Stroke Risk Factors, Course and Long-Term Functional Outcome of First-Ever Stroke in Women

Authors

  • Anetta Lasek-Bal Department of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice
  • Jan Szymszal Silesian Technical University, Katowice
  • Zofia Kazibutowska Department of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice

DOI:

https://doi.org/10.3889/oamjms.2014.021

Keywords:

stroke, risk factors, aethiology of stroke, gender, female.

Abstract

BACKGROUND: Recently, many studies regarding stroke in men and women showing differences in its incidence and course have been conducted, but the cause of sex differences remains unclear.

AIM: The objective of study was to assess the incidence of selected stroke risk factors, the course and long-term consequences of first-ever stroke in women.

MATERIAL AND METHODS: 304 women and 207 men with first-ever stroke were studied. We assessed: age at which stroke occurred; presence of hypertension, lipid disorders, coronary disease, atrial fibrillation, diabetes, carotid/cerebral artery stenoses; stroke aetiology, state on days 1 (NIHSS) and 90 (Rankin).

RESULTS: The age at which first-ever stroke occurred was higher in women (p = 0.030). Atrial fibrillation occurred more frequently in them (p = 0.0007). Hypertension and coronary disease occurred less commonly in women under 55 (p = 0.038 and 0.035 respectively). In women < 55, lipid disorders (p = 0.004) and diabetes (p = 0.018) were observed more rarely, they were more common in > 55 group (p = 0.042 and 0.023). In women, carotid artery stenoses were less common (p = 0.07), cardiogenic stroke more common (p = 0.001). They were in worse neurological state both on day 1 (p = 0.001) and 90 (p = 0.033) of disease.

CONCLUSIONS: Cardiogenic stroke is significantly more common in women. Women exhibit more severe post-stroke disability, resulting in more frequent use of institutional care.

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References

Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 113: e85-e151. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.171600

Hannon N, Sheehan O, Kelly L. Stroke associated with atrial fibrillation--incidence and early outcomes in the north Dublin population stroke study. Cerebrovasc Dis. 2010; 29: 43-49. DOI: https://doi.org/10.1159/000255973

Gargano JW, Reeves M. Sex differences in stroke recovery and stroke-specific quality of life. Stroke. 2007; 38: 2541-2548. DOI: https://doi.org/10.1161/STROKEAHA.107.485482

Glader EL, Stegmayr B, Norrving B, et al. Sex differences in management and outcome after stroke: a Swedish national perspective. Stroke. 2003; 34: 1970-1975. DOI: https://doi.org/10.1161/01.STR.0000083534.81284.C5

Elkind M, Prabhakaran S, Pittman J, et al. Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke. Neurology. 2007; 68: 842-848. DOI: https://doi.org/10.1212/01.wnl.0000256748.28281.ad

Kent D, Price L, Ringleb P, at al. Sex-based differences in response to recombinant tissue plasminogen activator in acute ischemic stroke: a pooled analysis of randomized clinical trials. Stroke. 2005; 36: 62-65. DOI: https://doi.org/10.1161/01.STR.0000150515.15576.29

Saposnik G, Di Legge S, Webster F, et al. Predictors of major neurologic improvement after thrombolysis in acute stroke. Neurology. 2005; 65: 1169-1174. DOI: https://doi.org/10.1212/01.wnl.0000180687.75907.4b

McCullough LD, Hurn PD. Estrogen and ischemic neuroprotection: an integrated view. Trends Endocrinol Metab. 2003; 14: 228–235. DOI: https://doi.org/10.1016/S1043-2760(03)00076-6

Wiszniewska M, Niewada M, Czlonkowska A. Sex differences in risk factor distribution, severity, and outcome of ischemic stroke. Acta Clin Croat. 2011; 50: 21-28.

The World Bank. World Development Report 1993. Investing in health. Oxford University Press, Oxford 1993.

Polskie Towarzystwo Nadciśnienia tętniczego: www.nadcisnienietetnicze.pl

Young FB, Weir CJ, Lees KR. GAIN International Trial Steering Committee and Investigators. Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials. Stroke. 2005; 36: 2187–2192. DOI: https://doi.org/10.1161/01.STR.0000181089.41324.70

Weisscher N, Vermeulen M, Roos YB, et al. What should be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2? J Neurol. 2008; 255: 867–874. DOI: https://doi.org/10.1007/s00415-008-0796-8

Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22: 983-988. DOI: https://doi.org/10.1161/01.STR.22.8.983

Furberg CD, Psaty BM, Manolio T, et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994; 74: 236-241. DOI: https://doi.org/10.1016/0002-9149(94)90363-8

Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285: 2370-2375. DOI: https://doi.org/10.1001/jama.285.18.2370

Humphries KH, Kerr CR, Connolly SJ, et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation. 2001; 103: 2365-2370. DOI: https://doi.org/10.1161/01.CIR.103.19.2365

Wartofsky L. Diseases of the thyroid. In: Fauci A, Braunwald E, Isselbacher K, et al, eds. Harrison’s Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998: 2024.

Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285: 2864-2870. DOI: https://doi.org/10.1001/jama.285.22.2864

Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV. Sex differences and similarities in the management and outcome of stroke patients. Stroke. 2000; 31: 1833-1837. DOI: https://doi.org/10.1161/01.STR.31.8.1833

Förster A, Gass A, Kern R, et al. Gender differences in acute ischemic stroke: etiology, stroke patterns and response to thrombolysis. Stroke. 2009; 40: 2428-2432. DOI: https://doi.org/10.1161/STROKEAHA.109.548750

Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009; 40: 1195-1203. DOI: https://doi.org/10.1161/STROKEAHA.108.529883

Fukuda M, Kanda T, Kamide N, et al. Gender differences in long-term functional outcome after first-ever ischemic stroke. Intern Med. 2009; 48: 967-973. DOI: https://doi.org/10.2169/internalmedicine.48.1757

Smith DB, Murphy P, Santos P, et al. Gender differences in the Colorado Stroke Registry. Stroke. 2009; 40: 1078-1081.

Giroud M, Milan C, Beuriat P, et al. Incidence and survival rates during a two-year period of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischemic attacks. The Stroke Registry of Dijon: 1985-1989. Int J Epidemiol. 1991; 20: 892-899. DOI: https://doi.org/10.1093/ije/20.4.892

Hays SN, Taler SJ. Hypertension in women current understanding of gender differences. Mayo ClinProc. 1998; 73: 157-165. DOI: https://doi.org/10.1016/S0025-6196(11)63649-5

Zhang X Sun Z, Zheng L, et al. Gender in blood lipid and the risk of ischemic stroke among the hypertensive adults in rural China. Neurol India. 2007; 55: 338-342. DOI: https://doi.org/10.4103/0028-3886.37092

Goldstein LB, Amarenco P, et al. Relative Effects of Statin Therapy on Stroke and Cardiovascular Events in Men and Women. Secondary Analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Study. Stroke. 2008; 39: 2444-2448. DOI: https://doi.org/10.1161/STROKEAHA.107.513747

Stuart-Shor EM, Wellenius GA, DelloIacono DM, Mittleman MA. Gender differences in presenting and prodromal stroke symptoms. Stroke. 2009; 40: 1121-1126. DOI: https://doi.org/10.1161/STROKEAHA.108.543371

Smith DB, Murphy P, Santos P, et al. Gender differences in the Colorado Stroke Registry. Stroke. 2009; 40: 1078-1081. DOI: https://doi.org/10.1161/STROKEAHA.108.541730

Roquer J, Rodríguez Campello A, Gomis M, et al. Sex Differences in First-Ever Acute Stroke. Stroke; 2003; 34: 1581-1585. DOI: https://doi.org/10.1161/01.STR.0000078562.82918.F6

Kapral MK, Fang J, Hill MD, et al. Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke. 2005; 36: 809–814. DOI: https://doi.org/10.1161/01.STR.0000157662.09551.e5

Di Carlo A, Lamassa M, Baldereschi M, et al. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke. 2003; 34: 1114–1119. DOI: https://doi.org/10.1161/01.STR.0000068410.07397.D7

Kissela B, Schneider A, Kleindorfer D, et al. Stroke in a biracial population: the excess burden of stroke among blacks. Stroke. 2004; 35: 426–431. DOI: https://doi.org/10.1161/01.STR.0000110982.74967.39

Barrett K, Brott T, Brown RJ, et al. Sex differences in stroke severity, symptoms, and deficits after first-ever ischemic stroke. J Stroke Cerebrovasc Dis. 2007; 16: 34–39. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.11.002

Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008; 7: 915-926. DOI: https://doi.org/10.1016/S1474-4422(08)70193-5

Alkayed NJ, Harukuni I, Kimes AS, et al. Gender-linked brain injury in experimental stroke. Stroke. 1998; 29: 159–165. DOI: https://doi.org/10.1161/01.STR.29.1.159

McCullough LD, Alkayed NJ, Traystman RJ et al. Postischemic estrogen reduces hypoperfusion and secondary ischemia after experimental stroke. Stroke. 2001; 32: 796–802. DOI: https://doi.org/10.1161/01.STR.32.3.796

Krause DN, Duckles SP, Pelligrino DA. Influence of sex steroid hormones on cerebrovascular function. J ApplPhysiol. 2006; 101: 1252–1261. DOI: https://doi.org/10.1152/japplphysiol.01095.2005

Appelros P, Stegmayr B, Terént A. Sex differences in stroke epidemiology: a systematic review. Stroke. 2009; 1082-1090. DOI: https://doi.org/10.1161/STROKEAHA.108.540781

Pappa T, Vemmos K, Mantzou E, et a. Estradiol levels predict short-term adverse health outcomes in postmenopausal acute stroke women. Eur J Neurol. 2012; 19: 1300-1304. DOI: https://doi.org/10.1111/j.1468-1331.2012.03714.x

Koellhoffer EC, McCullough LD. The effects of estrogen in ischemic stroke. Transl Stroke Res. 2013; 4: 390-401. DOI: https://doi.org/10.1007/s12975-012-0230-5

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Published

2014-03-15

How to Cite

1.
Lasek-Bal A, Szymszal J, Kazibutowska Z. Stroke Risk Factors, Course and Long-Term Functional Outcome of First-Ever Stroke in Women. Open Access Maced J Med Sci [Internet]. 2014 Mar. 15 [cited 2024 Nov. 23];2(1):119-23. Available from: https://oamjms.eu/index.php/mjms/article/view

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Section

B - Clinical Sciences