287 patients with aSAH included in the study were females. Patients were divided into female (n = 184) and male (n = 99) groups; the female patients were significantly older than the male patients (61.3 ± 8.5 years vs. 60.0 ± 8.5 years, p = 0.032). The incidence of comorbidities (hypertension, diabetes, and heart disease) was higher in the female group than in the male group, but the difference was not statistically significant. Although more female patients than male patients underwent endovascular treatment, there was no statistical difference in the treatment approach between the two groups. Comparison of post-operative complications and mRS scores at discharge revealed that the rate of cerebral ischemia and mRS ≥ 2 at discharge were significantly higher among female patients than among male patients. Moreover, this difference persisted after propensity adjustment for age and treatment approach. Analysis of risk factors for poor prognosis at discharge in both pre- and post-adjustment patients revealed cerebral ischemia and high mFisher score (mFisher = 3/4) to be independent risk factors. Conclusion Female patients with aSAH have a worse prognosis than male patients, and this difference may be because women are more susceptible to cerebral ischemia.
Collapse
|
30
|
Gámez Santiago AB, Martínez Cáceres CM, Hernández-Morante JJ. Effectiveness of Intensively Applied Mirror Therapy in Older Patients with Post-Stroke Hemiplegia: A Preliminary Trial. Eur Neurol 2022; 85:291-299. [PMID: 35378544 DOI: 10.1159/000522413] [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: 10/18/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The present work was carried out to determine the effectiveness of neuromuscular stimulation triggered by mirror therapy (MT) in older patients with post-stroke hemiplegia by two different intervention protocols, either intensively or spaced. METHODS A preliminary trial conducted on Spanish rehabilitation centres was conducted. Forty older patients (>70 years) with diagnosed post-stroke hemiplegia were randomly distributed to intensive intervention group (5 times/week for 6 weeks) or to spaced intervention group (3 times/week for 10 weeks), which underwent a similar number of MT sessions (n = 30). Muscle strength and activity were measured at baseline and at the end of treatment. Functional ability was also evaluated. RESULTS Although both interventions improved muscle activity parameters, intensive MT showed a significantly and statistically higher intervention effect on electromyographic activity (p < 0.001) and muscle strength (p < 0.001) than the spaced over time protocol. Attending to the Barthel Index scores, the effect on functionality was also greater in the intensive therapy group (p < 0.001), although the functional improvement measured by the Fugl-Meyer test was similar (p = 0.235). The effect of the interventions was independent of age and clinical antecedents. CONCLUSION Intensive MT appears to be more effective than a more spaced over time therapy; therefore, at least in the older adults, this treatment protocol should be recommended in the post-stroke recovery of these patients. Further studies will confirm with certainty whether this treatment is the most suitable guideline for to treat these patients.
Collapse
|
31
|
Basu E, Salehi Omran S, Kamel H, Parikh NS. Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack. Eur Stroke J 2022; 6:367-373. [PMID: 35342804 DOI: 10.1177/23969873211058568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022] Open
Abstract
Background Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients and methods We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence. Results Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%-6.85%) compared to men (5.67%; 95% CI, 4.83%-6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80-1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42-1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk. Discussion and Conclusion Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.
Collapse
Affiliation(s)
- Elora Basu
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | | | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
32
|
Lucà F, Abrignani MG, Parrini I, Di Fusco SA, Giubilato S, Rao CM, Piccioni L, Cipolletta L, Passaretti B, Giallauria F, Leone A, Francese GM, Riccio C, Gelsomino S, Colivicchi F, Gulizia MM. Update on Management of Cardiovascular Diseases in Women. J Clin Med 2022; 11:1176. [PMID: 35268267 PMCID: PMC8911459 DOI: 10.3390/jcm11051176] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.
Collapse
Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Big Metropolitan Hospital, 89129 Reggio Calabria, Italy;
| | | | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I Hospital, 10128 Turin, Italy;
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
| | - Simona Giubilato
- Division of Cardiology, Cannizzaro Hospital, 95121 Catania, Italy;
| | | | - Laura Piccioni
- Italy Cardiology Department, “G. Mazzini” Hospital, 64100 Teramo, Italy;
| | - Laura Cipolletta
- Division of Cardiology, Department of Cardiovascular Sciences, University of Ancona, 60126 Ancona, Italy;
| | - Bruno Passaretti
- Rehabilitation Cardiology Department, Humanitas Gavazzeni, 24125 Bergamo, Italy;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Angelo Leone
- Cardiology Division, Annunziata Hospital Cosenza, 87100 Cosenza, Italy;
| | | | - Carmine Riccio
- Division of Clinical Cardiology, ‘Sant’Anna e San Sebastiano’ Hospital, 81100 Caserta, Italy;
| | - Sandro Gelsomino
- Cardio Thoracic Department, Maastricht University, 6202 AZ Maastricht, The Netherlands;
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
| | | |
Collapse
|
33
|
Abstract
Women face a disproportionate burden of stroke mortality and disability. Biologic sex and sociocultural gender both contribute to differences in stroke risk factors, assessment, treatment, and outcomes. There are substantial differences in the strength of association of stroke risk factors, as well as female-specific risk factors. Moreover, there are differences in presentation, response to treatment, and stroke outcomes in women. This review outlines current knowledge of impact of sex and gender on stroke, as well as delineates research gaps and areas for future inquiry.
Collapse
Affiliation(s)
- Kathryn M. Rexrode
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Tracy E. Madsen
- Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence RI
| | - Amy Y. X. Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cheryl Carcel
- Neurology Program, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Judith H. Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Eliza C. Miller
- Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| |
Collapse
|
34
|
Liang C, Chung HF, Dobson AJ, Mishra GD. Infertility, Miscarriage, Stillbirth, and the Risk of Stroke Among Women: A Systematic Review and Meta-Analysis. Stroke 2022; 53:328-337. [PMID: 34983235 DOI: 10.1161/strokeaha.121.036271] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is one of the leading causes of mortality, and women are impacted more from stroke than men in terms of their absolute number and in having worse outcomes. A growing number of studies have explored the association between pregnancy complications, pregnancy outcomes, and stroke. Limited studies, however, have investigated links involving infertility, miscarriage, and stillbirth, which could plausibly be associated via a background of endocrine conditions, endothelial dysfunction, and chronic systematic inflammation. This review aims to summarize current evidence and provide up-to-date information on the associations of infertility, miscarriage, and stillbirth, with stroke incidence. METHODS A comprehensive literature search was conducted for cohort and case-control studies on associations between infertility, miscarriage, stillbirth, and stroke up to September 26, 2020. Seven databases were searched: PubMed, Embase, Cochrane, CINIHL, PsyclNFO, Wanfang, and CNKI. Random-effects models were used to estimate the pooled hazard ratios (HRs) and 95% CIs. RESULTS Sixteen cohort studies and 2 case-control studies enrolling 7 808 521 women were included in this meta-analysis. Women who had experienced miscarriage or stillbirth were at higher risk of stroke (miscarriage: HR, 1.07 [95% CI, 1.00-1.14]; stillbirth: HR, 1.38 [95% CI, 1.11-1.71]) than other women. The HRs of stroke for each additional miscarriage and stillbirth were 1.13 (95% CI, 0.96-1.33) and 1.25 (95% CI, 1.06-1.49), respectively. In subgroup analysis, increased risk of stroke was associated with repeated miscarriages and stillbirths (miscarriage ≥3: HR, 1.42 [95% CI, 1.05-1.90]; stillbirth ≥2: HR, 1.14 [95% CI, 1.04-1.26]). Associations between infertility and stroke were inconsistent and inconclusive (HR, 1.07 [95% CI, 0.87-1.32]). CONCLUSIONS Miscarriage and stillbirth are associated with increased risk of stroke among women, which could be used as a contributing risk factor to help identify women at higher risk of stroke.
Collapse
Affiliation(s)
- Chen Liang
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Hsin-Fang Chung
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Annette J Dobson
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Gita D Mishra
- The University of Queensland, School of Public Health, Brisbane, Australia
| |
Collapse
|
35
|
van der Weerd N, van Os HJA, Ali M, Schoones JW, van den Maagdenberg AMJM, Kruyt ND, Siegerink B, Wermer MJH. Sex Differences in Hemostatic Factors in Patients With Ischemic Stroke and the Relation With Migraine-A Systematic Review. Front Cell Neurosci 2021; 15:711604. [PMID: 34858141 PMCID: PMC8632366 DOI: 10.3389/fncel.2021.711604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Women are more affected by stroke than men. This might, in part, be explained by sex differences in stroke pathophysiology. The hemostasis system is influenced by sex hormones and associated with female risk factors for stroke, such as migraine. Aim: To systematically review possible sex differences in hemostatic related factors in patients with ischemic stroke in general, and the influence of migraine on these factors in women with ischemic stroke. Results: We included 24 studies with data on sex differences of hemostatic factors in 7247 patients with ischemic stroke (mean age 57–72 years, 27–57% women) and 25 hemostatic related factors. Levels of several factors were higher in women compared with men; FVII:C (116% ± 30% vs. 104% ± 30%), FXI (0.14 UI/mL higher in women), PAI-1 (125.35 ± 49.37 vs. 96.67 ± 38.90 ng/mL), D-dimer (1.25 ± 0.31 vs. 0.95 ± 0.24 μg/mL), and aPS (18.7% vs. 12.0% positive). In contrast, protein-S (86.2% ± 23.0% vs. 104.7% ± 19.8% antigen) and P-selectin (48.9 ± 14.4 vs. 79.1 ± 66.7 pg/mL) were higher in men. Most factors were investigated in single studies, at different time points after stroke, and in different stroke subtypes. Only one small study reported data on migraine and hemostatic factors in women with ischemic stroke. No differences in fibrinogen, D-dimer, t-PA, and PAI-1 levels were found between women with and without migraine. Conclusion: Our systematic review suggests that sex differences exist in the activation of the hemostatic system in ischemic stroke. Women seem to lean more toward increased levels of procoagulant factors whereas men exhibit increased levels of coagulation inhibitors. To obtain better insight in sex-related differences in hemostatic factors, additional studies are needed to confirm these findings with special attention for different stroke phases, stroke subtypes, and not in the least women specific risk factors, such as migraine.
Collapse
Affiliation(s)
- Nelleke van der Weerd
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - Hine J A van Os
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Mariam Ali
- Department of Neurology, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Centre, Leiden, Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.,Department of Neurology, University Neurovascular Centre, The Hague, Netherlands
| | - Bob Siegerink
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.,Department of Neurology, University Neurovascular Centre, The Hague, Netherlands
| |
Collapse
|
36
|
Kurmann L, Okoniewski M, Dubey RK. Estradiol Inhibits Human Brain Vascular Pericyte Migration Activity: A Functional and Transcriptomic Analysis. Cells 2021; 10:cells10092314. [PMID: 34571963 PMCID: PMC8472363 DOI: 10.3390/cells10092314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022] Open
Abstract
Stroke is the third leading cause of mortality in women and it kills twice as many women as breast cancer. A key role in the pathophysiology of stroke plays the disruption of the blood–brain barrier (BBB) within the neurovascular unit. While estrogen induces vascular protective actions, its influence on stroke remains unclear. Moreover, experiments assessing its impact on endothelial cells to induce barrier integrity are non-conclusive. Since pericytes play an active role in regulating BBB integrity and function, we hypothesize that estradiol may influence BBB by regulating their activity. In this study using human brain vascular pericytes (HBVPs) we investigated the impact of estradiol on key pericyte functions known to influence BBB integrity. HBVPs expressed estrogen receptors (ER-α, ER-β and GPER) and treatment with estradiol (10 nM) inhibited basal cell migration but not proliferation. Since pericyte migration is a hallmark for BBB disruption following injury, infection and inflammation, we investigated the effects of estradiol on TNFα-induced PC migration. Importantly, estradiol prevented TNFα-induced pericyte migration and this effect was mimicked by PPT (ER-α agonist) and DPN (ER-β agonist), but not by G1 (GPR30 agonist). The modulatory effects of estradiol were abrogated by MPP and PHTPP, selective ER-α and ER-β antagonists, respectively, confirming the role of ER-α and ER-β in mediating the anti-migratory actions of estrogen. To delineate the intracellular mechanisms mediating the inhibitory actions of estradiol on PC migration, we investigated the role of AKT and MAPK activation. While estradiol consistently reduced the TNFα-induced MAPK and Akt phosphorylation, only the inhibition of MAPK, but not Akt, significantly abrogated the migratory actions of TNFα. In transendothelial electrical resistance measurements, estradiol induced barrier function (TEER) in human brain microvascular endothelial cells co-cultured with pericytes, but not in HBMECs cultured alone. Importantly, transcriptomics analysis of genes modulated by estradiol in pericytes showed downregulation of genes known to increase cell migration and upregulation of genes known to inhibit cell migration. Taken together, our findings provide the first evidence that estradiol modulates pericyte activity and thereby improves endothelial integrity.
Collapse
Affiliation(s)
- Lisa Kurmann
- Department of Reproductive Endocrinology, University Hospital Zurich, 8952 Schlieren, Switzerland;
| | | | - Raghvendra K. Dubey
- Department of Reproductive Endocrinology, University Hospital Zurich, 8952 Schlieren, Switzerland;
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Correspondence:
| |
Collapse
|
37
|
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: 11] [Impact Index Per Article: 3.7] [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.
Collapse
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
| |
Collapse
|
38
|
Crump C, Sundquist J, Sundquist K. Preterm Delivery and Long-Term Risk of Stroke in Women: A National Cohort and Cosibling Study. Circulation 2021; 143:2032-2044. [PMID: 33966449 DOI: 10.1161/circulationaha.120.052268] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke has a high burden of disease in women, and adverse pregnancy outcomes have been identified as important risk factors for stroke later in life. However, long-term risks of stroke associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment and stroke prevention in women. METHODS A national cohort study was conducted of all 2 188 043 women with a singleton delivery in Sweden in 1973 through 2015 who were followed up for stroke identified from nationwide diagnoses through 2015. Cox regression was used to compute adjusted hazard ratios (aHRs) for stroke associated with pregnancy duration, and cosibling analyses assessed for confounding by shared familial (genetic or environmental) factors. RESULTS In 48.0 million person-years of follow-up, 36 372 (1.7%) women were diagnosed with stroke. In the 10 years after delivery, the aHR for stroke associated with preterm delivery (gestational age <37 weeks) was 1.61 (95% CI, 1.45-1.79) and further stratified was 2.81 (95% CI, 2.02-3.91) for extremely preterm (22-27 weeks), 2.07 (95% CI, 1.74-2.46) for very preterm (28-33 weeks), 1.38 (95% CI, 1.21-1.57) for late preterm (34-36 weeks), and 1.15 (95% CI, 1.06-1.24) for early term (37-38 weeks), compared with full-term (39-41 weeks) delivery. These risks remained similarly elevated at 10 to 19 years after delivery (preterm versus full-term: aHR, 1.61 [95% CI, 1.50-1.74]) and then declined but remained significantly elevated at 20 to 29 years (aHR, 1.35 [95% CI, 1.28-1.44]) and 30 to 43 years (aHR, 1.35 [95% CI, 1.27-1.42]). Preterm delivery was associated with both hemorrhagic (aHR, 1.31 [95% CI, 1.25-1.38]) and ischemic (aHR, 1.54 [95% CI, 1.47-1.61]) stroke across the entire follow-up period (up to 43 years). These findings were not explained by shared determinants of preterm delivery and stroke within families. Stroke risks were higher after either spontaneous or medically indicated preterm delivery, and recurrent preterm delivery was associated with further increases in risk. CONCLUSIONS In this large national cohort, preterm delivery was associated with higher future risks of both hemorrhagic and ischemic stroke. These associations remained substantially elevated at least 40 years later, and were largely independent of covariates and shared familial factors. Preterm delivery should be recognized as a risk factor for stroke in women across the life course.
Collapse
Affiliation(s)
- Casey Crump
- Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York (C.C., J.S., K.S.)
| | - Jan Sundquist
- Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York (C.C., J.S., K.S.).,Center for Primary Health Care Research, Lund University, Malmö, Sweden (J.S., K.S.)
| | - Kristina Sundquist
- Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York (C.C., J.S., K.S.).,Center for Primary Health Care Research, Lund University, Malmö, Sweden (J.S., K.S.)
| |
Collapse
|
39
|
Liver Fibrosis is Associated with Ischemic Stroke Risk in Women but not Men: The REGARDS Study. J Stroke Cerebrovasc Dis 2021; 30:105788. [PMID: 33866274 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105788] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease is inconsistently associated with ischemic stroke, with one study suggesting an association in women and not men. The relative importance of liver fibrosis, as opposed to fatty liver, for cardiovascular risk is increasingly appreciated. We hypothesized that advanced liver fibrosis is associated with incident ischemic stroke risk, and especially in women. METHODS We performed a case-cohort study in the REasons for Geographic and Racial Differences in Stroke cohort. Black and white individuals aged 45 and older were recruited between 2003 and 2007 and followed for ischemic stroke. The Fibrosis-4 (FIB-4) score and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS) were calculated using baseline data for stroke cases and a cohort random sample; advanced liver fibrosis was classified using validated cutoffs. Cox proportional hazards models were used to estimate hazard ratios (HR) of stroke after adjusting for potential confounders. Sex differences were assessed. RESULTS There were 572 incident ischemic strokes (285 in women) over 5.4 (SD, 2.2) years. Advanced liver fibrosis was not significantly associated with ischemic stroke overall using the FIB-4 (HR 1.44; 95% CI 0.49-4.28) or NFS (HR 1.76; 95% CI 0.67-4.61). However, liver fibrosis was associated with stroke in women (HR 3.51; 95% CI 1.00-12.34) but not men (HR 0.70, 95% CI 0.16-3.16) (P = 0.098 for interaction) when using FIB-4. A similar but non-significant sex difference was seen for NFS. CONCLUSION Advanced liver fibrosis may be associated with a higher risk of ischemic stroke in women but not men.
Collapse
|
40
|
Mizuma A, Yenari MA. Clinical perspectives on ischemic stroke. Exp Neurol 2021; 338:113599. [PMID: 33440204 PMCID: PMC7904589 DOI: 10.1016/j.expneurol.2021.113599] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/13/2020] [Accepted: 01/07/2021] [Indexed: 01/01/2023]
Abstract
Treatments for acute stroke have improved over the past years, but have largely been limited to revascularization strategies. The topic of neuroprotection, or strategies to limit brain tissue damage or even reverse it, has remained elusive. Thus, the clinical mainstays for stroke management have focused on prevention. The lack of clinical translation of neuroprotective therapies which have shown promise in the laboratory may, in part, be due to a historic inattention to comorbidities suffered by a majority of stroke patients. With the advent of more stroke models that include one or more relevant comorbidities, it may be possible to identify effective treatments that may translate into new treatments at the clinical level. In the meantime, we review comorbidities in stroke patients, modification of stroke risk factors and available acute stroke treatments in the clinic.
Collapse
Affiliation(s)
- Atsushi Mizuma
- Department of Neurology, University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Neurology, Tokai University School of Medicine, Isehara, Japan
| | - Midori A Yenari
- Department of Neurology, University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| |
Collapse
|
41
|
How I treat unexplained arterial thrombosis. Blood 2021; 136:1487-1498. [PMID: 32584955 DOI: 10.1182/blood.2019000820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/22/2020] [Indexed: 12/27/2022] Open
Abstract
Most arterial thrombotic events have a clear atherosclerotic or cardioembolic etiology, but hematologists are frequently asked to assist in the diagnosis and management of a patient with a nonatherosclerotic and noncardioembolic arterial event, referred to here as an unexplained arterial thrombosis. Because there is an assorted list of factors that can precipitate an arterial event, we present a systematic diagnostic approach to ensure consideration of not only primary hypercoagulable disorders, but also pro-thrombotic medications or substances, vascular and anatomic abnormalities, and undiagnosed systemic disorders, such as malignancy and autoimmune diseases. We also review existing literature of the role of hypercoagulable disorders in arterial thrombosis and discuss our approach to thrombophilia workup in patients after an unexplained arterial event. We conclude with 3 representative cases to both illustrate the application of the outlined diagnostic schema and discuss common management considerations, specifically the selection of anticoagulation vs antiplatelet therapy for secondary prevention.
Collapse
|
42
|
Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, Kelli HM, Ferdinand KC, Echols MR, Weintraub H, Bostrom J, Johnson HM, Hoppe KK, Shapiro MD, German CA, Virani SS, Hussain A, Ballantyne CM, Agha AM, Toth PP. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol 2021; 5:100149. [PMID: 34327491 PMCID: PMC8315386 DOI: 10.1016/j.ajpc.2021.100149] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The "American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update" is a summary document (updated yearly) regarding CVD risk factors. This "ASPC Top Ten CVD Risk Factors 2021 Update" summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the "ASPC Top Ten CVD Risk Factors 2021 Update" to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.
Collapse
Affiliation(s)
- Harold E. Bays
- Medical Director / President, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
| | - Pam R. Taub
- University of California San Diego Health, San Diego, CA USA
| | | | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A. Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison L. Bailey
- Chief, Cardiology, Centennial Heart at Parkridge, Chattanooga, TN USA
| | - Heval M. Kelli
- Northside Hospital Cardiovascular Institute, Lawrenceville, GA USA
| | - Keith C. Ferdinand
- Professor of Medicine, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Melvin R. Echols
- Assistant Professor of Medicine, Department of Medicine, Cardiology Division, Morehouse School of Medicine, New Orleans, LA USA
| | - Howard Weintraub
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - John Bostrom
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Clinical Affiliate Associate Professor, Florida Atlantic University, Boca Raton, FL USA
| | - Kara K. Hoppe
- Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Charles A. German
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Aliza Hussain
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Christie M. Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Ali M. Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
| |
Collapse
|
43
|
Kumar A, McCullough L. Cerebrovascular disease in women. Ther Adv Neurol Disord 2021; 14:1756286420985237. [PMID: 33552237 PMCID: PMC7844450 DOI: 10.1177/1756286420985237] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Cerebrovascular disease is a major cause of morbidity, mortality, and disability in women. The spectrum of disease differs between men and women, with women being particularly vulnerable to certain conditions, especially during specific periods of life such as pregnancy. There are several unique risk factors for cerebrovascular disease in women, and the influence of some traditional risk factors for stroke is stronger in women. Moreover, disparities persist in representation of women in clinical trials, acute intervention, and stroke outcomes. In this review, we aimed to explore the epidemiology, etiologies, and management of cerebrovascular disease in women, highlighting some of these differences and the growing need for sex-specific management guidelines and health policies.
Collapse
Affiliation(s)
- Aditya Kumar
- Department of Neurology, 6431 Fannin Street, Houston, TX 77030, USA
| | | |
Collapse
|
44
|
Mishra SR, Waller M, Chung HF, Mishra GD. Association of the length of oestrogen exposure with risk of incident stroke in postmenopausal women: Insights from a 20-year prospective study. Int J Cardiol 2020; 328:206-214. [PMID: 33321126 DOI: 10.1016/j.ijcard.2020.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND To examine the relationship between the length of oestrogen exposure and risk of incident stroke. Also, the additive value of each model was compared for assessing oestrogen exposure and stroke risk in postmenopausal women. STUDY DESIGN AND SETTING Prospective study of 5632 post-menopausal women without a prior history of stroke from 1996 through 2016 in Australian Longitudinal Study on Women's Health. Data on surrogate measures of oestrogen exposure were used to derive five indices of oestrogen exposure including reproductive lifespan (RLS) (age at menopause-age at menarche), endogenous oestrogen and total oestrogen exposure (which included menopausal hormone therapy (MHT use)). The relationships between the length of oestrogen exposure (quartiles) and incident stroke events were examined using multivariable adjusted Cox proportional hazard regression and their predictive accuracy were compared using area under the Receiver Operating Characteristic Curve. RESULTS The mean (SD) for RLS was 37.9(4.3) years. A shorter RLS (≤34 years) was associated with a higher risk of incident stroke after adjustment (HR: 1.85, 95%CI: 1.08, 3.15), compared with 38-40 years. There was 7% decrease in risk of stroke per 1-year increase in RLS (HR: 0.93, 95%CI: 0.89, 0.97). Even though the combination of endogenous oestrogen and exogenous hormones aimed to provide more accurate length of oestrogen exposure, the results showed that each model had similar goodness of fit and did not improve the model of just using RLS as a predictor of incident stroke. CONCLUSIONS A shorter RLS (≤34 years) was associated with higher risk of incident stroke compared to medium RLS. Endogenous oestrogen and of total oestrogen exposure (which included MHT use) did not improve the model of just using RLS as a predictor of incident stroke.
Collapse
Affiliation(s)
- Shiva Raj Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Michael Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
| |
Collapse
|
45
|
Chelluboina B, Vemuganti R. Therapeutic potential of nutraceuticals to protect brain after stroke. Neurochem Int 2020; 142:104908. [PMID: 33220386 DOI: 10.1016/j.neuint.2020.104908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Stroke leads to significant neuronal death and long-term neurological disability due to synergistic pathogenic mechanisms. Stroke induces a change in eating habits and in many cases, leads to undernutrition that aggravates the post-stroke pathology. Proper nutritional regimen remains a major strategy to control the modifiable risk factors for cardiovascular and cerebrovascular diseases including stroke. Studies indicate that nutraceuticals (isolated and concentrated form of high-potency natural bioactive substances present in dietary nutritional components) can act as prophylactic as well as adjuvant therapeutic agents to prevent stroke risk, to promote ischemic tolerance and to reduce post-stroke consequences. Nutraceuticals are also thought to regulate blood pressure, delay neurodegeneration and improve overall vascular health. Nutraceuticals potentially mediate these effects by their powerful antioxidant and anti-inflammatory properties. This review discusses the studies that have highlighted the translational potential of nutraceuticals as stroke therapies.
Collapse
Affiliation(s)
- Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; William S. Middleton Veterans Administration Hospital, Madison, WI, USA.
| |
Collapse
|
46
|
Sui Y, Hong CT, Chien LN, Liu HY, Chiou HY, Hsieh YC. Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7440. [PMID: 33066053 PMCID: PMC7600941 DOI: 10.3390/ijerph17207440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022]
Abstract
Optimal stroke prevention strategies for women should take into account specific sex-related stroke risk factors. Anemia is a common medical condition in females, particularly in women of reproductive age. This study investigated whether anemia is an independent risk factor for stroke in females in a population-based cohort study. We investigated newly diagnosed anemic female patients with no history of central nervous system disease, psychiatric disorders, traumatic brain injury, major operations or hemorrhagic diseases identified from the Taiwan National Health Insurance Research Database. Non-anemic matched controls (1:1) were selected based on a propensity score estimated using a logistic regression model that included demographic characteristics and comorbidities. A competing risk analysis was applied to estimate the stroke risk in anemic patients compared to that of their matched controls. In our study, the adjusted sub-distribution hazard ratios (aSHRs) of overall, hemorrhagic and ischemic stroke in anemic female patients aged <50 years were 1.35 (95% confidence interval (CI): 1.19-1.52, p < 0.001), 1.31 (95% CI, 1.09-1.56, p < 0.003), and 1.35 (95% CI, 1.15-1.58, p < 0.001), respectively, compared to non-anemic female controls. However, a positive association between anemia and stroke was not found for those aged ≥50 years. Similar results were observed when the follow-up age was limited to 50 years to reduce the potential effects of menopause on stroke. In conclusion, the present population-based cohort study found that anemia is a potential risk factor for overall, hemorrhagic and ischemic stroke in females of reproductive age.
Collapse
Affiliation(s)
- Yuan Sui
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (Y.S.); (C.-T.H.)
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (Y.S.); (C.-T.H.)
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei 11031, Taiwan; (L.-N.C.); (H.-Y.L.)
- Health and Clinical Research Data Center, Office of Data, Taipei Medical University, Taipei 11031, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Office of Data, Taipei Medical University, Taipei 11031, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan;
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Chen Hsieh
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
- PhD Program of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- PhD Program in Biotechnology Research and Development, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan
| |
Collapse
|
47
|
Eslam Abd Alkreem Allsassmah. MEASURING KNOWLEDGE OF JORDANIAN NURSES WORKING IN CRITICAL CARE UNITS TOWARD STROKE PATIENTS. WORLD SCIENCE 2020. [DOI: 10.31435/rsglobal_ws/31102020/7214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Background. Stroke is a devastating disease. It is a major cause for the neurological admission to hospitals all over the world. Limited knowledge among the critical care nurses about stroke in general and specifically about the risk factors, signs, and symptoms of stroke usually is a main source of delayed prompt stroke management and non-compliance with follow-up rehabilitation. Therefore, there is a need for a study that examines the impact of these factors in order to promote stroke management and improve nursing care outcomes.Aim. This study aimed at measuring the knowledge of Jordanian nurses working in critical care units toward stroke patients.Methods. This cross-sectional study used the descriptive approach in order to measure the knowledge of the Jordanian nurses working in critical care units regarding stroke patients in the Jordanian hospitals. Data were collected from Jordanian critical care units' nurses from seven hospitals; five private and two public hospitals. Critical care units’ nurses were selected conveniently based on specific inclusion criteria. Eligible participants were required to complete self–reported questionnaires about knowledge in addition to completing demographic questionnaires. The descriptive and inferential statistics were conducted using the SPSS software. Results. A total of (200) Critical care units’ nurses from public and private hospitals participated in the study. The nurses in this study exhibited poor knowledge on the study scales. There were statistically significant differences among nurses according to the type of hospital on the one scales (P< .05). There is a negative relationship between the knowledge and years of nursing practice in ER or ICU (P= .013).Conclusions. The measures of knowledge among the nurses in critical care units in the Jordanian hospitals towards stroke patients seem to be highly poor. Nurses in critical care units seem to have acceptable information, but inadequate to correctly enhance stroke awareness. There is a gap that should be stuffed via planning and implementation of educational and instructional programs focused on hospital nurses as well as community sectors in order to improve the stoke focus and experience and avoid the delay in accessing the medical help which would, in return, improve stroke management and reduce its effect in Jordan.
Collapse
|
48
|
Tang M, Yao M, Zhu Y, Peng B, Zhou L, Ni J. Sex differences of ischemic stroke in young adults-A single-center Chinese cohort study. J Stroke Cerebrovasc Dis 2020; 29:105087. [PMID: 32807483 PMCID: PMC7332448 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Stroke at a young age is a societal challenge with a rising incidence. Our aim was to investigate sex differences in risk factors, etiology, and diagnostic process of ischemic stroke in Chinese young adults. METHODS We retrospectively recruited 411 consecutive patients with first-ever ischemic stroke who were 18 to 50 years of age (mean age, 38.2 ± 8.1 years, women 31.4%), admitted to Peking Union Medical College Hospital from 2007 to 2018. Sex differences in demographics, risk factors, etiology, and diagnostic testing were analyzed. RESULTS Females were significantly younger than males (36.9 versus 38.7 years, P<0.05). Hypertension (43.0%), smoking (41.1%), hyperlipidemia (37.2%), and hyperhomocysteinemia (27.9%) were common risk factors, statistically higher among males than females (P<0.05). Stroke etiology showed a significant sex difference that large-artery atherosclerosis and small-vessel diseases were more common among males than females (48.6% versus 19.4%, P<0.001; 9.9% versus 3.1%, P<0.05, respectively). Stroke of other determined etiology was more common among females (50.4% versus 19.1%, P<0.001). Relevant abnormality rates were higher among females on screening for autoimmune diseases and thrombophilia (23.3% versus 11.1%, P<0.05 and 50.0% versus 16.7%, P<0.001, respectively). CONCLUSIONS A high rate of the traditional stroke risk factors and etiological subtype of large artery atherosclerosis in males were found, as well as prominent sex differences in relevant diagnostic testing abnormality rates, providing useful information for developing sex-specific strategies in stroke evaluation and prevention in young adults.
Collapse
Affiliation(s)
- Mingyu Tang
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongdan Dongcheng District, Beijing 100730, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongdan Dongcheng District, Beijing 100730, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongdan Dongcheng District, Beijing 100730, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongdan Dongcheng District, Beijing 100730, China
| | - Lixin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongdan Dongcheng District, Beijing 100730, China.
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongdan Dongcheng District, Beijing 100730, China.
| |
Collapse
|
49
|
Stewart CE, Sohrabji F. Gonadal hormones and stroke risk: PCOS as a case study. Front Neuroendocrinol 2020; 58:100853. [PMID: 32640267 DOI: 10.1016/j.yfrne.2020.100853] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/20/2023]
Abstract
It is well known that stroke incidence and outcome is sex-dependent and influenced by age and gonadal hormones. In post-menopausal and/or aged females, declining estrogen levels increases stroke risk. However, women who experience early menopause also have an increase in stroke risk. This suggests that, regardless of age, gonadal hormones regulate stroke risk and severity. This review discusses prolonged gonadal hormone dysfunction in a common female endocrine disorder known as polycystic ovarian syndrome, PCOS, and the associated increased risk of stroke due to resulting hyperandrogenism and metabolic comorbidities.
Collapse
Affiliation(s)
- Courtney E Stewart
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX 77807, USA
| | - Farida Sohrabji
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX 77807, USA.
| |
Collapse
|
50
|
The burden and outcomes of stroke in young adults at a tertiary hospital in Tanzania: a comparison with older adults. BMC Neurol 2020; 20:206. [PMID: 32450825 PMCID: PMC7247244 DOI: 10.1186/s12883-020-01793-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background Stroke burden in young adults is growing associated with unique risk factors and devastating outcomes. We aimed to investigate the magnitude, risk factors and outcomes of first ever stroke in young adults ≤45 years compared to older adults > 45 years. Methods All patients with a World Health Organization clinical definition of stroke at a tertiary hospital in Tanzania were enrolled. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess admission stroke severity and outcomes respectively. Kaplan-Meier analysis was used to describe survival and Cox-proportional hazards model was used to examine predictors of fatality. Results We enrolled 369 first ever stroke participants over 8 months. First strokes accounted for one quarter of the medical admissions in both younger and older groups, 123/484 {(25.4%) [95% CI 21.5–29.3%]} and 246/919 {(26.8%) [95% CI 23.9–29.6%]} respectively. Hemorrhagic stroke occurred in 47 (42.3%) vs 62 (27.2%) for the young and old respectively p = 0.005. Factors associated with stroke in the young were: a new diagnosis of hypertension in 33 (26.8%) vs 23 (9.3%) p < 0.001, HIV infection 12 (9.8%) vs 7 (2.8%) p = 0.005, use of hormonal contraception in females 33 (48.5%) vs 13 (9.4%) p < 0.001, elevated serum low density lipoproteins 28 (27.7%) vs 29 (16.4%) p = 0.024, hypercholesteremia 34 (31.2%) vs 40 (20.2%), p = 0.031, sickle cell disease 11 (9.7%) vs 9 (4.2%) p = 0.047 and thrombocytosis 12 (16.9%) vs 8 (5.6%) p = 0.007. The overall 30-day fatality rate was 215 (61.3%); 57 (49.1%) vs 158 (67.2%) in the young and old respectively. Independent predictors of fatality were: severe stroke {HR 10.35 (95% CI: 1.397–76.613)}, leukocytosis {HR 2.23 (95% CI: 1.448–3.419)} and fever {HR 1.79 (95% CI: 1.150–2.776)}. Conclusions There is a high burden of stroke in young adults that is coupled with a high 30-day fatality rate. Screening and management of hypertension is crucial in the prevention of stroke. More research is needed to identify factors which cause death, allowing the development of sustainable interventions to reduce early post stroke fatality in this group.
Collapse
|