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Pua DKA, Anand P, Bhattacharyya S. Stroke associated with sarcoidosis: A systematic review of reported cases. J Neurol Sci 2024; 462:123080. [PMID: 38850770 DOI: 10.1016/j.jns.2024.123080] [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: 01/30/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Sarcoidosis can be associated with stroke. Whether granulomatous vasculitis directly causes stroke in patients with sarcoidosis remains unclear. This systematic review aims to consolidate reports of concurrent sarcoidosis and stroke. METHODS Medline and Embase were searched for terms encompassing sarcoidosis and stroke with a censoring date of March 25, 2023. Cases were reviewed by two authors, with the inclusion criteria: biopsy-confirmed systemic sarcoidosis, stroke confirmed by imaging or pathology, clinical description of individual patient history, and English language publications. RESULTS Of 1628 articles screened, 51 patients from 49 articles were included (65% male, mean age 41 years). Seventy-one percent of strokes were ischemic and 29% were hemorrhagic. Lesions were supratentorial in 78% of cases, infratentorial in 34%, and multifocal in 45%. Presenting symptoms were variable, with the most common being headache (38%) followed by weakness (35%). 10 patients had recurrent strokes. Stroke was the presenting symptom of sarcoidosis in 65%. 21 patients had brain biopsies. The most common neuropathologic findings were perivascular (33%) or intramural (33%) non-caseating granulomas. On imaging, 32 patients had findings suggestive of neurosarcoidosis, including 35% with evidence of meningeal enhancement. 63% of patients were treated with corticosteroids and/or other immunomodulatory therapy, with varying clinical improvement. CONCLUSIONS Stroke associated with sarcoidosis generally follows trends in stroke incidence, with infarction being more common than hemorrhage and male sex carrying a higher risk. Most patients were diagnosed with sarcoidosis during or following their stroke episode. Brain biopsy infrequently shows clear granulomatous vasculitis.
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Affiliation(s)
- Danielle Kei A Pua
- Brigham and Women's Hospital, 75 Francis Street, 02115 Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Pria Anand
- Boston University Medical Center, 725 Albany Street, 02118 Boston, MA, United States of America.
| | - Shamik Bhattacharyya
- Brigham and Women's Hospital, 75 Francis Street, 02115 Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
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Ojo DT, Brewer PC, Imeh-Nathaniel A, Imeh-Nathaniel S, Broughton PX, Nathaniel TI. Sex differences in clinical risk factors in obese ischemic stroke patients with a history of smoking. BMC Cardiovasc Disord 2024; 24:288. [PMID: 38816791 PMCID: PMC11138086 DOI: 10.1186/s12872-024-03952-6] [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: 11/20/2023] [Accepted: 05/21/2024] [Indexed: 06/01/2024] Open
Abstract
Clinical risk factors associated obesity and smoking, as well as their combined effect, are not fully understood. This study aims to determine sex differences in risk factors in a population of acute ischemic stroke (AIS) patients who are obese and with a history of previous or current smoking. METHODS A retrospective analysis of risk factors in male and female AIS patients with baseline data of obesity and current or previous history of smoking, smoking, and obesity alone was determined. The primary predictor and outcome are risk factors associated with male and female AIS patients. Baseline risk factors were analyzed using a multivariate regression analysis to determine specific risk factors linked with the combined effect of obesity and current or previous history of smoking''. RESULTS Male obese AIS patients who are current or previous smokers were more likely to be older patients(OR = 1.024, 95% CI, 1.022-1.047, P = 0.033) that present with coronary artery disease (OR = 1.806, 95% CI, 1.028-3.174, P = 0.040), a history of alcohol use (OR = 2.873, 95% CI, 1.349-6.166, P = 0.006), elevated serum creatinine (OR = 4.724, 95% CI, 2.171-10.281, P < 0.001) and systolic blood pressure (OR = 1.029, 95% CI, 1.011-1.047, P < 0.002). Females were more associated with depression (OR = 0.432, 95% CI, 0.244-0.764, P = 0.004), previous TIA (OR = 0.319, 95% CI, 0.142-0.714, P < 0.005), and higher levels of HDL (OR = 0.938, 95% CI, 0.915-0.962, P < 0.001). CONCLUSION Our results reveal sex differences in risk factors in obese AIS patients with a current or past history of smoking. This finding emphasizes the need to develop management strategies to improve the care of obese AIS patients who are either current or former smokers.
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Affiliation(s)
- Dami T Ojo
- University of South Carolina School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Philip C Brewer
- University of South Carolina School of Medicine-Greenville, Greenville, SC, 29605, USA
| | | | | | - Philip X Broughton
- University of South Carolina School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina School of Medicine-Greenville, Greenville, SC, 29605, USA.
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3
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Bai X, Li Z, Cai Z, Yao M, Chen L, Wang Y. Gender differences in risk factors for ischemic stroke: a longitudinal cohort study in East China. BMC Neurol 2024; 24:171. [PMID: 38783249 PMCID: PMC11112765 DOI: 10.1186/s12883-024-03678-0] [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: 12/16/2023] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Epidemiological studies of stroke and its risk factors can help develop strategies to prevent stroke. We aimed to explore the current gender-specific prevalence of stroke and associated risk factors. METHODS Data were collected using a structured precoded questionnaire designed by the Stroke Screening and Prevention Programme of the National Health and Wellness Commission Stroke Prevention and Control Project Committee, between June 2020 and November 2021. A total of 7394 residents took part in the study, 187 of whom had a stroke. The baseline information of each participant was obtained and included in this study. The chi-square test and Kruskal-Wallis tests were used to examine the relationship between these indicators and stroke, and then multivariate logistic regression was used to construct the prediction scale between different genders. RESULTS of 7394 participants,4571 (61.82%) were female. The overall prevalence of stroke patients in the study population was 2.53%, Multivariate analysis found that residence status (OR = 0.43, p = 0.002) 、HCY (OR = 0.962, p = 0.000)、Previous TIA (OR = 0.200, p = 0.002) 、Hypertension (OR = 0.33, p = 0.000) and Dyslipidemia (OR = 0.668, p = 0.028) were significant predictors of stroke. there are gender differences in the traditional risk factors for stroke, and women have more risk factors. ROC analysis confirmed the accuracy of the stroke risk model, and the AUC of the stroke risk model for the general population was 0.79 with p < 0.05. In the gender model, the female AUC was 0.796 (p < 0.05). and the male AUC was 0.786 with p < 0.05. CONCLUSION The prevalence of stroke in adults aged 40 years and above is high in eastern China were high. management of risk factors can effectively prevent the occurrence of most strokes. more attention should be paid to gender differences associated with stroke.
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Affiliation(s)
- Xinping Bai
- Department of Neurology, Fuyang People's Hospital, Anhui, 236000, People's Republic of China
| | - Zifeng Li
- Department of Neurology, Fuyang People's Hospital, Anhui, 236000, People's Republic of China
| | - Zhuo Cai
- Department of Neurology, Fuyang Hospital Affiliated to Bengbu Medical University, Anhui, 236000, People's Republic of China
| | - Mingren Yao
- Department of Neurology, Fuyang People's Hospital, Anhui, 236000, People's Republic of China
| | - Lin Chen
- Department of Neurology, Fuyang People's Hospital, Anhui, 236000, People's Republic of China
| | - Youmeng Wang
- Department of Neurology, Fuyang People's Hospital, Anhui, 236000, People's Republic of China.
- Department of Neurology, Fuyang Hospital Affiliated to Bengbu Medical University, Anhui, 236000, People's Republic of China.
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4
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Kwapong WR, Yan Y, Cao L, Wang H, Ye C, Jiang S, Tao W, Wu B. Retinal Ischemic Perivascular Lesion Reflects Cerebral Small Vessel Disease Burden in Single Subcortical Infarction. J Am Heart Assoc 2024; 13:e033081. [PMID: 38639343 PMCID: PMC11179934 DOI: 10.1161/jaha.123.033081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Retinal ischemic perivascular lesions (RIPLs) are an indicator of ischemia in the middle retina. We aimed to determine the relationship between RIPLs and single subcortical infarction (SSI). We also investigated the differences in cerebral small vessel disease imaging burden between groups with and without RIPLs in SSI. METHODS AND RESULTS In this case-control study, we enrolled 82 patients with SSI and 72 nonstroke controls. All participants underwent magnetic resonance imaging and swept-source optical coherence tomography/optical coherence tomography angiography. Small vessel disease markers such as lacunes, cerebral microbleeds, white matter hyperintensity, and perivascular spaces were rated on brain imaging. RIPLs were assessed via swept-source optical coherence tomography. Optical coherence tomography angiography was used to measure the superficial vascular complex and deep vascular complex of the retina. After adjusting for risk factors, the presence of RIPLs was significantly associated with SSI (odds ratio [OR], 1.506 [95% CI, 1.365-1.662], P<0.001). Eyes with RIPLs showed lower deep vascular complex density (P=0.035) compared with eyes without RIPLs in patients with SSI. After adjusting for vascular risk factors, the presence of RIPLs in patients with SSI was associated with an increased periventricular white matter hyperintensity burden (β=0.414 [95% CI, 0.181-0.647], P<0.001) and perivascular spaces-basal ganglia (β=0.296 [95% CI, 0.079-0.512], P=0.008). CONCLUSIONS RIPLs are associated with SSI independent of underlying risk factors. The relationship between the presence of RIPLs and small vessel disease markers provides evidence that RIPLs might be an additional indicator of cerebral ischemic changes.
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Affiliation(s)
- William R. Kwapong
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yuying Yan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Hang Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
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5
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Indraswari F, Yaghi S, Khan F. Sex specific outcomes after ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107754. [PMID: 38703877 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024] Open
Affiliation(s)
- Fransisca Indraswari
- Department of Neurology, Brown Medical School, Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA
| | - Shadi Yaghi
- Department of Neurology, Brown Medical School, Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA.
| | - Farhan Khan
- Department of Neurology, Brown Medical School, Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA
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Burton TM, Madsen TE, Karb R, Furie KL. Importance of sex and gender differences in enrollment and interpretation of stroke clinical trials. J Stroke Cerebrovasc Dis 2024; 33:107735. [PMID: 38679215 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107735] [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: 10/02/2023] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES This review aims to reinforce the importance of improving sex balance in preclinical trials and sex and gender diversity and proportional balance in clinical trials enrollment and how this influences interpretation of stroke clinical trials. It also aims to identify strategies for improvement in data collection. MATERIALS AND METHODS A PubMed search was conducted of publications in English, using MeSH terms sex, sex characteristics, gender identity, transgender, gender-nonconforming persons, clinical trials as topic, stroke. Of 249 search results, 217 were human or animal studies related to stroke, the majority of which were reviews, secondary analyses of stroke clinical trials, meta analyses, or retrospective studies, subject to the methods of sex and gender acquisition per the primary data source. Articles were reviewed, noting inclusion or absence of sex and gender definitions and trial design. Selected articles were supplemented with United States Food and Drug Administration, National Institutes of Health, and National Academy of Science, Engineering, and Medicine publications. RESULTS The majority of preclinical studies continue to report sex as a binary variable, and the majority of stroke clinical trials report sex and gender as interchangeable and binary. Mindful trial design and statistical analysis can improve accuracy in the interpretation of sex and gender differences. Guidance exists to improve reporting on currently accepted sex and gender definitions, recommended data collection instruments, and appropriate statistical analyses. CONCLUSIONS Despite acknowledgement of having failed to achieve diverse and proportionally balanced enrollment, sex and gender imbalance across the research continuum remains prevalent. Responsible incorporation of sex and gender in stroke clinical trials can be achieved through thoughtful study design, use of contemporary sex and gender definitions, inclusive prospective data collection, balanced enrollment with prespecified goals, and appropriate statistical analysis.
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Affiliation(s)
- Tina M Burton
- The Warren Alpert Medical School of Brown University, Department of Neurology, USA.
| | - Tracy E Madsen
- The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, USA; Brown University School of Public Health, USA
| | - Rebecca Karb
- The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, USA
| | - Karen L Furie
- The Warren Alpert Medical School of Brown University, Department of Neurology, USA
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Hahka TM, Slotkowski RA, Akbar A, VanOrmer MC, Sembajwe LF, Ssekandi AM, Namaganda A, Muwonge H, Kasolo JN, Nakimuli A, Mwesigwa N, Ishimwe JA, Kalyesubula R, Kirabo A, Anderson Berry AL, Patel KP. Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review. Circ Res 2024; 134:459-473. [PMID: 38359096 PMCID: PMC10885774 DOI: 10.1161/circresaha.123.324077] [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] [Indexed: 02/17/2024]
Abstract
Hypertension is the leading cause of cardiovascular disease in women, and sub-Saharan African (SSA) countries have some of the highest rates of hypertension in the world. Expanding knowledge of causes, management, and awareness of hypertension and its co-morbidities worldwide is an effective strategy to mitigate its harms, decrease morbidities and mortality, and improve individual quality of life. Hypertensive disorders of pregnancy (HDPs) are a particularly important subset of hypertension, as pregnancy is a major stress test of the cardiovascular system and can be the first instance in which cardiovascular disease is clinically apparent. In SSA, women experience a higher incidence of HDP compared with other African regions. However, the region has yet to adopt treatment and preventative strategies for HDP. This delay stems from insufficient awareness, lack of clinical screening for hypertension, and lack of prevention programs. In this brief literature review, we will address the long-term consequences of hypertension and HDP in women. We evaluate the effects of uncontrolled hypertension in SSA by including research on heart disease, stroke, kidney disease, peripheral arterial disease, and HDP. Limitations exist in the number of studies from SSA; therefore, we will use data from countries across the globe, comparing and contrasting approaches in similar and dissimilar populations. Our review highlights an urgent need to prioritize public health, clinical, and bench research to discover cost-effective preventative and treatment strategies that will improve the lives of women living with hypertension in SSA.
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Affiliation(s)
- Taija M Hahka
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Rebecca A Slotkowski
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Anum Akbar
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Matt C VanOrmer
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Lawrence Fred Sembajwe
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdul M Ssekandi
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Namaganda
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Muwonge
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Josephine N Kasolo
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology (A. Nakimuli), Makerere University College of Health Sciences, Kampala, Uganda
| | - Naome Mwesigwa
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Jeanne A Ishimwe
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Robert Kalyesubula
- Department of Medical Physiology (L.F.S., A.M.S., A. Namaganda, H.M., J.N.K., R.K.), Makerere University College of Health Sciences, Kampala, Uganda
| | - Annet Kirabo
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (N.M., J.A.I., A.K.)
| | - Ann L Anderson Berry
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
- Department of Pediatrics (T.M.H., R.A.S., A.A., M.C.V., A.L.A.B.), University of Nebraska Medical Center, Omaha, NE
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology (T.M.H., A.L.A.B., K.P.P.), University of Nebraska Medical Center, Omaha, NE
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Wu Y, Hu C, Li Z, Li F, Lv J, Guo M, Liu X, Li C, Huo X, Chen Z, Yang L, Du X. Development of a new cerebral ischemia reperfusion model of Mongolian gerbils and standardized evaluation system. Animal Model Exp Med 2024; 7:48-55. [PMID: 38372486 PMCID: PMC10961892 DOI: 10.1002/ame2.12378] [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: 07/21/2023] [Accepted: 10/19/2023] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The Mongolian gerbil is an excellent laboratory animal for preparing the cerebral ischemia model due to its inherent deficiency in the circle of Willis. However, the low incidence and unpredictability of symptoms are caused by numerous complex variant types of the circle. Additionally, the lack of an evaluation system for the cerebral ischemia/reperfusion (I/R) model of gerbils has shackled the application of this model. METHODS We created a symptom-oriented principle and detailed neurobehavioral scoring criteria. At different time points of reperfusion, we analyzed the alteration in locomotion by rotarod test and grip force score, infarct volume by triphenyltetrazolium chloride (TTC) staining, neuron loss using Nissl staining, and histological characteristics using hematoxylin-eosin (H&E) straining. RESULTS With a successful model rate of 56%, 32 of the 57 gerbils operated by our method harbored typical features of cerebral I/R injury, and the mortality rate in the male gerbils was significantly higher than that in the female gerbils. The successfully prepared I/R gerbils demonstrated a significant reduction in motility and grip strength at 1 day after reperfusion; formed obvious infarction; exhibited typical pathological features, such as tissue edema, neuronal atrophy and death, and vacuolated structures; and were partially recovered with the extension of reperfusion time. CONCLUSION This study developed a new method for the unilateral common carotid artery ligation I/R model of gerbil and established a standardized evaluation system for this model, which could provide a new cerebral I/R model of gerbils with more practical applications.
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Affiliation(s)
- Ying Wu
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Caijiao Hu
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Zhihui Li
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Feiyang Li
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Jianyi Lv
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Meng Guo
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Xin Liu
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Changlong Li
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Xueyun Huo
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Zhenwen Chen
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
| | - Lifeng Yang
- College of Veterinary MedicineChina Agricultural UniversityBeijingChina
| | - Xiaoyan Du
- School of Basic Medical SciencesCapital Medical UniversityBeijingChina
- Laboratory for Clinical MedicineCapital Medical UniversityBeijingChina
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9
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Lee JS, Choi J, Shin HJ, Jung JM, Seo WK. Incidence and risk of stroke in Korean patients with congenital heart disease. J Stroke Cerebrovasc Dis 2023; 32:107408. [PMID: 37980821 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107408] [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: 03/21/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVES The incidence and risk of ischemic stroke (IS) and hemorrhagic stroke (HS) in Korean patients with CHD have not been reported, therefore, we aimed to investigate this. MATERIALS AND METHODS Participants were selected from the Korean National Health Insurance Service benefit records from 2006-2017. Cases were extracted using diagnosis codes related to CHD. Controls without CHD were selected through age- and sex-matched random sampling at a 1:10 ratio. RESULTS The case and control groups included 232,203 and 3,024,633 participants, respectively. The median (interquartile range) follow-up period was 7.28 (3.59-8.73) years. The incidence rates of IS and HS per 100,000 person-years were much higher in cases than in controls (IS: 135 vs. 47; HS: 41.7 vs. 24.9). After adjusting for confounders, CHD was a risk factor for IS and HS (subdistribution HR; 1.96 and 1.71, respectively). In patients with CHD, the following risk factors were identified: diabetes, heart failure, and atrial fibrillation for any stroke; hypertension, atrial septal defects, and use of antiplatelet agents for IS only; and coronary artery bypass graft surgery for HS only. CONCLUSIONS Korean patients with CHD have a high risk of stroke. A personalized preventive approach is needed to reduce the incidence of stroke in this population.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongun Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Myoungju Hospital, Yongin, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea; Korea University Zebrafish Translational Medical Research Center, Ansan, Korea.
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Wan M, Lindsay P, Yu AYX, Hill MD, Holodinsky JK. Sex Differences of Hospital and Emergency Department Presentations of Stroke in Canada. Can J Neurol Sci 2023:1-5. [PMID: 37830291 DOI: 10.1017/cjn.2023.290] [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: 10/14/2023]
Abstract
We provide an updated estimate of adult stroke event rates by age group, sex, and stroke type using Canadian administrative data. In the 2017-2018 fiscal year, there were an estimated 81,781 hospital or emergency department visits for stroke events in Canada, excluding Quebec. Our findings show that overall, the event rate of stroke is similar between women and men. There were slight differences in stroke event rate at various ages by sex and stroke type and emerging patterns warrant attention in future studies. Our findings emphasize the importance of continuous surveillance to monitor the epidemiology of stroke in Canada.
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Affiliation(s)
- Miranda Wan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Calgary, AB, Canada
| | - Jessalyn K Holodinsky
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Center for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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11
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Maimaiti A, Turhon M, Abulaiti A, Dilixiati Y, Zhang F, Axieer A, Kadeer K, Zhang Y, Maimaitili A, Yang X. DNA methylation regulator-mediated modification patterns and risk of intracranial aneurysm: a multi-omics and epigenome-wide association study integrating machine learning, Mendelian randomization, eQTL and mQTL data. J Transl Med 2023; 21:660. [PMID: 37742034 PMCID: PMC10518114 DOI: 10.1186/s12967-023-04512-w] [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: 05/08/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Intracranial aneurysms (IAs) pose a significant and intricate challenge. Elucidating the interplay between DNA methylation and IA pathogenesis is paramount to identify potential biomarkers and therapeutic interventions. METHODS We employed a comprehensive bioinformatics investigation of DNA methylation in IA, utilizing a transcriptomics-based methodology that encompassed 100 machine learning algorithms, genome-wide association studies (GWAS), Mendelian randomization (MR), and summary-data-based Mendelian randomization (SMR). Our sophisticated analytical strategy allowed for a systematic assessment of differentially methylated genes and their implications on the onset, progression, and rupture of IA. RESULTS We identified DNA methylation-related genes (MRGs) and associated molecular pathways, and the MR and SMR analyses provided evidence for potential causal links between the observed DNA methylation events and IA predisposition. CONCLUSION These insights not only augment our understanding of the molecular underpinnings of IA but also underscore potential novel biomarkers and therapeutic avenues. Although our study faces inherent limitations and hurdles, it represents a groundbreaking initiative in deciphering the intricate relationship between genetic, epigenetic, and environmental factors implicated in IA pathogenesis.
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Affiliation(s)
- Aierpati Maimaiti
- Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, 830017, People's Republic of China
| | - Mirzat Turhon
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, People's Republic of China
- Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Aimitaji Abulaiti
- Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | | | - Fujunhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, People's Republic of China
- Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Aximujiang Axieer
- Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, 830017, People's Republic of China
| | - Kaheerman Kadeer
- Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, 830017, People's Republic of China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, People's Republic of China.
- Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China.
| | - Aisha Maimaitili
- Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, 830017, People's Republic of China.
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, People's Republic of China.
- Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China.
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12
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Tschiderer L, Peters SAE, van der Schouw YT, van Westing AC, Tong TYN, Willeit P, Seekircher L, Moreno‐Iribas C, Huerta JM, Crous‐Bou M, Söderholm M, Schulze MB, Johansson C, Själander S, Heath AK, Macciotta A, Dahm CC, Ibsen DB, Pala V, Mellemkjær L, Burgess S, Wood A, Kaaks R, Katzke V, Amiano P, Rodriguez‐Barranco M, Engström G, Weiderpass E, Tjønneland A, Halkjær J, Panico S, Danesh J, Butterworth A, Onland‐Moret NC. Age at Menopause and the Risk of Stroke: Observational and Mendelian Randomization Analysis in 204 244 Postmenopausal Women. J Am Heart Assoc 2023; 12:e030280. [PMID: 37681566 PMCID: PMC10547274 DOI: 10.1161/jaha.123.030280] [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: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Background Observational studies have shown that women with an early menopause are at higher risk of stroke compared with women with a later menopause. However, associations with stroke subtypes are inconsistent, and the causality is unclear. Methods and Results We analyzed data of the UK Biobank and EPIC-CVD (European Prospective Investigation Into Cancer and Nutrition-Cardiovascular Diseases) study. A total of 204 244 postmenopausal women without a history of stroke at baseline were included (7883 from EPIC-CVD [5292 from the subcohort], 196 361 from the UK Biobank). Pooled mean baseline age was 58.9 years (SD, 5.8), and pooled mean age at menopause was 47.8 years (SD, 6.2). Over a median follow-up of 12.6 years (interquartile range, 11.8-13.3), 6770 women experienced a stroke (5155 ischemic strokes, 1615 hemorrhagic strokes, 976 intracerebral hemorrhages, and 639 subarachnoid hemorrhages). In multivariable adjusted observational Cox regression analyses, the pooled hazard ratios per 5 years younger age at menopause were 1.09 (95% CI, 1.07-1.12) for stroke, 1.09 (95% CI, 1.06-1.13) for ischemic stroke, 1.10 (95% CI, 1.04-1.16) for hemorrhagic stroke, 1.14 (95% CI, 1.08-1.20) for intracerebral hemorrhage, and 1.00 (95% CI, 0.84-1.20) for subarachnoid hemorrhage. When using 2-sample Mendelian randomization analysis, we found no statistically significant association between genetically proxied age at menopause and risk of any type of stroke. Conclusions In our study, earlier age at menopause was related to a higher risk of stroke. We found no statistically significant association between genetically proxied age at menopause and risk of stroke, suggesting no causal relationship.
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Affiliation(s)
- Lena Tschiderer
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- The George Institute for Global Health, School of Public HealthImperial College LondonLondonUnited Kingdom
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Anniek C. van Westing
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Division of Human Nutrition and HealthWageningen UniversityWageningenthe Netherlands
| | - Tammy Y. N. Tong
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Peter Willeit
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Lisa Seekircher
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Conchi Moreno‐Iribas
- Instituto de Salud Pública y Laboral de NavarraPamplonaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Department of EpidemiologyMurcia Regional Health Council‐IMIBMurciaSpain
| | - Marta Crous‐Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)–Bellvitge Biomedical Research Institute (IDIBELL)L’Hospitalet de LlobregatBarcelonaSpain
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
| | - Martin Söderholm
- Department of NeurologySkåne University Hospital, Lund and MalmöMalmöSweden
- Department of Clinical Sciences, MalmöLund UniversityMalmöSweden
| | - Matthias B. Schulze
- Department of Molecular EpidemiologyGerman Institute of Human Nutrition Potsdam‐RehbrueckeNuthetalGermany
- Institute of Nutritional ScienceUniversity of PotsdamNuthetalGermany
| | - Cecilia Johansson
- Skellefteå Research Unit, Department of Public Health and Clinical MedicineUmeå UniversityUmeåVästerbottenSweden
| | - Sara Själander
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
| | - Alessandra Macciotta
- Centre for Biostatistics, Epidemiology, and Public Health (C‐BEPH), Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | | | - Daniel B. Ibsen
- Department of Public HealthAarhus UniversityAarhusDenmark
- Steno Diabetes Center AarhusAarhusDenmark
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenFrederiksbergDenmark
| | - Valeria Pala
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Stephen Burgess
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
- MRC Biostatistics Unit, School of Clinical MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Angela Wood
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center, DKFZHeidelbergGermany
| | - Verena Katzke
- Division of Cancer EpidemiologyGerman Cancer Research Center, DKFZHeidelbergGermany
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Ministry of Health of the Basque GovernmentSub Directorate for Public Health and Addictions of GipuzkoaSan SebastianSpain
- Biodonostia Health Research InstituteEpidemiology of Chronic and Communicable Diseases GroupSan SebastianSpain
| | - Miguel Rodriguez‐Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Escuela Andaluza de Salud Pública (EASP)GranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
| | - Gunnar Engström
- Department of Clinical Sciences, MalmöLund UniversityMalmöSweden
| | | | - Anne Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public Health, Section of Environmental Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Jytte Halkjær
- Danish Cancer Society Research CenterCopenhagenDenmark
| | | | - John Danesh
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- National Institute for Health and Care Research Cambridge Biomedical Research CentreCambridge University HospitalsCambridgeUnited Kingdom
- The National Institute for Health and Care Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and GenomicsUniversity of CambridgeCambridgeUnited Kingdom
- Human GeneticsWellcome Sanger InstituteSaffron WaldenUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUnited Kingdom
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular MedicineAddenbrooke’s HospitalCambridgeUnited Kingdom
| | - Adam Butterworth
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUnited Kingdom
- NIHR Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeCambridgeUnited Kingdom
- BHF Centre of Research Excellence, School of Clinical MedicineAddenbrooke’s HospitalCambridgeUnited Kingdom
| | - N. Charlotte Onland‐Moret
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
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13
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Papa L, Cienki JJ, Wilson JW, Axline V, Coyle EA, Earwood RC, Thundiyil JG, Ladde JG. Sex Differences in Neurological Emergencies Presenting to Multiple Urban Level 1 Trauma Centers. Neurotrauma Rep 2023; 4:605-612. [PMID: 37731649 PMCID: PMC10507943 DOI: 10.1089/neur.2023.0050] [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: 09/22/2023] Open
Abstract
Previous studies have suggested that there are sex differences in the treatment and outcome of neurological emergencies; however, research identifying the role these sex differences play in the management of neurological emergencies is lacking. More knowledge of the way sex factors into the pathophysiology of neurological emergencies will be helpful in improving outcomes for these patients. The aim of this cross-sectional study was to assess the prevalence and management of neurological emergencies while evaluating sex differences in the diagnosis and treatment of these emergencies. We analyzed a cohort of 530 adult patients from four level 1 trauma centers over a period of 4 weeks who had a chief complaint of a neurological emergency, including seizures, cerebrovascular events, headache disorders, traumatic brain injuries, and central nervous system infections. Among patients with neurological emergencies, a significantly lower proportion of female patients underwent neurosurgery and were admitted to the intensive care unit compared to male patients, but there were no significant differences between sexes in the time of symptom onset, type of hospital transportation, amount of neuroimaging performed, admission rates, hospital length of stay, and disposition from the emergency department. Although female patients were more likely to have a chief complaint of headache compared to traumatic injuries in male patients, this was not statistically significant. A significantly higher proportion of female patients had health insurance coverage than male patients.
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Affiliation(s)
- Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - John J. Cienki
- Department of Emergency Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jason W. Wilson
- Division of Emergency Medicine, Morsani College of Medicine, Tampa, Florida, USA
| | - Virginia Axline
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Emily A. Coyle
- Department of Emergency Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Ryan C. Earwood
- Department of Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Josef G. Thundiyil
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Jay G. Ladde
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
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14
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De Matteis G, Biscetti F, Della Polla DA, Serra A, Burzo ML, Fuorlo M, Nicolazzi MA, Novelli A, Santoliquido A, Gambassi G, Gasbarrini A, Flex A, Franceschi F, Covino M. Sex-Based Differences in Clinical Characteristics and Outcomes among Patients with Peripheral Artery Disease: A Retrospective Analysis. J Clin Med 2023; 12:5094. [PMID: 37568498 PMCID: PMC10420161 DOI: 10.3390/jcm12155094] [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: 06/16/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Peripheral arterial disease (PAD) is a prevalent medical condition associated with high mortality and morbidity rates. Despite the high clinical burden, sex-based differences among PAD patients are not well defined yet, in contrast to other atherosclerotic diseases. This study aimed to describe sex-based differences in clinical characteristics and outcomes among hospitalized patients affected by PAD. This was a retrospective study evaluating all patients with a diagnosis of PAD admitted to the Emergency Department from 1 December 2013 to 31 December 2021. The primary endpoint of the study was the difference between male and female PAD patients in cumulative occurrence of Major Adverse Cardiovascular Events (MACEs) and Major Adverse Limb Events. A total of 1640 patients were enrolled. Among them, 1103 (67.3%) were males while females were significantly older (median age of 75 years vs. 71 years; p =< 0.001). Females underwent more angioplasty treatments for revascularization than men (29.8% vs. 25.6%; p = 0.04); males were treated with more amputations (19.9% vs. 15.3%; p = 0.012). A trend toward more MALEs and MACEs reported in the male group did not reach statistical significance (OR 1.27 [0.99-1.64]; p = 0.059) (OR 0.75 [0.50-1.11]; p = 0.153). However, despite lower extremity PAD severity seeming similar between the two sexes, among these patients males had a higher probability of undergoing lower limb amputations, of cardiovascular death and of myocardial infarction. Among hospitalized patients affected by PAD, even if there was not a sex-based significant difference in the incidence of MALEs and MACEs, adverse clinical outcomes were more common in males.
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Affiliation(s)
- Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
| | - Federico Biscetti
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | | | - Amato Serra
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
| | - Maria Livia Burzo
- Department of Internal Medicine, Ospedale Santo Spirito in Sassia, 00193 Rome, Italy
| | - Mariella Fuorlo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Maria Anna Nicolazzi
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Angela Novelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Angelo Santoliquido
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Giovanni Gambassi
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Andrea Flex
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
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15
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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.
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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.
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16
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Dawson J, MacDonald A. Sex and hypertensive organ damage: stroke. J Hum Hypertens 2023; 37:644-648. [PMID: 37059829 PMCID: PMC10403348 DOI: 10.1038/s41371-023-00830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
Stroke is a common cause of death and disability in both men and women. Differences in the incidence, presenting features and outcome after stroke have been reported between men and women. The global lifetime risk of stroke of approximately 25% is similar in men and women, although in women, the first cardiovascular event is more likely to be stroke than in men. Concerningly, there are reports of underuse of some treatments in women, although these differences may be diminishing over time. In addition, there are specific clinical challenges that can arise in women with stroke, such as stroke in people taking hormonal therapy, and stroke during pregnancy and stroke in the post-partum period. This review will cover these areas highlighting important differences and areas for future research. We found there are important differences in incidence of stroke, which differ by age. Further, there is concerning evidence that some treatments such as intravenous thrombolysis are underused in women. While there may be some differences in the relative effectiveness of treatments such as antiplatelet therapy and blood pressure reduction between men and women, for most aspects of stroke care, benefit is clear in both men and women and the emphasis must be on more equitable access. There is limited evidence to inform decision making during pregnancy and the post-partum period, but guidelines now exist and further research is needed in these areas.
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Affiliation(s)
- Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Alexander MacDonald
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
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17
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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] [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.
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Affiliation(s)
- Disi Gao
- School of Health Humanities, Peking University, Beijing 100191, China
| | - Huan Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Yue Wang
- School of Health Humanities, Peking University, Beijing 100191, China
| | - Sheng Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
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18
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Jong GP, Lin TK, Liao PL, Huang JY, Yang TY, Pan LF. Risk of New-onset Stroke in Patients with Type 2 Diabetes with Chronic Kidney Disease on Sodium-glucose Co-transporter-2 Inhibitor Users. Transl Stroke Res 2023:10.1007/s12975-023-01174-0. [PMID: 37442919 DOI: 10.1007/s12975-023-01174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023]
Abstract
Clinical studies have investigated the effects of using sodium-glucose co-transporter-2 (SGLT2) inhibitors on the development of new-onset stroke (NOS) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), but the findings are inconsistent. This study aimed to examine the association between the use of SGLT2 inhibitors and NOS risk in patients with T2D and CKD. We conducted a nationwide retrospective cohort study using data from the Taiwan Health Insurance Review and Assessment Service database for the years 2004 to 2019. The primary outcome was the risk of incident stroke, which was estimated using hazard ratios (HRs) and 95% confidence intervals (CIs). We used multiple Cox regression modeling to analyze the association between SGLT2 inhibitor use and the risk of stroke in patients with T2D and CKD. In a cohort of 113,710 patients with T2D and CKD who were using SGLT2 inhibitors and 227,420 patients with T2D and CKD who were not using SGLT2 inhibitors, after applying a 1:2 sex- and age-matching strategy, 2,842 and 7,169 NOS events were recorded, respectively. The event rate per 10,000 person-months was 10.60 (95% CI 10.21 to 11.03) for SGLT2 inhibitor users and 13.71 (13.39-14.03) for non-SGLT2 inhibitor users. After adjusting for the index year, sex, age, comorbidities, and concurrent medication, there was a decreased risk of NOS for SGLT2 inhibitor users (adjusted HR 0.80; 95% CI 0.77-0.84) compared with non-SGLT2 inhibitor users. The sensitivity test for the propensity score 1:1-matched analyses showed similar results (adjusted HR 0.80; 95% CI 0.76-0.84). The type of SGLT2 inhibitor subgroup analysis for incident stroke showed consistent results. We concluded that the use of SGLT2 inhibitors in patients with T2D and CKD was associated with significantly low rates of NOS. The significantly low rates of NOS in patients with T2D and CKD were greater among females and less than 50 years patients.
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Affiliation(s)
- Gwo-Ping Jong
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Tsung-Kun Lin
- Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Jing-Yang Huang
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Tsung-Yuan Yang
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Lung-Fa Pan
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, ROC.
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung, Taiwan, ROC.
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19
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Chen B, Jin W. A comprehensive review of stroke-related signaling pathways and treatment in western medicine and traditional Chinese medicine. Front Neurosci 2023; 17:1200061. [PMID: 37351420 PMCID: PMC10282194 DOI: 10.3389/fnins.2023.1200061] [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: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
This review provides insight into the complex network of signaling pathways and mechanisms involved in stroke pathophysiology. It summarizes the historical progress of stroke-related signaling pathways, identifying potential interactions between them and emphasizing that stroke is a complex network disease. Of particular interest are the Hippo signaling pathway and ferroptosis signaling pathway, which remain understudied areas of research, and are therefore a focus of the review. The involvement of multiple signaling pathways, including Sonic Hedgehog (SHH), nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE), hypoxia-inducible factor-1α (HIF-1α), PI3K/AKT, JAK/STAT, and AMPK in pathophysiological mechanisms such as oxidative stress and apoptosis, highlights the complexity of stroke. The review also delves into the details of traditional Chinese medicine (TCM) therapies such as Rehmanniae and Astragalus, providing an analysis of the recent status of western medicine in the treatment of stroke and the advantages and disadvantages of TCM and western medicine in stroke treatment. The review proposes that since stroke is a network disease, TCM has the potential and advantages of a multi-target and multi-pathway mechanism of action in the treatment of stroke. Therefore, it is suggested that future research should explore more treasures of TCM and develop new therapies from the perspective of stroke as a network disease.
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Affiliation(s)
- Binhao Chen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Weifeng Jin
- College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
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20
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Naveed H, Almasri M, Kazani B, Nauman A, Akhtar N, Singh R, Kamran S, Al Jerdi S, Thermalingem S, Shuaib A. Women and stroke: disparities in clinical presentation, severity, and short- and long-term outcomes. Front Neurol 2023; 14:1147858. [PMID: 37255725 PMCID: PMC10225500 DOI: 10.3389/fneur.2023.1147858] [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: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Objectives There are limited data from the Middle East on sex-related differences in short- and long-term stroke outcomes. We present 8 years of experience based on the Qatar stroke database. Setting The Qatar stroke database prospectively collects data on all stroke patients admitted to Hamad General Hospital. For this study, we compared female and male acute ischemic stroke patients on their characteristics at admission, short-term outcomes [modified Rankin Scale (mRS) score], and long-term outcomes [incidence of major adverse cardiovascular events (MACEs)]. Participants A total of 7,300 patients [F: 1,406 (19.3%), M: 5,894 (80.7%); mean age 55.1 ± 13.3 (F: 61.6 ± 15.1, M: 53.5 ± 12.3; p < 0.001)] were admitted with acute ischemic stroke. Results Significantly fewer women presented within 4.5 h of onset (F: 29% vs. M: 32.8%; p = 0.01). Although women were more likely to experience severe stroke (NIHSS >10; F: 19.9% vs. M: 14.5%; p < 0.001), fewer were treated with thrombolysis (F: 9.8% vs. M: 12.1%; p = 0.02). Women experienced more medical complications (F: 11.7% vs. M: 7.4%; p < 0.001) and tended to have a more prolonged length of stay in the hospital (F: 6.4 ± 7.6 days vs. M: 5.5 ± 6.8 days; p < 0.001). Primary and secondary outcome measures Good outcomes at 90 days (mRS score of 0-2) were less frequent in women (F: 53.3% vs. M: 71.2%; p < 0.001). Fewer female patients were taking antiplatelets (F: 78% vs. M: 84.8%; p < 0.001) or statins (F: 81.2% vs. M: 85.7%; p < 0.001). Significantly more female patients experienced a MACE (F: 12.6% vs. M: 6.5%; p < 0.001). Conclusion Older age at presentation contributes to poor outcomes following acute stroke in women. Other contributing factors include delays in admission to the hospital, lower rates of thrombolysis, and lower rates of provision of preventative treatments.
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Affiliation(s)
- Hiba Naveed
- Weill Cornell College of Medicine, Doha, Qatar
| | | | | | | | - Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sathvika Thermalingem
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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21
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Irie F, Matsuo R, Nakamura K, Wakisaka Y, Ago T, Kitazono T, Kamouchi M. Sex Differences in Long-Term Functional Decline after Ischemic Stroke: A Longitudinal Observational Study from the Fukuoka Stroke Registry. Cerebrovasc Dis 2023; 52:409-416. [PMID: 36754022 DOI: 10.1159/000526940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/30/2022] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Data on sex differences in poststroke functional status for a period longer than 1 year based on large cohorts are sparse. This study aimed to determine whether there are sex differences in long-term functional decline after ischemic stroke. METHODS We tracked functional status for 5 years among 3-month survivors of acute ischemic stroke and compared outcomes between women and men using a large-scale hospital-based stroke registry in Fukuoka, Japan. Functional status was assessed using the modified Rankin Scale (mRS). Functional dependency was defined as an mRS score of 3, 4, or 5. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals of outcomes after adjusting for possible confounders. RESULTS A total of 8,446 patients (71.9 ± 12.5 years, 3,377 (40.0%) female patients) were enrolled in this study. Female sex was associated with a higher risk of functional dependency at 5 years poststroke even when adjusting for age, 3-month mRS score, and other confounding factors (multivariable-adjusted OR vs. men, 1.56 [95% confidence interval, 1.26-1.93]). This significant association of female sex with higher dependency at 5 years was also found among patients who were independent at 3 months poststroke. Subgroup analysis showed that increased risk of functional dependency in female patients was more marked in patients aged ≥75 years than in those aged <75 years (p for heterogeneity = 0.02). Conversely, female sex was associated with a lower risk of death. No sex difference was observed in stroke recurrence during 5 years poststroke. DISCUSSION/CONCLUSION This longitudinal observational study suggests that female sex was independently associated with an increased risk of functional decline in the chronic phase of stroke, especially in older patients. There was no sex difference in 5-year stroke recurrence, and thus, other factors might be involved in more significant deterioration of functional status in female survivors of ischemic stroke. Further studies are needed to elucidate underlying causes of sex differences in long-term functional decline after stroke.
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Affiliation(s)
- Fumi Irie
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Oliveira LC, Ponciano A, Tuozzo C, Viswanathan A, Rost NS, Etherton MR. Poststroke Disability: Association Between Sex and Patient-Reported Outcomes. Stroke 2023; 54:345-353. [PMID: 36689580 DOI: 10.1161/strokeaha.122.041502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/12/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ischemic stroke (IS) is a leading cause of long-term disability with sex-specific differences in outcomes. Identifying the influential factors that contribute to sex-specific disparities in stroke outcomes, therefore, holds potential to develop individualized interventions for reducing long-term disability. Further, investigating the association between sex and Patient-Reported Outcome Measures (PROMs) provides additional information on the individual impact and heterogeneity of IS. We aimed to identify sex-specific differences in stroke outcomes and relationship with PROMs in IS patients with 3-month follow-up. METHODS Between February 2017 and February 2020, a total of 410 patients admitted with IS to the Massachusetts General Hospital, in Boston, were enrolled in this prospective cohort. At 3-month poststroke, patients were assessed for Barthel Index, modified Rankin Scale, and PROM-10 questionnaires. T scores for physical and mental health were determined from the summing of PROM-10 responses in each domain. Regression analysis was performed to identify sex-specific determinants of functional and patient-reported outcomes. RESULTS At baseline, 242 participants were male (mean age, 65 years) and 168 were female (mean age, 70 years). Groups had similar rates of cardiovascular risk factors, admission National Institutes of Health Stroke Scale, and discharge modified Rankin Scale. At follow-up, male participants were more likely to have better rates of T Physical and Barthel Index. In regression analysis, PROMs T Physical (odds ratio, 1.06; P=0.01), Barthel Index (odds ratio, 1.06; P=0.01), and modified Rankin Scale score of ≥2 (odds ratio, 2.60; P=0.01) were associated with female sex. Female sex was also associated with lower scores for PROMs Physical subcomponents and with patient-reported general health and emotional problems. CONCLUSIONS Women have worse outcomes after ischemic stroke, including objective measures of functional disability and patient-reported outcomes. Incorporating PROMs into IS outcome measures may offer additional insight into sex-specific differences in stroke recovery and outcomes.
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Affiliation(s)
- Lara C Oliveira
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.C.O., A.P., C.T., A.V., N.S.R.)
| | - Ana Ponciano
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.C.O., A.P., C.T., A.V., N.S.R.)
| | - Carissa Tuozzo
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.C.O., A.P., C.T., A.V., N.S.R.)
| | - Anand Viswanathan
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.C.O., A.P., C.T., A.V., N.S.R.)
| | - Natalia S Rost
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.C.O., A.P., C.T., A.V., N.S.R.)
| | - Mark R Etherton
- Biogen Inc, Stroke/Acute Neurology Neurovascular Therapeutics Development Unit, Cambridge, MA (M.R.E.)
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23
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Liu J, Wang M, Zhao Y, Chen H, Liu H, Yang B, Shan H, Li H, Shi Y, Wang L, Wang G, Han C. Associations between short-term exposure to ambient PM 2.5 and incident cases of cerebrovascular disease in Yantai, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:21970-21977. [PMID: 36282388 DOI: 10.1007/s11356-022-23626-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
There are limited studies examining the association between PM2.5 exposure and incident cerebrovascular disease (CD) cases in China. In this study, daily counts of incident CD cases and daily PM2.5 concentrations were obtained in Yantai, Shandong Province, China from 2014 to 2019. We used a combination of the Poisson-distribution generalized linear model (GLM) and a distributed lag nonlinear model (DLNM) to examine the association of short-term exposure to ambient PM2.5 and incident cases of CD. The results revealed that for every 10 μg/m3 increment of PM2.5 would increase the incident CD cases by 0.216% (RR:1.00216, 95%CI:1.0016-1.0028) at lag4. The stratified analysis demonstrated that the females and residents aged 65 years or above presented higher short-term PM2.5-associated CD risks than the males and aged below 65 years. Targeted prevention strategies should be adopted to reduce the PM2.5-related CD burden, especially for the susceptible population in China.
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Affiliation(s)
- Junyan Liu
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Maobo Wang
- Yantai Center for Disease Control and Prevention, Yantai, 264003, Shandong, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Haotian Chen
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Haiyun Liu
- Department of Public Health, Shandong College of Traditional Chinese Medicine, 264199, Yantai, China
| | - Baoshun Yang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Haifeng Shan
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Hongyu Li
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Yukun Shi
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Luyang Wang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Guangcheng Wang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Chunlei Han
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China.
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24
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Stroke Risk in Young Women with Primary Dysmenorrhea: A Propensity-Score-Matched Retrospective Cohort Study. J Pers Med 2023; 13:jpm13010114. [PMID: 36675775 PMCID: PMC9866310 DOI: 10.3390/jpm13010114] [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: 10/15/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Studies on strokes associated with dysmenorrhea are limited. We conducted a propensity-score-matched retrospective cohort study to assess the risk of stroke in women with primary dysmenorrhea (PD). METHODS From the claims data of one million people in Taiwan's insurance program, we identified 18,783 women aged 15-40 years, newly diagnosed with PD in 2000-2010, without a history of stroke. We randomly selected a comparison cohort without stroke history and dysmenorrhea, with the same sample size matched by age, index date, and propensity score. We began a follow-up with individuals one year after cohort entry to the end of 2013 to capture stroke events. RESULTS The two study cohorts were well-matched for age and comorbidities, with 54% of women aged 15-24. Stroke incidence was 1.5-fold higher in the PD cohort than in the comparison cohort (6.05 vs. 4.01 per 10,000 person-years, or 99 vs. 65 cases), with an adjusted hazard ratio (aHR) of 1.51 (95%CI 1.11-2.06) after adjustment for matched pairs. Nearly 70% of strokes were ischemic strokes, which occurred 1.6 times more frequently in the PD cohort than in the comparison cohort (4.40 vs. 2.71 per 10,000 person-years, or 72 vs. 44 cases), aHR = 1.61 (95% CI 1.11-2.33), after adjustment for matched pairs. The incidence of hemorrhagic stroke was also higher in the PD cohort than in the comparison cohort (1.65 vs. 1.29 per 10,000 person-years, or 27 versus 21 cases), but the difference was not significant. CONCLUSION Women of reproductive age with PD are at increased risk for ischemic stroke.
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25
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Yoon CW, Bushnell CD. Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes. J Stroke 2023; 25:2-15. [PMID: 36746378 PMCID: PMC9911842 DOI: 10.5853/jos.2022.03468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
Stroke is a particularly important issue for women. Women account for over half of all persons who experienced a stroke. The lifetime risk of stroke is higher in women than in men. In addition, women have worse stroke outcomes than men. Several risk factors have a higher association with stroke in women than in men, and women-specific risk factors that men do not have should be considered. This focused review highlights recent findings in stroke epidemiology, risk factors, and outcomes in women.
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Affiliation(s)
- Cindy W. Yoon
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA,Correspondence: Cheryl D. Bushnell Department of Neurology, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA Tel: +1-336-716-2983
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26
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Singh SK, McCullough L. Sex Differences in the Evaluation and Treatment of Stroke. Handb Exp Pharmacol 2023; 282:77-106. [PMID: 37460659 DOI: 10.1007/164_2023_682] [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: 10/13/2023]
Abstract
There are differences in the prevalence and strength of risk factors in women, along with sex-specific risk factors such as pregnancy. Women have a higher lifetime risk of stroke compared to men, with worse outcomes including higher rates of death and disability. We have made strides in the identification of sex-specific risk factors but with the paucity of sex-specific end points in clinical trials, stroke treatment and research are hindered.
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Affiliation(s)
- Sonia K Singh
- McGovern Medical School, UTHealth Houston, Houston, TX, USA
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27
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Niu P, Li L, Zhang Y, Su Z, Wang B, Liu H, Zhang S, Qiu S, Li Y. Immune regulation based on sex differences in ischemic stroke pathology. Front Immunol 2023; 14:1087815. [PMID: 36793730 PMCID: PMC9923235 DOI: 10.3389/fimmu.2023.1087815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/02/2023] [Indexed: 01/31/2023] Open
Abstract
Ischemic stroke is one of the world's leading causes of death and disability. It has been established that gender differences in stroke outcomes prevail, and the immune response after stroke is an important factor affecting patient outcomes. However, gender disparities lead to different immune metabolic tendencies closely related to immune regulation after stroke. The present review provides a comprehensive overview of the role and mechanism of immune regulation based on sex differences in ischemic stroke pathology.
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Affiliation(s)
- Pingping Niu
- Department of Neurosurgery, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.,Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - Liqin Li
- Department of Neurosurgery, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.,Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - Yonggang Zhang
- Department of Neurosurgery, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.,Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - Zhongzhou Su
- Department of Neurosurgery, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.,Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - Binghao Wang
- Department of Neurosurgery, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.,Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - He Liu
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - Shehong Zhang
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - Sheng Qiu
- Department of Neurosurgery, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.,Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
| | - Yuntao Li
- Department of Neurosurgery, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.,Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuro Modulation, Huzhou, China
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28
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Sex and Gender Bias as a Mechanistic Determinant of Cardiovascular Disease Outcomes. Can J Cardiol 2022; 38:1865-1880. [PMID: 36116747 DOI: 10.1016/j.cjca.2022.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/21/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022] Open
Abstract
Defined as a prejudice either for or against something, biases at the provider, patient, and societal level all contribute to differences in cardiovascular disease recognition and treatment, resulting in outcome disparities between sexes and genders. Provider bias in the under-recognition of female-predominant cardiovascular disease and risks might result in underscreened and undertreated patients. Furthermore, therapies for female-predominant phenotypes including nonobstructive coronary artery disease and heart failure with preserved ejection fraction are less well researched, contributing to undertreated female patients. Conversely, women are less likely to seek urgent medical attention, potentially related to societal bias to put others first, which contributes to diagnostic delays. Furthermore, women are less likely to have discussions around risk factors for coronary artery disease compared with men, partially because they are less likely to consider themselves at risk for heart disease. Provider bias in interpreting a greater number of presenting symptoms, some of which have been labelled as "atypical," can lead to mislabelling presentations as noncardiovascular. Furthermore, providers might avoid discussions around certain therapies including thrombolysis for stroke, and cardiac resynchronization therapy in heart failure, because it is incorrectly assumed that women are not interested in pursuing options deemed more invasive. To mitigate bias, organizations should aim to increase the visibility and involvement of women in research, health promotion, and clinical and leadership endeavours. More research needs to be done to identify effective interventions to mitigate sex and gender bias and the resultant cardiovascular outcome discrepancies.
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29
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Wang Y, Qiu L, Wang Y, He Z, Lan X, Cui L, Wang Y. Genetic variation within the pri-let-7f-2 in the X chromosome predicting stroke risk in a Chinese Han population from Liaoning, China: From a case-control study to a new predictive nomogram. Front Med (Lausanne) 2022; 9:936249. [DOI: 10.3389/fmed.2022.936249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background and objectivesStroke is the most common cause of disability and the second cause of death worldwide. Therefore, there is a need to identify patients at risk of developing stroke. This case-control study aimed to create and verify a gender-specific genetic signature-based nomogram to facilitate the prediction of ischemic stroke (IS) risk using only easily available clinical variables.Materials and methodsA total of 1,803 IS patients and 1,456 healthy controls from the Liaoning province in China (Han population) were included which randomly divided into training cohort (70%) and validation cohort (30%) using the sample function in R software. The distribution of the pri-let-7f-2 rs17276588 variant genotype was analyzed. Following genotyping analysis, statistical analysis was used to identify relevant features. The features identified from the multivariate logistic regression, the least absolute shrinkage and selection operator (LASSO) regression, and univariate regression were used to create a multivariate prediction nomogram model. A calibration curve was used to determine the discrimination accuracy of the model in the training and validation cohorts. External validity was also performed.ResultsThe genotyping analysis identified the A allele as a potential risk factor for IS in both men and women. The nomogram identified the rs17276588 variant genotype and several clinical parameters, including age, diabetes mellitus, body mass index (BMI), hypertension, history of alcohol use, history of smoking, and hyperlipidemia as risk factors for developing IS. The calibration curves for the male and female models showed good consistency and applicability.ConclusionThe pri-let-7f-2 rs17276588 variant genotype is highly linked to the incidence of IS in the northern Chinese Han population. The nomogram we devised, which combines genetic fingerprints and clinical data, has a lot of promise for predicting the risk of IS within the Chinese Han population.
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Gender inequality in source country modifies sex differences in stroke incidence in Canadian immigrants. Sci Rep 2022; 12:17965. [PMID: 36289316 PMCID: PMC9605977 DOI: 10.1038/s41598-022-22771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/19/2022] [Indexed: 01/24/2023] Open
Abstract
Research suggests that gender inequality, measured using the gender inequality index (GII), influences stroke mortality in women compared to men. We examine how source country GII modifies the rate of ischemic stroke in women compared to men after immigration to Canada, a country with low gender inequality. We used linked health data and immigration records of 452,089, stroke-free immigrants aged 40-69 year who migrated from 123 countries. Over 15 years of follow-up, 5991 (1.3%) had an incident ischemic stroke. We demonstrate (a) a lower adjusted rate of stroke in women compared to men (hazard ratio 0.64; 95% CI 0.61-0.67); (b) that sex differences in stroke incidence were modified by source country GII, as the hazard of stroke in women vs. men attenuated by a factor of 1.06 for every 0.1 increase in the GII of the source country (Psex*GII = 0.002); and (c) migration to a country with low GII attenuates the adverse effect of source country GII on sex differences in stroke incidence. Evaluating pathways through which source country gender inequality differentially influences stroke risk in immigrant women compared to men could help develop strategies to mitigate the effects of early-life gender inequality on stroke risk.
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Trentini A, Manfrinato MC, Castellazzi M, Bellini T. Sex-Related Differences of Matrix Metalloproteinases (MMPs): New Perspectives for These Biomarkers in Cardiovascular and Neurological Diseases. J Pers Med 2022; 12:jpm12081196. [PMID: 35893290 PMCID: PMC9331234 DOI: 10.3390/jpm12081196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
It is now established that sex differences occur in clinical manifestation, disease progression, and prognosis for both cardiovascular (CVDs) and central nervous system (CNS) disorders. As such, a great deal of effort is now being put into understanding these differences and turning them into “advantages”: (a) for the discovery of new sex-specific biomarkers and (b) through a review of old biomarkers from the perspective of the “newly” discovered sex/gender medicine. This is also true for matrix metalloproteinases (MMPs), enzymes involved in extracellular matrix (ECM) remodelling, which play a role in both CVDs and CNS disorders. However, most of the studies conducted up to now relegated sex to a mere confounding variable used for statistical model correction rather than a determining factor that can influence MMP levels and, in turn, disease prognosis. Consistently, this approach causes a loss of information that might help clinicians in identifying novel patterns and improve the applicability of MMPs in clinical practice by providing sex-specific threshold values. In this scenario, the current review aims to gather the available knowledge on sex-related differences in MMPs levels in CVDs and CNS conditions, hoping to shed light on their use as sex-specific biomarkers of disease prognosis or progression.
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Affiliation(s)
- Alessandro Trentini
- Department of Environmental and Prevention Sciences, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy;
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Cristina Manfrinato
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (M.C.M.); (T.B.)
| | - Massimiliano Castellazzi
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (M.C.M.); (T.B.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
- Correspondence:
| | - Tiziana Bellini
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (M.C.M.); (T.B.)
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Newel KT, Burma JS, Carere J, Kennedy C, Smirl JD. Does oscillation size matter? Impact of added resistance on the cerebral pressure-flow Relationship in females and males. Physiol Rep 2022; 10:e15278. [PMID: 35581899 PMCID: PMC9114660 DOI: 10.14814/phy2.15278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
Sinusoidal squat-stand maneuvers (SSM) without resistance have been shown to produce ~30-50 mmHg swings in mean arterial pressure which are largely buffered in the brain via dynamic cerebral autoregulation (dCA). This study aimed to further elucidate how this regulatory mechanism is affected during SSM with added resistance (~20% bodyweight). Twenty-five participants (sex/gender: 13 females/12 males) completed two bouts of 5-min SSM for both bodyweight and resistance conditions (10% bodyweight in each arm) at frequencies of 0.05 Hz (20-s squat/stand cycles) and 0.10 Hz (10-s squat/stand cycles). Middle and posterior cerebral artery (MCA/PCA) cerebral blood velocities were indexed with transcranial Doppler ultrasound. Beat-to-beat blood pressure (BP) was quantified via finger photoplesmography. Transfer function analysis was employed to quantify dCA in both cerebral arteries across the cardiac cycle (diastole, mean, and systole). Two-by-two Analysis of Variance with generalized eta squared effect sizes were utilized to determine differences between resistance vs. bodyweight squats and between sexes/genders. Absolute mean and diastolic BP were elevated during the resistance squats (p < 0.001); however, only the BP point-estimate power spectrum densities were augmented at 0.10 Hz (p < 0.048). No differences were noted for phase and gain metrics between bodyweight and resistance SSM (p > 0.067); however, females displayed attenuated systolic regulation (p < 0.003). Despite augmented systemic BP during resistance SSM, the brain was effective at buffering the additional stress to mitigate overperfusion/pressure. Females displayed less dCA regulation within the systolic aspect of the cardiac cycle, which may be associated with physiological underpinnings related to various clinical conditions/presentations.
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Affiliation(s)
- Kailey T. Newel
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Health and Exercise ScienceUniversity of British ColumbiaKelownaBritish ColumbiaCanada
| | - Joel S. Burma
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Joseph Carere
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Courtney M. Kennedy
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion LabFaculty of KinesiologyUniversity of CalgaryAlbertaCanada
- Sport Injury Prevention Research CentreFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance LaboratoryFaculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
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Ferket BS, Hunink MM, Masharani U, Max W, Yeboah J, Burke GL, Fleischmann KE. Lifetime Cardiovascular Disease Risk by Coronary Artery Calcium Score in Individuals With and Without Diabetes: An Analysis From the Multi-Ethnic Study of Atherosclerosis. Diabetes Care 2022; 45:975-982. [PMID: 35168253 PMCID: PMC9114718 DOI: 10.2337/dc21-1607] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess lifetime cardiovascular disease (CVD) risk by coronary artery calcium (CAC) score in individuals with diabetes from the Multi-Ethnic Study of Atherosclerosis (MESA) and compare risk with that in individuals without diabetes. RESEARCH DESIGN AND METHODS We developed a microsimulation model with well, diabetes, post-CVD, and death health states using multivariable time-dependent Cox regression with age as time scale. We initially used 10-year follow-up data of 6,769 MESA participants, including coronary heart disease (CHD) (n = 272), heart failure (n = 201), stroke (n = 186), and competing death (n = 619) and assessed predictive validity at 15 years. We externally validated the model in matched National Health and Nutrition Examination Survey (NHANES) participants. Subsequently, we predicted CVD risk until age 100 years by diabetes, 10-year pooled cohort equations risk, and CAC score category (0, 1-100, or 100+). RESULTS The model showed good calibration and discriminative performance at 15 years, with discrimination indices 0.71-0.78 across outcomes. In the NHANES cohort, predicted 15-year mortality risk corresponded well with Kaplan-Meier risk, especially for those with diabetes: 29.6% (95% CI 24.9-34.8) vs. 32.4% (95% CI 27.2-37.2), respectively. Diabetes increased lifetime CVD risk, similar to shifting one CAC category upward (from 0 to 1-100 or from 1-100 to 100+). Patients with diabetes and CAC score of 0 had a lifetime CVD risk that overlapped with that of individuals without diabetes who were at low 10-year pooled cohort equations risk (<7.5%). CONCLUSIONS Patients with diabetes carry a spectrum of CVD risk. CAC scoring may improve decisions for preventive interventions for patients with diabetes by better delineating lifetime CVD risk.
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Affiliation(s)
- Bart S. Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - M.G. Myriam Hunink
- Departments of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Umesh Masharani
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Wendy Max
- Institute for Health & Aging and Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston Salem, NC
| | - Gregory L. Burke
- Division of Public Health, Wake Forest School of Medicine, Winston Salem, NC
| | - Kirsten E. Fleischmann
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
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Lynch MA. Exploring Sex-Related Differences in Microglia May Be a Game-Changer in Precision Medicine. Front Aging Neurosci 2022; 14:868448. [PMID: 35431903 PMCID: PMC9009390 DOI: 10.3389/fnagi.2022.868448] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/08/2022] [Indexed: 12/16/2022] Open
Abstract
One area of microglial biology that has been relatively neglected until recently is sex differences and this is in spite of the fact that sex is a risk factor in several diseases that are characterized by neuroinflammation and, by extension, microglial activation. Why these sex differences exist is not known but the panoply of differences extend to microglial number, genotype and phenotype. Significantly, several of these sex-related differences are also evident in health and change during life emphasizing the dynamic and plastic nature of microglia. This review will consider how age impacts on sex-related differences in microglia and ask whether the advancement of personalized medicine demands that a greater focus is placed on studying sex-related differences in microglia in Alzheimer's disease, Parkinson's disease and models of inflammatory stress and trauma in order to make true progress in dealing with these conditions.
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Affiliation(s)
- Marina A. Lynch
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
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Olié V, Grave C, Tuppin P, Duloquin G, Béjot Y, Gabet A. Patients Hospitalized for Ischemic Stroke and Intracerebral Hemorrhage in France: Time Trends (2008-2019), In-Hospital Outcomes, Age and Sex Differences. J Clin Med 2022; 11:jcm11061669. [PMID: 35329995 PMCID: PMC8949281 DOI: 10.3390/jcm11061669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Rates of patients hospitalized for stroke increased among people aged under 65 years in France, as has been found in other countries. Methods: To analyze time trends in the rates of patients hospitalized for ischemic stroke (IS) and intracerebral hemorrhage (ICH) in France between 2008 and 2019 and determine related short-term outcomes mainly, we selected all patients hospitalized for stroke using the French national hospital database. Results: The average annual percentage change in the rates of patients hospitalized for IS increased significantly in men and women aged 50–64 years (+2.0%) and in men aged 18–34 years (+1.5%) and 35–44 years (+2.2%). A decrease in the average annual percentage change was observed for IS among people aged over 75 years and among those over 50 years for ICH. After adjustment on confounding factors, women were less likely to die in hospital. Case fatality rates decreased overtime in all age groups for both sexes, with a more pronounced decrease for IS than ICH. Conclusions: The increasing trend of IS among adults under 65 years is ongoing, highlighting the urgent need for stroke prevention programs in that age. For the first time, we recorded a decrease in the rates of patients hospitalized for ICH among the population over 50 years.
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Affiliation(s)
- Valérie Olié
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
| | - Clémence Grave
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
| | - Philippe Tuppin
- Department of Health Studies and Statistics, Caisse Nationale de l’Assurance Maladie, 75020 Paris, France;
| | - Gauthier Duloquin
- Dijon Stroke Registry, University Hospital of Burgundy, 21000 Dijon, France; (G.D.); (Y.B.)
| | - Yannick Béjot
- Dijon Stroke Registry, University Hospital of Burgundy, 21000 Dijon, France; (G.D.); (Y.B.)
| | - Amélie Gabet
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
- Correspondence:
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Hoyer C, Schlenker J, Sandikci V, Ebert A, Wittayer M, Platten M, Szabo K. Sex-Specific Differences in Pre-Stroke Characteristics Reveal Vulnerability of Elderly Women. J Pers Med 2022; 12:jpm12030344. [PMID: 35330344 PMCID: PMC8951678 DOI: 10.3390/jpm12030344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
While the sexually dimorphic character of ischemic stroke has been acknowledged along several dimensions, age-specific sex disparities regarding pre-stroke characteristics in particular have received comparatively little attention. This study aimed to identify age-dependent associations between sex and risk factors, premorbidity, and living situation in patients with ischemic stroke to foster the continuing development of dedicated preventative strategies. In a retrospective single-center study, data of patients with acute ischemic stroke (AIS) admitted to the Department of Neurology, University Hospital Mannheim, Germany, between June 2004−June 2020 were included; AIS frequency, vascular risk factors, premorbidity, living situation, and stroke etiology were analyzed across sexes and different age spectra. From a total of 11,003 patients included in the study, 44.1% were female. Women aged >70−≤90 years showed a pronounced increase in stroke frequency, lived alone significantly more frequently, and had a significantly higher degree of pre-stroke disability than men; however, only hypertension and atrial fibrillation were more prevalent in women in this age segment. The seventh and eighth decades are a critical time in which the pre-stroke risk profile changes resulting in an increase in stroke morbidity in women. This emphasizes the relevance of and need for an approach to stroke prevention that is both targeted and integrative.
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Affiliation(s)
- Carolin Hoyer
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, 68167 Mannheim, Germany; (C.H.); (J.S.); (V.S.); (A.E.); (M.W.); (M.P.)
- CCU Healthy Brain, Competence Network Preventive Medicine Baden-Württemberg, 68167 Mannheim, Germany
| | - Jan Schlenker
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, 68167 Mannheim, Germany; (C.H.); (J.S.); (V.S.); (A.E.); (M.W.); (M.P.)
| | - Vesile Sandikci
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, 68167 Mannheim, Germany; (C.H.); (J.S.); (V.S.); (A.E.); (M.W.); (M.P.)
| | - Anne Ebert
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, 68167 Mannheim, Germany; (C.H.); (J.S.); (V.S.); (A.E.); (M.W.); (M.P.)
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, 68167 Mannheim, Germany; (C.H.); (J.S.); (V.S.); (A.E.); (M.W.); (M.P.)
- CCU Healthy Brain, Competence Network Preventive Medicine Baden-Württemberg, 68167 Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, 68167 Mannheim, Germany; (C.H.); (J.S.); (V.S.); (A.E.); (M.W.); (M.P.)
| | - Kristina Szabo
- Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, 68167 Mannheim, Germany; (C.H.); (J.S.); (V.S.); (A.E.); (M.W.); (M.P.)
- CCU Healthy Brain, Competence Network Preventive Medicine Baden-Württemberg, 68167 Mannheim, Germany
- Correspondence:
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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.
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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
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Leppert MH, Burke JF, Lisabeth LD, Madsen TE, Kleindorfer DO, Sillau S, Schwamm LH, Daugherty SL, Bradley CJ, Ho PM, Poisson SN. Systematic Review of Sex Differences in Ischemic Strokes Among Young Adults: Are Young Women Disproportionately at Risk? Stroke 2022; 53:319-327. [PMID: 35073188 PMCID: PMC8852306 DOI: 10.1161/strokeaha.121.037117] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Recent evidence suggests that young women (18-45 years) may be at higher risk of ischemic strokes than men of the same age. The goal of this systematic review is to reconcile and synthesize existing evidence of sex differences among young adults with ischemic strokes. METHODS We searched PubMed from January 2008 to July 2021 for relevant articles and reviews and consulted their references. We included original studies that (1) were population based and (2) reported stroke incidence by sex or sex-specific incidence rate ratios of young adults ≤45 years. We excluded studies that (1) omitted measurements of error for incidence rates or incidence rate ratios, (2) omitted age adjustment, and (3) were not in English. Statistical synthesis was performed to estimate sex difference by age group (≤35, 35-45, and ≤45) and stroke type. RESULTS We found 19 studies that reported on sex-specific stroke incidence among young adults, including 3 that reported on overlapping data. Nine studies did not find a statistically significant sex difference among young adults ≤45 years. Three studies found higher rates of ischemic stroke among men among young adults ≥30 to 35 years. Four studies found more women with ischemic strokes among young adults ≤35 years. Overall, in young adults ≤35 years, the estimated effect size favored more ischemic strokes in women (incidence rate ratio, 1.44 [1.18-1.76], I2=82%) and a nonsignificant sex difference in young adults 35 to 45 years (incidence rate ratio, 1.08 [0.85-1.38], I2=95%). CONCLUSIONS Overall, there were 44% more women ≤35 years with ischemic strokes than men. This gap narrows in young adults, 35 to 45 years, and there is conflicting evidence whether more men or women have ischemic strokes in the 35 to 45 age group.
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Affiliation(s)
- Michelle H. Leppert
- Department of Neurology,University of Colorado School of Medicine,Aurora,CO,Corresponding Author:/919-906-2068/Twitter:@humich
| | - James F. Burke
- Department of Neurology,University of Michigan Health System,Ann Arbor,MI
| | - Lynda D. Lisabeth
- Department of Epidemiology,School of Public Health,University of Michigan,Ann Arbor,MI
| | - Tracy E. Madsen
- Department of Emergency Medicine,Alpert Medical School of Brown University,Providence,RI
| | | | - Stefan Sillau
- Department of Neurology,University of Colorado School of Medicine,Aurora,CO
| | - Lee H. Schwamm
- Department of Neurology,Massachusetts General Hospital,Boston,MA
| | - Stacie L. Daugherty
- Division of Cardiology,University of Colorado Anschutz Medical Campus,Aurora,CO
| | - Cathy J. Bradley
- Colorado Comprehensive Cancer Center,University of Colorado,Aurora,CO
| | - P. Michael Ho
- Division of Cardiology,University of Colorado Anschutz Medical Campus,Aurora,CO
| | - Sharon N. Poisson
- Department of Neurology,University of Colorado School of Medicine,Aurora,CO
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Affiliation(s)
- Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC (C.D.B)
| | - Moira K Kapral
- Department of Medicine, University of Toronto, ON, Canada (M.K.K.)
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Human-Induced Pluripotent Stem Cell-Based Models for Studying Sex-Specific Differences in Neurodegenerative Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1387:57-88. [PMID: 34921676 DOI: 10.1007/5584_2021_683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The prevalence of neurodegenerative diseases is steadily increasing worldwide, and epidemiological studies strongly suggest that many of the diseases are sex-biased. It has long been suggested that biological sex differences are crucial for neurodegenerative diseases; however, how biological sex affects disease initiation, progression, and severity is not well-understood. Sex is a critical biological variable that should be taken into account in basic research, and this review aims to highlight the utility of human-induced pluripotent stem cells (iPSC)-derived models for studying sex-specific differences in neurodegenerative diseases, with advantages and limitations. In vitro systems utilizing species-specific, renewable, and physiologically relevant cell sources can provide powerful platforms for mechanistic studies, toxicity testings, and drug discovery. Matched healthy, patient-derived, and gene-corrected human iPSCs, from both sexes, can be utilized to generate neuronal and glial cell types affected by specific neurodegenerative diseases to study sex-specific differences in two-dimensional (2D) and three-dimensional (3D) human culture systems. Such relatively simple and well-controlled systems can significantly contribute to the elucidation of molecular mechanisms underlying sex-specific differences, which can yield effective, and potentially sex-based strategies, against neurodegenerative diseases.
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Niu PP, Wang X, Xu YM. Association of Interleukin-6 Signaling and C-Reactive Protein With Intracranial Aneurysm: A Mendelian Randomization and Genetic Correlation Study. Front Genet 2021; 12:679363. [PMID: 34168680 PMCID: PMC8219052 DOI: 10.3389/fgene.2021.679363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background and objective Evidence suggests that interleukin-6 (IL6) signaling is causally associated with aortic aneurysm independently of the effect of C-reactive protein (CRP). We aimed to explore the genetic overlap and associations between inflammation (IL6 signaling and CRP) and intracranial aneurysm (IA) risk. Methods Two-sample Mendelian randomization (MR) methods were used to assess the causal effects of soluble IL6 receptor (sIL6R) (n = 21,758) and CRP (n = 204,402) levels on IA (7,495 cases and 71,934 controls) risk using genome-wide association study summary data of European individuals. Cross-trait linkage disequilibrium score regression was used to estimate the genetic correlations of CRP (n = 400,094) with IA. Results MR analyses showed that circulating sIL6R and CRP levels were not associated with the risk of IA. The odds ratios based on the inverse variance-weighted method were 0.986 (0.950-1.023, p = 0.45) and 0.957 (0.846-1.084, p = 0.49) for sIL6R and CRP, respectively. MR analyses using data of ruptured and unruptured IA each showed no association. Linkage disequilibrium score regression showed that the genetic correlation between CRP and IA was 0.16 (SE = 0.04, p = 0.0003). The genetic correlation diminished after conditioning IA on blood pressure (0.07 ± 0.05, p = 0.16), smoking (0.02 ± 0.05, p = 0.65), or blood pressure plus smoking (-0.03 ± 0.05, p = 0.53). Conclusion Using associated genetic variants as instrument variables, two-sample MR analyses showed no evidence that circulating sIL6R and CRP levels were associated with IA risk. Although a positive genetic correlation was found between CRP levels and IA risk, it was mainly driven by the shared genetic background of blood pressure and smoking with both CRP and IA.
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Affiliation(s)
- Peng-Peng Niu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xue Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Edzie EK, Dzefi-Tettey K, Gorleku P, Amankwa AT, Idun E, Brakohiapa EK, Cudjoe O, Quarshie F, Edzie RA, Asemah AR. Evaluation of the Anatomical Locations of Stroke Events From Computed Tomography Scan Examinations in a Tertiary Facility in Ghana. Cureus 2021; 13:e14097. [PMID: 33907641 PMCID: PMC8065308 DOI: 10.7759/cureus.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Stroke events are leading causes of mortalities globally and currently increasing alarmingly in low- and middle-income nations including Ghana, thus overburdening national healthcare delivery sectors. This trend is predicted to ultimately have an impact on the socio-economic development of these countries, thus gaining the attention of policy-makers and implementers. This study was therefore conducted to evaluate the anatomical locations of stroke events from CT scan examinations and the possibly associated variables to assist in managing this non-communicable pandemic. Methods All computed tomography (CT) scans performed for stroke events at the Cape Coast Teaching Hospital from June 2016 to June 2020 were retrieved and reviewed for this study. The socio-demographics and the presence of hypertensive risk factor were also retrieved. Data were then collated, grouped, coded, inputted, and used for analysis. Chi-square test of independence was employed for assessing possible associations, and logistic regression analysis was performed to predict the anatomical locations of stroke events using sex and hypertension. Statistical significance level was specified at p ≤ 0.05. Results A total of 1,750 stroke cases were recorded during the study period, comprising 1,237 (70.7%) ischemic strokes and 513 (29.3%) hemorrhagic strokes. Majority (54.3%) of the patients were males. The average age of participants was 62.46±14.74 years. Basal ganglia (43.0%), parietal lobe (26.7%), and frontal lobe (6.9%) were the commonest anatomical locations. The elderly (≥ 60 years) were significantly affected at the basal ganglia (p=0.006), parietal lobe (p=0.005), frontal lobe (p=0.013), temporal lobe (p=0.048), and cerebellum (p=0.049). Basal ganglia lesions were significantly recorded in men, whereas lesions located at the pons were significantly seen in females. The regression model revealed that the risk of stroke at the pons increased by 2.155-folds in males (p=0.043; 95% CI=1.026-4.528). Generally, gender and hypertension were not significant predictors of stroke lesion locations. Conclusions The basal ganglia area, which falls under the middle cerebral artery territory, was the commonest anatomical location for stroke events in our setting. Knowing the anatomical locations of these stroke events has an impact on the type of interventions needed, especially at the early stages of these stroke events. CT perfusion, CT angiography, and magnetic resonance imaging (MRI) with MR angiography (MRA) when available can further assist in determining the exact cause so that urgent interventions such as endovascular treatments can be offered.
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Affiliation(s)
- Emmanuel K Edzie
- Medical Imaging, University of Cape Coast School of Medical Sciences, Cape Coast, GHA
| | | | - Philip Gorleku
- Medical Imaging, University of Cape Coast School of Medical Sciences, Cape Coast, GHA
| | | | | | | | - Obed Cudjoe
- Anatomical Sciences, University of Cape Coast School of Medical Sciences, Cape Coast, GHA
| | - Frank Quarshie
- Epidemiology and Public Health, African Institute for Mathematical Sciences (AIMS), Accra, GHA
| | - Richard A Edzie
- Medical Imaging, University of Cape Coast School of Medical Sciences, Cape Coast, GHA
| | - Abdul R Asemah
- Medical Imaging, University of Cape Coast School of Medical Sciences, Cape Coast, GHA
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