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Owais SB, Bulwa ZB, Ammar FE. Differences in stroke clinical presentation among sexes. J Stroke Cerebrovasc Dis 2024:107807. [PMID: 38851548 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/03/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION There are sex-based differences in stroke epidemiology, treatment, and outcomes. In this manuscript, we discuss the differences that exist in the clinical presentation of acute stroke among sexes. DISCUSSION We present the differences in stroke presentation among sexes including age at the time of presentation, severity of stroke on presentation, and stroke type and location. We discuss the atypical clinical presentations, explore the radiographic findings on presentation (including location, infarct core volume, the impact of collateral circulation, hematoma location in intracranial hemorrhage), and discuss differences in time elapsed between symptom onset and management amongst sexes. CONCLUSION Differences exist in stroke clinical presentation amongst sexes. These disparities have public health implications, and as they become better understood, impact awareness campaigns in both the public and healthcare communities.
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Affiliation(s)
- Syeda B Owais
- Department of Neurology, University of Illinois Chicago, Chicago, Illinois.
| | - Zachary B Bulwa
- Department of Neurology, NorthShore University HealthSystem, Evanston, Illinois.
| | - Faten El Ammar
- Department of Neurology, University of Illinois Chicago, Chicago, Illinois.
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McCandless MG, Powers AY, Baker KE, Strickland AE. Trends in Demographic and Geographic Disparities in Stroke Mortality Among Older Adults in the United States. World Neurosurg 2024; 185:e620-e630. [PMID: 38403013 DOI: 10.1016/j.wneu.2024.02.094] [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: 08/10/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality in the United States among older adults. However, the impact of demographic and geographic risk factors remains ambiguous. A clear understanding of these associations and updated trends in stroke mortality can influence health policies and interventions. METHODS This study characterizes stroke mortality among older adults (age ≥55) in the US from January 1999 to December 2020, sourcing data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. Segmented regression was used to analyze trends in crude mortality rate and age-adjusted mortality rate (AAMR) per 100,000 individuals stratified by stroke subcategory, sex, ethnicity, urbanization, and state. RESULTS A total of 3,691,305 stroke deaths occurred in older adults in the US between 1999 and 2020 (AAMR = 233.3), with an overall decrease in AAMR during these years. The highest mortality rates were seen in nonspecified stroke (AAMR = 173.5), those 85 or older (crude mortality rate1276.7), men (AAMR = 239.2), non-Hispanic African American adults (AAMR = 319.0), and noncore populations (AAMR = 276.1). Stroke mortality decreased in all states from 1999 to 2019 with the greatest and least decreases seen in California (-61.9%) and Mississippi (-35.0%), respectively. The coronavirus pandemic pandemic saw increased stroke deaths in most groups. CONCLUSIONS While there's a decline in stroke-related deaths among US older adults, outcome disparities remain across demographic and geographic sectors. The surge in stroke deaths during coronavirus pandemic reaffirms the need for policies that address these disparities.
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Affiliation(s)
- Martin G McCandless
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA; Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | - Andrew Y Powers
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E Baker
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Allison E Strickland
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Hepworth LR, Kirkham JJ, Perkins E, Helliwell B, Howard C, Liptrot M, Tawana S, Wilson E, Rowe FJ. Validation of the brain injury associated visual impairment - impact questionnaire (BIVI-IQ). Qual Life Res 2024; 33:777-791. [PMID: 38112864 PMCID: PMC10894123 DOI: 10.1007/s11136-023-03565-0] [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] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The Brain Injury associated Visual Impairment - Impact Questionnaire (BIVI-IQ) was developed to assess the impact of post-stroke visual impairment. The development of the questionnaire used robust methods involving stroke survivors and clinicians. The aim of this study was to assess the validity of the BIVI-IQ in a stroke population. METHODS Stroke survivors with visual impairment were recruited from stroke units, outpatient clinics and non-healthcare settings. Participants were asked to complete questionnaire sets on three separate occasions; the BIVI-IQ at each visit with additional questionnaires at baseline and visit 2. Vision assessment and anchor questions from participants and clinicians were collected. The analysis included assessment of missing data, acceptability, Rasch model analysis, test-retest reliability, construct validity (NEI VFQ-25, EQ-5D-5L) and responsiveness to change. RESULTS 316 stroke survivors completed at least one questionnaire of the 326 recruited. Mean age was 67 years and 64% were male. Adequate fit statistics to the Rasch model were reached (χ2 = 73.12, p = 0.02) with two items removed and thresholds of two adjusted, indicating validity and unidimensionality. Excellent test-retest reliability was demonstrated (ICC = 0.905) with a 3-month interval. Construct validity was demonstrated with a strong significant correlation to the NEI VFQ-25 (r = 0.837, p < 0.01). The BIVI-IQ also demonstrated responsiveness to change with significant differences identified between groups based on participant and clinician anchor questions (X2 = 23.29, p < 0.001; X2 = 24.56, p < 0.001). CONCLUSION The BIVI-IQ has been shown to be valid and practical for 'everyday' use by clinicians and researchers to monitor vision-related quality of life in stroke survivors with visual impairment.
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Affiliation(s)
- L R Hepworth
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
- Northern Care Alliance NHS Foundation Trust, Salford, UK.
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK.
| | - J J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - E Perkins
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - B Helliwell
- VISable, Patient and Public Representative, Liverpool, UK
| | - C Howard
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - M Liptrot
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - S Tawana
- Buckinghamshire Healthcare NHS Trust, High Wycombe, UK
| | - E Wilson
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - F J Rowe
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, First Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
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van der Meij A, Holswilder G, Bernsen MLE, van Os HJ, Hofmeijer J, Spaander FH, Martens JM, van den Wijngaard IR, Lingsma HF, Konduri PR, Blm Majoie C, Schonewille WJ, Dippel DW, Kruyt ND, Nederkoorn PJ, van Walderveen MA, Wermer MJ. Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy. Eur Stroke J 2024:23969873241231125. [PMID: 38420950 DOI: 10.1177/23969873241231125] [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: 03/02/2024] Open
Abstract
INTRODUCTION To improve our understanding of the relatively poor outcome after endovascular treatment (EVT) in women we assessed possible sex differences in baseline neuroimaging characteristics of acute ischemic stroke patients with large anterior vessel occlusion (LVO). PATIENTS AND METHODS We included all consecutive patients from the MR CLEAN Registry who underwent EVT between 2014 and 2017. On baseline non-contrast CT and CT angiography, we assessed clot location and clot burden score (CBS), vessel characteristics (presence of atherosclerosis, tortuosity, size, and collateral status), and tissue characteristics with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Radiological outcome was assessed with the extended thrombolysis in cerebral infarction score (eTICI) and functional outcome with the modified Rankin Scale score (mRS) at 90 days. Sex-differences were assessed with multivariable regression analyses with adjustments for possible confounders. RESULTS 3180 patients were included (median age 72 years, 48% women). Clots in women were less often located in the intracranial internal carotid artery (ICA) (25%vs 28%, odds ratio (OR) 0.85;95% confidence interval: 0.73-1.00). CBS was similar between sexes (median 6, IQR 4-8). Intracranial (aOR 0.73;95% CI:0.62-0.87) and extracranial (aOR 0.64;95% CI:0.43-0.95) atherosclerosis was less prevalent in women. Vessel tortuosity was more frequent in women in the cervical ICA (aOR 1.89;95% CI:1.39-2.57) and women more often had severe elongation of the aortic arch (aOR 1.38;95% CI:1.00-1.91). ICA radius was smaller in women (2.3vs 2.5 mm, mean difference 0.22;95% CI:0.09-0.35) while M1 radius was essentially equal (1.6vs 1.7 mm, mean difference 0.09;95% CI:-0.02-0.21). Women had better collateral status (⩾50% filling in 62%vs 53% in men, aOR 1.48;95% CI:1.29-1.70). Finally, ASPECT scores were equal between women and men (median 9 in both sexes, IQR 8-10vs 9-10). Reperfusion rates were similar between women and men (acOR 0.94;95% CI:0.83-1.07). However, women less often reached functional independence than men (34%vs 46%, aOR 0.68;95% CI:0.53-0.86). DISCUSSION AND CONCLUSION On baseline imaging of this Dutch Registry, men and women with LVO mainly differ in vessel characteristics such as atherosclerotic burden, extracranial vessel tortuosity, and collateral status. These sex differences do not result in different reperfusion rates and are, therefore, not likely to explain the worse functional outcome in women after EVT.
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Affiliation(s)
- Anne van der Meij
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ghislaine Holswilder
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Louise E Bernsen
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Hendrikus Ja van Os
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | | | - Jasper M Martens
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Praneeta R Konduri
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Blm Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Diederik Wj Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marieke Jh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
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Abdalkader M, Ning S, Qureshi MM, Haussen DC, Strbian D, Nagel S, Demeestere J, Puetz V, Mohammaden MH, Olive Gadea M, Winzer S, Yamagami H, Tanaka K, Marto JP, Tomppo L, Henon H, Sheth SA, Ortega-Gutierrez S, Martinez-Majander N, Caparros F, Lemmens R, Dusart A, Bellante F, Zaidi SF, Siegler JE, Nannoni S, Kaesmacher J, Dobrocky T, Farooqui M, Salazar-Marioni S, Virtanen P, Vandewalle L, Wouters A, Jesser J, Ventura R, Castonguay AC, Uchida K, Puri AS, Masoud HE, Klein P, Mansoor Z, Bui J, Kang M, Mujanovic A, Rizzo F, Kokkonen T, Ramos JN, Strambo D, Michel P, Möhlenbruch MA, Lin E, Kaiser DPO, Yoshimura S, Sakai N, Cordonnier C, Ringleb PA, Roy D, Zaidat OO, Fischer U, Ribo M, Raymond J, Nogueira RG, Nguyen TN. Sex Differences in Outcomes of Late-Window Endovascular Stroke Therapy. Stroke 2024; 55:278-287. [PMID: 38252759 DOI: 10.1161/strokeaha.123.045015] [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: 09/02/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The association between sex and outcome after endovascular thrombectomy of acute ischemic stroke is unclear. The aim of this study was to compare the clinical and safety outcomes between men and women treated with endovascular thrombectomy in the late 6-to-24-hour window period. METHODS This multicenter, retrospective observational cohort study included consecutive patients who underwent endovascular thrombectomy of anterior circulation stroke in the late window from 66 clinical sites in 10 countries from January 2014 to May 2022. The primary outcome was the 90-day ordinal modified Rankin Scale score. Secondary outcomes included 90-day functional independence (FI), return of Rankin (RoR) to prestroke baseline, FI or RoR, symptomatic intracranial hemorrhage, and mortality. Multivariable and inverse probability of treatment weighting methods were used. We explored the interaction of sex with baseline characteristics on the outcomes ordinal modified Rankin Scale and FI or RoR. RESULTS Of 1932 patients, 1055 were women and 877 were men. Women were older (77 versus 69 years), had higher rates of atrial fibrillation, hypertension, and greater prestroke disability, but there was no difference in baseline National Institutes of Health Stroke Scale score. Inverse probability of treatment weighting analysis showed no difference between women and men in ordinal modified Rankin Scale (odds ratio, 0.98 [95% CI, 0.79-1.21]), FI or RoR (odds ratio, 0.98 [95% CI, 0.78-1.22]), severe disability or mortality (odds ratio, 0.99 [95% CI, 0.80-1.23]). The multivariable analysis of the above end points was concordant. There were no interactions between baseline characteristics and sex on the outcomes of ordinal modified Rankin Scale and FI or RoR. CONCLUSIONS In late presenting patients with anterior circulation stroke treated with endovascular thrombectomy in the 6 to 24-hour window, there was no difference in clinical or safety outcomes between men and women.
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Affiliation(s)
- Mohamad Abdalkader
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Shen Ning
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Muhammad M Qureshi
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Radiation Oncology (M.M.Q.), Boston Medical Center
| | - Diogo C Haussen
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
| | - Daniel Strbian
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Germany (S. Nagel)
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Jelle Demeestere
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Volker Puetz
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | | | - Marta Olive Gadea
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Simon Winzer
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Hiroshi Yamagami
- Department of Stroke Neurology, NHO Osaka National Hospital, Japan (H.Y.)
| | - Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - João Pedro Marto
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Liisa Tomppo
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Hilde Henon
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Sunil A Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston (S.A.S., S.S.-M.)
| | | | | | - Francois Caparros
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Robin Lemmens
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Syed F Zaidi
- Department of Neurology, University of Toledo, Toledo (S.F.Z., A.C.C.)
| | | | - Stefania Nannoni
- Clinical Neurosciences, University of Cambridge, United Kingdom (S. Nannoni)
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | | | | | - Pekka Virtanen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - Lieselotte Vandewalle
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anke Wouters
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Jessica Jesser
- Radiology (J.J., M.A.M.). Heidelberg University Hospital, Germany
| | - Rita Ventura
- Departments of Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | | | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Ajit S Puri
- Interventional Neuroradiology, University of Massachusetts Memorial Medical Center (A.S.P.)
| | - Hesham E Masoud
- Department of Neurology, State University of New York (H.E.M.)
| | - Piers Klein
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Zain Mansoor
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Jenny Bui
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Matthew Kang
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Adnan Mujanovic
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Federica Rizzo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Tatu Kokkonen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - João Nuno Ramos
- Radiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | - Davide Strambo
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | | | - Eugene Lin
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Daniel P O Kaiser
- Institute of Neuroradiology (D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Nobuyuki Sakai
- Neurovascular Research, Kobe City Medical Center General Hospital, Japan (N.S.)
| | - Charlotte Cordonnier
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Peter A Ringleb
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Daniel Roy
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, Switzerland (U.F.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Jean Raymond
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Raul G Nogueira
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
- Department of Neurology, University of Pittsburgh Medical Center (R.G.N.)
| | - Thanh N Nguyen
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Neurology (T.N.N.), Boston Medical Center
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Mehta SL, Chelluboina B, Morris-Blanco KC, Bathula S, Jeong S, Arruri V, Davis CK, Vemuganti R. Post-stroke brain can be protected by modulating the lncRNA FosDT. J Cereb Blood Flow Metab 2024; 44:239-251. [PMID: 37933735 PMCID: PMC10993881 DOI: 10.1177/0271678x231212378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/09/2023] [Accepted: 09/29/2023] [Indexed: 11/08/2023]
Abstract
We previously showed that knockdown or deletion of Fos downstream transcript (FosDT; a stroke-induced brain-specific long noncoding RNA) is neuroprotective. We presently tested the therapeutic potential of FosDT siRNA in rodents subjected to transient middle cerebral artery occlusion (MCAO) using the Stroke Treatment Academic Industry Roundtable criteria, including sex, age, species, and comorbidity. FosDT siRNA (IV) given at 30 min of reperfusion significantly improved motor function recovery (rotarod test, beam walk test, and adhesive removal test) and reduced infarct size in adult and aged spontaneously hypertensive rats of both sexes. FosDT siRNA administered in a delayed fashion (3.5 h of reperfusion following 1 h transient MCAO) also significantly improved motor function recovery and decreased infarct volume. Furthermore, FosDT siRNA enhanced post-stroke functional recovery in normal and diabetic mice. Mechanistically, FosDT triggered post-ischemic neuronal damage via the transcription factor REST as REST siRNA mitigated the enhanced functional outcome in FosDT-/- rats. Additionally, NF-κB regulated FosDT expression as NF-κB inhibitor BAY 11-7082 significantly decreased post-ischemic FosDT induction. Thus, FosDT is a promising target with a favorable therapeutic window to mitigate secondary brain damage and facilitate recovery after stroke regardless of sex, age, species, and comorbidity.
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Affiliation(s)
- Suresh L Mehta
- Department of Neurological Surgery University of Wisconsin, Madison, WI, USA
| | - Bharath Chelluboina
- Department of Neurological Surgery University of Wisconsin, Madison, WI, USA
| | - Kahlilia C Morris-Blanco
- Department of Neurological Surgery University of Wisconsin, Madison, WI, USA
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Soomin Jeong
- Department of Neurological Surgery University of Wisconsin, Madison, WI, USA
- Neuroscience Training Program, University of Wisconsin, Madison, WI, USA
| | - Vijay Arruri
- Department of Neurological Surgery University of Wisconsin, Madison, WI, USA
| | - Charles K Davis
- Department of Neurological Surgery University of Wisconsin, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery University of Wisconsin, Madison, WI, USA
- Neuroscience Training Program, University of Wisconsin, Madison, WI, USA
- William S. Middleton Veterans Hospital, Madison, WI, USA
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Liu H, Jin A, Pan Y, Jing J, Meng X, Li H, Li Z, Wang Y. Trends of Sex Differences and Associated Factors in Stroke Outcomes Among Patients With Acute Ischemic Stroke: 2007 to 2018. Neurology 2024; 102:e207818. [PMID: 38165366 PMCID: PMC10834133 DOI: 10.1212/wnl.0000000000207818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Female patients have been shown to experience worse clinical outcomes after acute ischemic stroke (AIS) compared with male patients. We aimed to estimate the temporal trends in the sex differences in stroke outcomes and identify risk factors contributing to the sex differences spanning 10 years in China. METHODS This cohort study was conducted based on data from the China National Stroke Registries (CNSRs, comprising 3 phases, I-III, from 2007 to 2018). Patients with ischemic stroke within 7 days of symptom onset were included. The primary outcome was a 12-month poor functional outcome. Other outcomes included mortality and disability-adjusted life-year (DALY) lost. The sex differences in outcomes and associated factors were estimated using multivariable logistic regression. The sex differences between CNSRs were tested by the interaction of sex and time. RESULTS Among 42,564 patients included, 35.4% were female. The age-adjusted event rate of 12-month poor functional outcome and mortality decreased both in male and female patients after stroke onset (CNSRs I, II, and III, all p varies over time <0.001). There was a decrease in DALY lost for both sexes over the decade (male patients: from 10.1 to 9.3 DALYs; female patients: from 10.9 to 9.6 DALYs). Female patients showed worse 12-month poor functional outcome in CNSRs I and II (odds ratio [OR] with 95% CI: 1.24 [1.10-1.39] and 1.12 [1.01-1.25], respectively) compared with male patients, but the sex difference attenuated in CNSR III (OR with 95% CI: 1.02 [0.89-1.16]), with the temporal trend (p varies over time = 0.004). The sex difference and the temporal trend of the sex difference in mortality from 2007 to 2018 were not found (p varies over time = 0.45). The most important factors attenuating the sex difference in poor functional outcome in CNSRs I and III were education level, socioeconomic deprivation, baseline stroke severity, and current smoking. DISCUSSION This study demonstrated that the sex disparity in poor functional outcome at 12 months was substantially narrowed covering 10 years and completely attenuated in 2015-2018. The findings suggested that female patients have experienced larger improvements in stroke outcomes than male patients over the past decade.
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Affiliation(s)
- Huihui Liu
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Aoming Jin
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Yuesong Pan
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Jing Jing
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Xia Meng
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Hao Li
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Zixiao Li
- From the Department of Neurology, Beijing Tiantan Hospital, China
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, China
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Simon Machado R, Mathias K, Joaquim L, Willig de Quadros R, Petronilho F, Tezza Rezin G. From diabetic hyperglycemia to cerebrovascular Damage: A narrative review. Brain Res 2023; 1821:148611. [PMID: 37793604 DOI: 10.1016/j.brainres.2023.148611] [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: 07/13/2023] [Revised: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
Diabetes mellitus is a globally significant disease that can lead to systemic complications, particularly vascular damage, including cardiovascular and cerebrovascular diseases of relevance. The physiological changes resulting from the imbalance in blood glucose levels play a crucial role in initiating vascular endothelial damage. Elevated glucose levels can also penetrate the central nervous system, triggering diabetic encephalopathy characterized by oxidative damage to brain components and activation of alternative and neurotoxic pathways. This brain damage increases the risk of ischemic stroke, a leading cause of mortality worldwide and a major cause of disability among surviving patients. The aim of this review is to highlight important pathways related to hyperglycemic damage that extend to the brain and result in vascular dysfunction, ultimately leading to the occurrence of a stroke. Understanding how diabetes mellitus contributes to the development of ischemic stroke and its impact on patient outcomes is crucial for implementing therapeutic strategies that reduce the incidence of diabetes mellitus and its complications, ultimately decreasing morbidity and mortality associated with the disease.
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Affiliation(s)
- Richard Simon Machado
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciuma, SC, Brazil; Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Tubarão, SC, Brazil.
| | - Khiany Mathias
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciuma, SC, Brazil
| | - Larissa Joaquim
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciuma, SC, Brazil
| | - Rafaella Willig de Quadros
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciuma, SC, Brazil
| | - Fabricia Petronilho
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciuma, SC, Brazil
| | - Gislaine Tezza Rezin
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Tubarão, SC, Brazil
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9
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Etkin Y, Iyeke L, Yu G, Ahmed I, Matera P, Aminov J, Kokkosis A, Hastings L, Garg K, Rockman C. Sex disparities in outcomes after carotid artery interventions: A systematic review. Semin Vasc Surg 2023; 36:476-486. [PMID: 38030321 DOI: 10.1053/j.semvascsurg.2023.09.004] [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: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023]
Abstract
This systematic review aimed to identify sex-specific outcomes in men and women after carotid endarterectomy (CEA) and carotid artery stenting (CAS), including transfemoral and transcarotid. A search of literature published from January 2000 through December 2022 was conducted using key terms attributed to carotid interventions on PubMed. Studies comparing outcome metrics post intervention (ie, myocardial infarction [MI], cerebral vascular accident [CVA] or stroke, and long-term mortality) among male and female patients were reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Overall, all studies reported low rates of perioperative complications. Among the studies that did not stratify outcomes by the preoperative symptom status, there were no significant sex differences in rates of perioperative strokes or MIs. Two studies, however, noted a higher rate of 30-day mortality in male patients undergoing CEA than in female patients. Analysis of asymptomatic patients undergoing CEA revealed no difference in perioperative MIs (female: 0% to 1.8% v male: 0.4% to 4.3%), similar rates of CVAs (female: 0.8% to 5% v male: 0.8% to 4.9%), and no significant differences in the long-term mortality outcomes. Alternatively, symptomatic patients undergoing CEA reported a higher rate of CVAs in female patients vs. male patients (7.7% v 6.2%) and showed a higher rate of death in female patients (1% v 0.7%). Among studies that did not stratify outcome by symptomatology, there was no difference in the 30-day outcomes between sexes for patients undergoing CAS. Asymptomatic patients undergoing CAS demonstrated similar incident rates across perioperative MIs (female: 0% to 5.9% v male: 0.28% to 3.3%), CVAs (female: 0.5% to 4.1% v male: 0.4% to 6.2%), and long-term mortality outcomes (female: 0% to 1.75% v male: 0.2% to 1.5%). Symptomatic patients undergoing CAS similarly reported higher incidences of perioperative MIs (female: 0.3% to 7.1% v male: 0% to 5.5%), CVAs (female: 0% to 9.9% v male: 0% to 7.6%), and long-term mortality outcomes (female: 0.6% to 7.1% v male: 0.5% to 8.2%). Sex-specific differences in outcomes after major vascular procedures are well recognized. Our review suggests that symptomatic female patients have a higher incidence of neurologic and cardiac events after carotid interventions, but that asymptomatic patients do not.
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Affiliation(s)
- Yana Etkin
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, 1999 Marcus Avenue, Suite 106, Lake Success, NY, 11042.
| | - Lisa Iyeke
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, 1999 Marcus Avenue, Suite 106, Lake Success, NY, 11042
| | - Grace Yu
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, 1999 Marcus Avenue, Suite 106, Lake Success, NY, 11042
| | | | | | - Jonathan Aminov
- Division of Vascular and Endovascular Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Angela Kokkosis
- Division of Vascular and Endovascular Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Laurel Hastings
- Division of Vascular Surgery, Einstein Medical Center, Philadelphia, PA
| | - Karan Garg
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY
| | - Caron Rockman
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY
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10
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Chen C, Khanthiyong B, Thaweetee-Sukjai B, Charoenlappanit S, Roytrakul S, Thanoi S, Reynolds GP, Nudmamud-Thanoi S. Proteomic association with age-dependent sex differences in Wisconsin Card Sorting Test performance in healthy Thai subjects. Sci Rep 2023; 13:20238. [PMID: 37981639 PMCID: PMC10658079 DOI: 10.1038/s41598-023-46750-4] [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: 02/16/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023] Open
Abstract
Sex differences in cognitive function exist, but they are not stable and undergo dynamic change during the lifespan. However, our understanding of how sex-related neural information transmission evolves with age is still in its infancy. This study utilized the Wisconsin Card Sorting Test (WCST) and the label-free proteomics method with bioinformatic analysis to investigate the molecular mechanisms underlying age-related sex differences in cognitive performance in 199 healthy Thai subjects (aged 20-70 years), as well as explore the sex-dependent protein complexes for predicting cognitive aging. The results showed that males outperformed females in two of the five WCST sub-scores: %Corrects and %Errors. Sex differences in these scores were related to aging, becoming noticeable in those over 60. At the molecular level, differently expressed individual proteins and protein complexes between both sexes are associated with the potential N-methyl-D-aspartate type glutamate receptor (NMDAR)-mediated excitotoxicity, with the NMDAR complex being enriched exclusively in elderly female samples. These findings provided a preliminary indication that healthy Thai females might be more susceptible to such neurotoxicity, as evidenced by their cognitive performance. NMDAR protein complex enrichment in serum could be proposed as a potential indication for predicting cognitive aging in healthy Thai females.
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Affiliation(s)
- Chen Chen
- Medical Science Graduate Program, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | | | | | - Sawanya Charoenlappanit
- National Centre for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Sittiruk Roytrakul
- National Centre for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Samur Thanoi
- School of Medical Sciences, University of Phayao, Phayao, Thailand.
| | - Gavin P Reynolds
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
- Centre of Excellence in Medical Biotechnology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Sutisa Nudmamud-Thanoi
- Centre of Excellence in Medical Biotechnology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand.
- Department of Anatomy, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand.
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11
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Yu AYX, Kapral MK, Park AL, Fang J, Hill MD, Kamal N, Field TS, Joundi RA, Peterson S, Zhao Y, Austin PC. Change in Hospital Risk-standardized Stroke Mortality Performance With and Without the Passive Surveillance Stroke Severity Score. Med Care 2023:00005650-990000000-00180. [PMID: 37962442 DOI: 10.1097/mlr.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting for the Passive Surveillance Stroke SeVerity (PaSSV) score, a measure of stroke severity derived using administrative data, changed hospital-specific estimated 30-day risk-standardized mortality rate (RSMR) after stroke. METHODS We used linked administrative data to identify adults who were hospitalized with ischemic stroke or intracerebral hemorrhage across 157 hospitals in Ontario, Canada between 2014 and 2019. We fitted a random effects logistic regression model using Markov Chain Monte Carlo methods to estimate hospital-specific 30-day RSMR and 95% credible intervals with adjustment for age, sex, Charlson comorbidity index, and stroke type. In a separate model, we additionally adjusted for stroke severity using PaSSV. Hospitals were defined as low-performing, average-performing, or high-performing depending on whether the RSMR and 95% credible interval were above, overlapping, or below the cohort's crude mortality rate. RESULTS We identified 65,082 patients [48.0% were female, the median age (25th,75th percentiles) was 76 years (65,84), and 86.4% had an ischemic stroke]. The crude 30-day all-cause mortality rate was 14.1%. The inclusion of PaSSV in the model reclassified 18.5% (n=29) of the hospitals. Of the 143 hospitals initially classified as average-performing, after adjustment for PaSSV, 20 were reclassified as high-performing and 8 were reclassified as low-performing. Of the 4 hospitals initially classified as low-performing, 1 was reclassified as high-performing. All 10 hospitals initially classified as high-performing remained unchanged. CONCLUSION PaSSV may be useful for risk-adjusting mortality when comparing hospital performance. External validation of our findings in other jurisdictions is needed.
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Affiliation(s)
- Amy Y X Yu
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto
- ICES
| | - Moira K Kapral
- ICES
- Department of Medicine (General Internal Medicine), University of Toronto-University Health Network, Toronto, ON
| | | | | | - Michael D Hill
- Departments of Clinical Neurosciences, Community Health Sciences, Medicine, Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB
| | - Noreen Kamal
- Department of Industrial Engineering, Dalhousie University, Halifax, NS
| | - Thalia S Field
- Department of Medicine (Neurology), Vancouver Stroke Program, University of British Columbia, Vancouver, BC
| | - Raed A Joundi
- Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, ON
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia
| | - Yinshan Zhao
- Population Data BC, University of British Columbia, Vancouver, BC, Canada
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12
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Venditti V, Bleve E, Morano S, Filardi T. Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health. Metabolites 2023; 13:1087. [PMID: 37887412 PMCID: PMC10609002 DOI: 10.3390/metabo13101087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
This review explores the impact of gender on medication adherence in the context of metabolic and cardiovascular diseases. Optimal adherence to medication is crucial for achieving treatment goals and preventing adverse outcomes in chronic diseases. The review examines specific conditions such as type 2 diabetes, hypercholesterolemia, arterial hypertension, cardiovascular diseases, and heart failure. In type 2 diabetes, female sex, younger age, new drug prescription, non-white ethnicity, low education level, and low income were identified as predictors of non-adherence. Depressive disorders were also found to influence adherence. In hypercholesterolemia, women exhibited poorer adherence to statin therapy compared to men, with statin-related side effects and patient perception being significant factors. Adherence to anti-hypertensive therapy showed conflicting results, with studies reporting both higher and lower adherence in women. Limited evidence suggests that women may have poorer adherence after acute myocardial infarction and stroke. Regarding heart failure, adherence studies have shown inconsistent findings. The reasons for gender differences in medication adherence are multifactorial and include sociodemographic, disease-related, treatment-related, and psychological factors. This review emphasizes the need for further research to better understand these differences and develop gender-customized interventions that can improve medication adherence and reduce the burden of metabolic and cardiovascular diseases.
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Affiliation(s)
- Vittorio Venditti
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Enrico Bleve
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Susanna Morano
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Tiziana Filardi
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
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Lackovic M, Nikolic D, Jankovic M, Rovcanin M, Mihajlovic S. Stroke vs. Preeclampsia: Dangerous Liaisons of Hypertension and Pregnancy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1707. [PMID: 37893425 PMCID: PMC10608338 DOI: 10.3390/medicina59101707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Stroke during pregnancy and preeclampsia are two distinct but interrelated medical conditions, sharing a common denominator-blood control failure. Along with cardiovascular diseases, diabetes, dyslipidemia, and hypercoagulability, hypertension is undoubtedly a major risk factor associated with stroke. Even though men have higher age-specific stroke rates, women are facing higher life-long stroke risk, primarily due to longer life expectancy. Sex hormones, especially estrogen and testosterone, seem to play a key link in the chain of blood pressure control differences between the genders. Women affected with stroke are more susceptible to experience some atypical stroke manifestations, which might eventually lead to delayed diagnosis establishment, and result in higher morbidity and mortality rates in the population of women. Preeclampsia is a part of hypertensive disorder of pregnancy spectrum, and it is common knowledge that women with a positive history of preeclampsia are at increased stroke risk during their lifetime. Preeclampsia and stroke display similar pathophysiological patterns, including hypertension, endothelial dysfunction, dyslipidemia, hypercoagulability, and cerebral vasomotor reactivity abnormalities. High-risk pregnancies carrying the burden of hypertensive disorder of pregnancy have up to a six-fold higher chance of suffering from stroke. Resemblance shared between placental and cerebral vascular changes, adaptations, and sophisticated auto-regulatory mechanisms are not merely coincidental, but they reflect distinctive and complex cardiovascular performances occurring in the maternal circulatory system during pregnancy. Placental and cerebral malperfusion appears to be in the midline of both of these conditions; placental malperfusion eventually leads to preeclampsia, and cerebral to stoke. Suboptimal performances of the cardiovascular system are proposed as a primary cause of uteroplacental malperfusion. Placental dysfunction is therefore designated as a secondary condition, initiated by the primary disturbances of the cardiovascular system, rather than an immunological disorder associated with abnormal trophoblast invasion. In most cases, with properly and timely applied measures of prevention, stroke is predictable, and preeclampsia is a controllable condition. Understanding the differences between preeclampsia and stroke in pregnancy is vital for healthcare providers to enhance their clinical decision-making strategies, improve patient care, and promote positive maternal and pregnancy outcomes. Management approaches for preeclampsia and stroke require a multidisciplinary approach involving obstetricians, neurologists, and other healthcare professionals.
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Affiliation(s)
- Milan Lackovic
- University Hospital “Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.); (S.M.)
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marija Rovcanin
- Clinic for Gynecology and Obstetrics “Narodni Front”, 11000 Belgrade, Serbia;
| | - Sladjana Mihajlovic
- University Hospital “Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.); (S.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
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14
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Ananth CV, Brandt JS, Keyes KM, Graham HL, Kostis JB, Kostis WJ. Epidemiology and trends in stroke mortality in the USA, 1975-2019. Int J Epidemiol 2023; 52:858-866. [PMID: 36343092 PMCID: PMC10244057 DOI: 10.1093/ije/dyac210] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/18/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Whether changes in stroke mortality are affected by age distribution and birth cohorts, and if the decline in stroke mortality exhibits heterogeneity by stroke type, remains uncertain. METHODS We undertook a sequential time series analysis to examine stroke mortality trends in the USA among people aged 18-84 years between 1975 and 2019 (n = 4 332 220). Trends were examined for overall stroke and by ischaemic and haemorrhagic subtypes. Mortality data were extracted from the US death files, and age-sex population data were extracted from US census. Age-standardized stroke mortality rates and incidence rate ratio (IRR) with 95% confidence interval [CI] were derived from Poisson regression models. RESULTS Age-standardized stroke mortality declined for females from 87.5 in 1975 to 30.9 per 100 000 in 2019 (IRR 0.27, 95% CI 0.26, 0.27; average annual decline -2.78%, 95% CI -2.79, -2.78). Among males, age-standardized mortality rate declined from 112.1 in 1975 to 38.7 per 100 000 in 2019 (RR 0.26, 95% CI 0.26, 0.27; average annual decline -2.80%, 95% CI -2.81, -2.79). Stroke mortality increased sharply with advancing age. Decline in stroke mortality was steeper for ischaemic than haemorrhagic strokes. CONCLUSIONS Stroke mortality rates have substantially declined, more so for ischaemic than haemorrhagic strokes.
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Affiliation(s)
- Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Katherine M Keyes
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hillary L Graham
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John B Kostis
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J Kostis
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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15
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Silva Y, Sánchez-Cirera L, Terceño M, Dorado L, Valls A, Martínez M, Abilleira S, Rubiera M, Quesada H, Llull L, Rodríguez-Campello A, Martí-Fàbregas J, Seró L, Purroy F, Payo I, García S, Cánovas D, Krupinski J, Mas N, Palomeras E, Cocho D, Font MÀ, Catena E, Puiggròs E, Pedroza C, Marín G, Carrión D, Costa X, Almendros MC, Torres I, Colom C, Velasquez JA, Diaz G, Jiménez X, Subirats T, Deulofeu A, Hidalgo V, Salvat-Plana M, Pérez de la Ossa N. Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia. Eur Stroke J 2023; 8:557-565. [PMID: 37231687 PMCID: PMC10334164 DOI: 10.1177/23969873231156260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. PATIENTS AND METHODS Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. RESULTS A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94-1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97-1.22). DISCUSSION AND CONCLUSION We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself.
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Affiliation(s)
| | | | | | - Laura Dorado
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Adrián Valls
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marina Martínez
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Marta Rubiera
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Helena Quesada
- Hospital Universitari de Bellvitge, L’Hospitalet de llobregat, Spain
| | - Laura Llull
- Hospital Clínic of Barcelona, Barcelona, Spain
| | | | | | - Laia Seró
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Iago Payo
- Hospital Verge de la Cinta, Tortosa, Spain
| | - Sònia García
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | | | | | | | | | | | | | - Esther Catena
- Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mercè Salvat-Plana
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
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16
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Jameie M, Jameie M, Farahmand G, Ilkhani S, Magrouni H, Ranjbar Z, Heydari S, Shahbazi M, Kaeedi M, Amani K, Amiri R, Alizade F, Balali P, Amanollahi M, Pourghaz B, Ghabaee M. The Effect of Easily Implementable Changes to the "D's of Stroke Care" in Reducing Sex Disparity in Door-to-Needle Time. Neurologist 2023; 28:198-203. [PMID: 36054454 DOI: 10.1097/nrl.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Door-to-needle (DTN) is the duration between patient's arrival at the hospital and receiving intravenous thrombolysis in ischemic stroke settings, for which studies have reported delays in women. The "D's of stroke care" describes 8 steps (D1 to D8) in patients' time tracker. We implemented simple modifications to the "D's of stroke care" by splitting D4 and D6 steps into these substeps: patients' arrival to the emergency room (D4-A), early assessment by a neurologist (D4-B), neurologist decision on patient's eligibility to receive recombinant tissue plasminogen activator (D6-A), and patient's transfer to the stroke unit (D6-B). We evaluated the effect of these changes on reducing DTN time disparity between men and women. METHODS This study was conducted from September 2019 to August 2021, at a comprehensive stroke center. Patients were analyzed in 2 groups: group 1, before, and group 2, after using the modifications. Sex as the main variable of interest along with other covariates was regressed toward the DTN time. RESULTS In groups 1 and 2, 47 and 56 patients received intravenous thrombolysis, respectively. Although there was a significant difference in DTN≤1 hour between women and men in group 1 (36% vs. 52%, P =0.019), it was not significantly different in group 2 ( P =0.97). Regression analysis showed being female was a significant predictor of DTN>1 hour in group 1 (adjusted odds ratio=6.65, P =0.02), whereas after using the modifications, sex was not a significant predictor for delayed DTN. CONCLUSIONS Implementing these substeps reduced sex disparity in DTN time in our center.
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Affiliation(s)
- Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute
| | - Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute
| | - Ghasem Farahmand
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Saba Ilkhani
- Department of Surgery and Vascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hana Magrouni
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Zahra Ranjbar
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Sanaz Heydari
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Mojtaba Shahbazi
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Maryam Kaeedi
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Kiana Amani
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Rosita Amiri
- Iranian Center of Neurological Research, Neuroscience Institute
| | - Fateme Alizade
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Pargol Balali
- Iranian Center of Neurological Research, Neuroscience Institute
| | | | | | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
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17
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Wouters A, Scheldeman L, Liessens H, Dupont P, Boutitie F, Cheng B, Ebinger M, Endres M, Fiebach JB, Gerloff C, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Thijs V, Thomalla G, Lemmens R. Sex differences in imaging and clinical characteristics of patients from the WAKE-UP trial. Eur J Neurol 2023; 30:641-647. [PMID: 36349887 PMCID: PMC10099623 DOI: 10.1111/ene.15629] [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: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Sex-based differences in acute ischemic stroke are a well-known phenomenon. We aimed to explore these differences between women and men in the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial. METHODS We compared baseline demographic and imaging characteristics (visual fluid-attenuated inversion recovery [FLAIR] positivity, relative FLAIR signal intensity, collateral status) between women and men in all screened patients. In randomized patients (i.e., those with diffusion-weighted imaging (DWI)-FLAIR mismatch), we evaluated a modifying role of sex on the treatment effect of alteplase in multivariable logistic regression, with treatment adjusted for National Institute of Health Stroke Scale (NIHSS) score and age. Dependent variables were modified Rankin Scale (mRS) score of 0-1 at 90 days and distribution of mRS scores at 90 days. RESULTS Of 1362 screened patients, 529 (38.8%) were women. Women were older than men, had higher baseline NIHSS scores and smoked less frequently. FLAIR positivity of the DWI lesion was equally present in women (174/529, 33.1%) and men (273/833, 33.3%; p = 1.00) and other imaging variables also did not differ between the sexes. In a total of 503 randomized patients, of whom 178 were women (35.4%), sex did not modify the treatment effect of alteplase on mRS score 0-1 or on the total distribution of mRS scores. CONCLUSION As in many other stroke trials, more men than women were included in the WAKE-UP trial, but the presence of a visual DWI-FLAIR mismatch and the relative FLAIR signal intensity did not differ between the sexes. The treatment effect of alteplase was not modified by sex.
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Affiliation(s)
- Anke Wouters
- Neurology, Amsterdam University Medical Centers location AMC, Amsterdam, the Netherlands
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
| | - Lauranne Scheldeman
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Leuven Brain Institute, Leuven, Belgium
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Université Lyon, Lyon, France
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1; Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomedica de Girona (IDIBGI), Parc Hospitalari Marti i Julia de Salt - Edifici M2, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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18
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Perrier J, Renard M, Pariente A, Bezin J. Systematic review on sex differences for drug use after stroke. Therapie 2023; 78:213-224. [PMID: 36517302 DOI: 10.1016/j.therap.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Systematic reviews and meta-analyses have synthetized the existing knowledge on sex-differences for the risk of stroke, the most recent ones highlighting an increased risk of stroke for women. However, whether there are sex differences in post stroke treatment in real world setting is not known. We therefore conducted a systematic review on this subject. MATERIAL AND METHODS All observational studies on sex-differences in poststroke drug use published until 20/04/2021 were identified from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third resolved disagreements. Data extraction was performed using a standardized form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. RESULTS Of the 604 identified articles, 33 were included. Most were published before 2015 and presented methodological limitations. These limitations differentially affected studies with statistically significant and non-significant results, questioning the reliability of conflicting results. The exploration of sex-differences in drug use varied between therapeutic classes (articles focusing on thrombolytics: 25; antithrombotics: 23; on antihypertensive: 13; lipid-lowering drugs: 9). After stroke, women were found less likely to be prescribed antithrombotics in 48% of the articles investigating this class, and lipid-lowering drugs in 56%. Thirty-one percent of the studies concerning antihypertensive drugs reported the opposite. DISCUSSION/CONCLUSION In women, a lack of use of antithrombotics and lipid-lowering drugs after stroke seem to emerge from this review. Conflicting results regarding sex-differences might relate to methodological limitations in studies with no statistical differences, and advocate for the conduct of newer and more comprehensive research.
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Affiliation(s)
- Julia Perrier
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France.
| | - Mathilde Renard
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France
| | - Antoine Pariente
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
| | - Julien Bezin
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
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19
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Shajahan S, Sun L, Harris K, Wang X, Sandset EC, Yu AY, Woodward M, Peters SA, Carcel C. Sex differences in the symptom presentation of stroke: A systematic review and meta-analysis. Int J Stroke 2023; 18:144-153. [PMID: 35411828 DOI: 10.1177/17474930221090133] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Early diagnosis through symptom recognition is vital in the management of acute stroke. However, women who experience stroke are more likely than men to be initially given a nonstroke diagnosis and it is unclear if potential sex differences in presenting symptoms increase the risk of delayed or missed stroke diagnosis. AIMS To quantify sex differences in the symptom presentation of stroke and assess whether these differences are associated with a delayed or missed diagnosis. METHODS PubMed, EMBASE, and the Cochrane Library were systematically searched up to January 2021. Studies were included if they reported presenting symptoms of adult women and men with diagnosed stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) and were published in English. Mean percentages with 95% confidence intervals (CIs) of each symptom were calculated for women and men. The crude relative risks (RRs) with 95% CI of symptoms being present in women, relative to men, were also calculated and pooled. Any data on the delayed or missed diagnosis of stroke for women compared to men based on symptom presentation were also extracted. RESULTS Pooled results from 21 eligible articles showed that women and men presented with a similar mean percentage of motor deficit (56% in women vs 56% in men) and speech deficit (41% in women vs 40% in men). Despite this, women more commonly presented with nonfocal symptoms than men: generalized nonspecific weakness (49% vs 36%), mental status change (31% vs 21%), and confusion (37% vs 28%), whereas men more commonly presented with ataxia (44% vs 30%) and dysarthria (32% vs 27%). Women also had a higher risk of presenting with some nonfocal symptoms: generalized weakness (RR 1.49, 95% CI 1.09-2.03), mental status change (RR 1.44, 95% CI 1.22-1.71), fatigue (RR 1.42, 95% CI 1.05-1.92), and loss of consciousness (RR 1.30, 95% CI 1.12-1.51). In contrast, women had a lower risk of presenting with dysarthria (RR 0.89, 95% CI 0.82-0.95), dizziness (RR 0.87, 95% CI 0.80-0.95), gait disturbance (RR 0.79, 95% CI 0.65-0.97), and imbalance (RR 0.68, 95% CI 0.57-0.81). Only one study linking symptoms to definite stroke/TIA diagnosis found that pain and unilateral sensory loss are associated with lower odds of a definite diagnosis in women compared to men. CONCLUSION Although women showed a higher prevalence of some nonfocal symptoms, the prevalence of focal neurological symptoms, such as motor weakness and speech deficit, was similar for both sexes. Awareness of sex differences in symptoms in acute stroke evaluation, careful consideration of the full constellation of presenting symptoms, and further studies linking symptoms to diagnostic outcomes can be helpful in improving early diagnosis and management in both sexes.
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Affiliation(s)
- Sultana Shajahan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lingli Sun
- The George Institute for Global Health, Beijing, China
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Amy Yx Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Sanne Ae Peters
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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20
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Abdu H, Seyoum G. Sex Differences in Stroke Risk Factors, Clinical Profiles, and In-Hospital Outcomes Among Stroke Patients Admitted to the Medical Ward of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Degener Neurol Neuromuscul Dis 2022; 12:133-144. [PMID: 36304698 PMCID: PMC9595065 DOI: 10.2147/dnnd.s383564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A stroke is a vascular accident that affects both men and women. The threat of stroke and outcome status differ between the sexes. Such data are lacking in Ethiopia. Therefore, this study assessed sex differences in stroke risk factors, clinical profiles, and outcomes in the medical ward of Dessie comprehensive specialized hospital. METHODS A retrospective cross-sectional study was employed among stroke patients. Medical records with complete information and a confirmed diagnosis of stroke using imaging techniques were included in the study. Using simple random sampling, 344 medical records were selected, 312 of which fulfilled the inclusion criteria. Bivariate and multivariate logistic regression analyses and a chi-square test were employed. The frequency, percentage, and mean and standard deviation of the variables were described using descriptive statistics. Findings with a P-value <0.05 were considered statistically significant. RESULTS Most of the patients were above or equal to 45 years old in both sexes. A significantly higher number of male than female patients were aged less than 45 years (p-value-0.001). Younger age (AOR: 2.998, p = 0.000), cigarette smoking (AOR: 2.911, p = 0.009), and Khat chewing (AOR: 3.650, p = 0.001) were risk factors for stroke in males. A higher number of males presented with hemiplegia/hemiparesis 89 (28.5%), aphasia 45 (14.4%), and facial palsy 19 (6.1%). However, more females were unconscious (15.1%). Significant differences were not seen in the stroke outcomes. Furthermore, there were no apparent differences in risk factors for stroke-related mortality. CONCLUSION Males developed stroke at a younger age. Women were older at the time of stroke onset and presented unconscious. More males experienced hemiplegia/hemiparesis, aphasia, and facial palsy. Smoking, drinking, and khat chewing were risk factors for stroke in men. There were no gender differences in the stroke death rate. Therefore, educating the public about stroke risk factors, lifestyle modification, and conducting prospective research is required.
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Affiliation(s)
- Hussen Abdu
- Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia,Correspondence: Hussen Abdu, Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia, Tel +251-910916321, Email
| | - Girma Seyoum
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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21
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Sex Differences in Ischemic Cerebral Infarction: A Nationwide German Real-Life Analysis from 2014 to 2019. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Female sex has been shown to be associated with an unfavorable outcome after ischemic stroke. In this nationwide analysis, we evaluate a large dataset of patients suffering from acute ischemic stroke to elucidate the factors associated with an increased risk of mortality after stroke in women. We analyzed a nationwide dataset from the German Federal Bureau of Statistics including 1,577,884 (761,537 female sex, 48.3%) in-hospital cases admitted between 1 January 2014 and 31 December 2019 with a primary diagnosis of acute ischemic cerebral infarction. Patients were analyzed regarding morbidity, treatments and in-hospital mortality. A multiple logistic regression analysis was performed, adjusted by patients’ risk profile including age, to evaluate the association of sex and in-hospital mortality. According to the median, women were older than men (79 years vs. 73 years). The multiple logistic regression analysis however revealed female sex remained an independent factor for an increased in-hospital mortality (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.11–1.14; p < 0.001). Women had a higher prevalence of relevant risk factors, namely arterial hypertension (77.0% vs. 74.7%), arterial fibrillation (33.3% vs. 25.6%), chronic heart failure (12.3% vs. 9.7%), chronic kidney disease (15.6% vs. 12.9%) and dementia (6.6% vs. 4.1%), but were less affected with respect to other relevant co-morbidities such as cerebrovascular disease (11.7% vs. 15.1%), coronary heart disease (11.7% vs. 18.8%), diabetes mellitus (26.4% vs. 29.6%), dyslipidemia (38.1% vs. 42.0%), ischemic heart disease (12.3% vs. 19.3%) and previous coronary artery bypass grafting (1.1% vs. 3.2%). Overall, therapeutic interventions were performed less frequently in women such as carotid endarterectomy (1.1% vs. 2.3%), carotid stent (0.7% vs. 1.4%), as well as hematoma drainage (0.1% vs. 0.2%), and renal replacement therapy (0.4% vs. 0.6%). Conclusions: Our nationwide analysis revealed a higher mortality rate after stroke in women. Nevertheless, women had fewer in-hospital complications and were also less likely to experience the severe effects of some important co-morbidities. The dataset, however, showed that women received surgical or interventional carotid treatments after stroke less often. It is important for research on sex disparities in stroke to keep these treatment frequency differences in mind.
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22
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Motamed-Gorji N, Hariri S, Masoudi S, Sharafkhah M, Nalini M, Oveisgharan S, Khoshnia M, Motamed-Gorji N, Gharavi A, Etemadi A, Poustchi H, Zand R, Malekzadeh R. Incidence, early case fatality and determinants of stroke in Iran: Golestan Cohort Study. J Stroke Cerebrovasc Dis 2022; 31:106658. [PMID: 35973398 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106658] [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: 02/26/2022] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES While few studies investigated the incidence of stroke in Iran, no Iranian cohort has estimated the standardized-incidence rate and early fatality of first-ever-stroke subtypes along with associated factors. METHODS Golestan Cohort Study is a prospective study launched in northeastern Iran in 2004, including 50,045 individuals aged 40-75 at baseline. Age-standardized incidence rate of first-ever-stroke was calculated per 100,000 person-years, according to World Standard Population. The 28-day case fatality was calculated by dividing the number of fatal first-ever-stroke during the first 28 days by total events. Cox proportional hazard models were conducted to assess incidence and fatality risk factors. We used Population Attributable Fractions to estimate the incidence and early fatality proportions reduced by ideal risk factor control. RESULTS 1,135 first-ever-strokes were observed during 8.6 (median) years follow-up. First-ever-stroke standardized incidence rate was estimated 185.2 (95% CI: 173.2-197.2) per 100,000 person-years. The 28-day case fatality was 44.1% (95% CI: 40.4-48.2). Hypertension and pre-stroke physical activity were the strongest risk factors associated with first-ever-stroke incidence (Hazard ratio: 2.83; 2.47-3.23) and 28-day case fatality (Hazard ratio: 0.59; 0.44-0.78), respectively. Remarkably, opium consumption was strongly associated with hemorrhagic stroke incidence (Hazard ratio: 1.52; 1.04-2.23) and ischemic stroke fatality (Hazard ratio: 1.44; 1.01-2.09). Overall, modifiable risk factors contributed to 83% and 61% of first-ever-stroke incidence and early fatality, respectively. CONCLUSION Efficient risk factor control can considerably reduce stroke occurrence and fatality in our study. Establishing awareness campaigns and 24-hour stroke units seem necessary for improving the stroke management in this area.
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Affiliation(s)
- Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Masoudi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Oveisgharan
- Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, IL, USA
| | - Masoud Khoshnia
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abdolsamad Gharavi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Zand
- Neuroscience Institute, Penn State University, Hershey, PA, USA; Neuroscience Institute, Geisinger, Danville, PA, USA.
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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23
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Determinants of metabolic syndrome and its prognostic implications among stroke patients in Africa: Findings from the Stroke Investigative Research and Educational Network (SIREN) study. J Neurol Sci 2022; 441:120360. [PMID: 35985161 DOI: 10.1016/j.jns.2022.120360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The prognostic implications of metabolic syndrome (METS) among African stroke patients are poorly understood. This study aimed to investigate the determinants of METS and its prognostic implications among Africans with newly diagnosed stroke in the SIREN study. METHODS We included stroke cases (adults aged >18 years with CT/MRI confirmed stroke). The validated tools comprehensively evaluated vascular, lifestyle, and psychosocial factors. We used logistic regression to estimate adjusted odds ratios (OR) with 95% CIs for the association between METS and risk factors. We also computed the prediction power of the domain of covariates in a sequential manner using the area under the receiver operating curve (ROC) curve. RESULTS Among 3998 stroke subjects enrolled in the study, 76.8% had METS by at least one of the clinical definitions. Factors associated with METS were age > 50 years (OR- 1.46, CI-1.19-1.80), male gender (OR 4.06, CI- 3.28-5.03), income >100USD (OR1.42, CI-1.17-1.71), stress (OR1.46, CI-1.14-1.87), family history of diabetes mellitus (OR1.38, CI-1.06-1.78), and cardiac disease (OR1.42, CI-1.18-1.65). Stroke severity was higher among those with METS (SLS = 5.8 ± 4.3) compared with those without METS (6.2 ± 4.5) at p = 0.037. METS was associated with higher odds (aOR 1.31, CI-1.08-1.58) of one-month fatality after adjusting for stroke severity, age > 50 years, and average monthly income >100USD. CONCLUSION METS is very common among African stroke patients and is associated with stroke severity and worse one-month fatality. Lifestyle interventions may prevent METS and attenuate its impact on stroke occurrence and outcomes.
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24
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Wang X, Carcel C, Hsu B, Shajahan S, Miller M, Peters S, Randall DA, Havard A, Redfern J, Anderson CS, Jorm L, Woodward M. Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales. Med J Aust 2022; 217:143-148. [PMID: 35831059 PMCID: PMC9541458 DOI: 10.5694/mja2.51652] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/29/2022] [Accepted: 05/10/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To examine whether pre-hospital emergency medical service care differs for women and men subsequently admitted to hospital with stroke. DESIGN, SETTING, PARTICIPANTS Population-based cohort study; analysis of linked Admitted Patient Data Collection and NSW Ambulance data for people admitted to New South Wales hospitals with a principal diagnosis of stroke at separation, 1 July 2005 - 31 December 2018. MAIN OUTCOME MEASURES Emergency medical service assessments, protocols, and management for patients subsequently diagnosed with stroke, by sex. RESULTS Of 202 231 people hospitalised with stroke (mean age, 73 [SD, 14] years; 98 599 women [51.0%]), 101 357 were conveyed to hospital by ambulance (50.1%). A larger proportion of women than men travelled by ambulance (52.4% v 47.9%; odds ratio [OR], 1.09; 95% CI, 1.07-1.11), but time between the emergency call and emergency department admission was similar for both sexes. The likelihood of being assessed as having a stroke (adjusted OR [aOR], 0.97; 95% CI, 0.93-1.01) or subarachnoid haemorrhage (aOR, 1.22; 95% CI, 0.73-2.03) was similar for women and men, but women under 70 years of age were less likely than men to be assessed as having a stroke (aOR, 0.89; 95% CI, 0.82-0.97). Women were more likely than men to be assessed by paramedics as having migraine, other headache, anxiety, unconsciousness, hypertension, or nausea. Women were less likely than men to be managed according to the NSW Ambulance pre-hospital stroke care protocol (aOR, 0.95; 95% CI, 0.92-0.97), but the likelihood of basic pre-hospital care was similar for both sexes (aOR, 1.01; 95% CI, 0.99-1.04). CONCLUSION Our large population-based study identified sex differences in pre-hospital management by emergency medical services of women and men admitted to hospital with stroke. Paramedics should receive training that improves the recognition of stroke symptoms in women.
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Affiliation(s)
- Xia Wang
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
| | - Cheryl Carcel
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
| | - Benjumin Hsu
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Sultana Shajahan
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
| | - Matthew Miller
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Sanne Peters
- The George Institute for Global HealthOxfordUnited Kingdom
| | - Deborah A Randall
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Alys Havard
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Julie Redfern
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW,School of Health Sciences, Faculty of Medicine and HealthUniversity of Sydney, NSW
| | - Craig S Anderson
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW,Royal Prince Alfred HospitalSydneyNSW
| | - Louisa Jorm
- Centre for Big Data Research in HealthUniversity of New South WalesSydneyNSW
| | - Mark Woodward
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
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Eliakundu AL, Cadilhac DA, Kim J, Kilkenny MF, Bagot KL, Andrew E, Cox S, Bladin CF, Stephenson M, Pesavento L, Sanders L, Clissold B, Ma H, Smith K. Determining the sensitivity of emergency dispatcher and paramedic diagnosis of stroke: statewide registry linkage study. J Am Coll Emerg Physicians Open 2022; 3:e12750. [PMID: 35795711 PMCID: PMC9249375 DOI: 10.1002/emp2.12750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Correctly identifying people with suspected stroke is essential for ensuring rapid treatment. Our aims were to determine the sensitivity of emergency dispatcher and paramedic identification of patients with stroke, the factors associated with correct identification, and whether there were any implications for hospital arrival times. Methods Observational study using patient‐level data from the Australian Stroke Clinical Registry (2015–2017) linked with ambulance and emergency department records for the state of Victoria. The registry diagnosis was the reference standard to compare with the provisional diagnoses made by emergency services personnel classified as “suspected” and “not suspected” stroke/transient ischemic attack (TIA). Multivariable logistic and quintile regressions were used to determine factors associated with correct identification and timely arrival to hospital. Results Overall, 4717 (64%) were matched to ambulance transport records (median age: 73 years, 43% female). Stroke/TIA was suspected in 56% of registrants by call‐takers and 69% by paramedics. Older patients (75+ years) (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.49–0.75), females (aOR: 0.86; 95% CI: 0.75–0.99), those with severe stroke or intracerebral hemorrhage were less often suspected as stroke. Cases identified as stroke had a shorter arrival time to hospital (unadjusted median minutes: stroke, 54 [43, 72] vs not stroke, 66 [51, 89]). Conclusions Emergency dispatchers and paramedics identified over half of patients with stroke in the prehospital setting. Important patient characteristics, such as being female and those having a severe stroke, were found that may enable refinement of prehospital ambulance protocols and dispatcher/paramedic education. Those correctly identified as stroke, arrived earlier to hospital optimizing their chances of receiving time‐critical treatments.
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Affiliation(s)
- Amminadab L. Eliakundu
- Stroke and Ageing Research Department of Medicine School of Clinical Sciences at Monash Health Monash University Victoria Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research Department of Medicine School of Clinical Sciences at Monash Health Monash University Victoria Australia
- Stroke Division Florey Institute of Neurosciences & Mental Health University of Melbourne Victoria Australia
| | - Joosup Kim
- Stroke and Ageing Research Department of Medicine School of Clinical Sciences at Monash Health Monash University Victoria Australia
- Stroke Division Florey Institute of Neurosciences & Mental Health University of Melbourne Victoria Australia
| | - Monique F. Kilkenny
- Stroke and Ageing Research Department of Medicine School of Clinical Sciences at Monash Health Monash University Victoria Australia
- Stroke Division Florey Institute of Neurosciences & Mental Health University of Melbourne Victoria Australia
| | - Kathleen L. Bagot
- Stroke and Ageing Research Department of Medicine School of Clinical Sciences at Monash Health Monash University Victoria Australia
- Stroke Division Florey Institute of Neurosciences & Mental Health University of Melbourne Victoria Australia
| | - Emily Andrew
- Ambulance Victoria Victoria Australia
- Department of Epidemiology and Preventive Medicine Monash University Victoria Australia
| | - Shelley Cox
- Ambulance Victoria Victoria Australia
- Department of Epidemiology and Preventive Medicine Monash University Victoria Australia
| | - Christopher F. Bladin
- Stroke Division Florey Institute of Neurosciences & Mental Health University of Melbourne Victoria Australia
- Ambulance Victoria Victoria Australia
| | - Michael Stephenson
- Ambulance Victoria Victoria Australia
- Department of Epidemiology and Preventive Medicine Monash University Victoria Australia
- Department of Paramedicine Monash University Victoria Australia
| | - Lauren Pesavento
- The Melbourne Brain Centre and Department of Neurology The Royal Melbourne Hospital Victoria Australia
| | - Lauren Sanders
- Department of Neurology St Vincent's Hospital FitzroyVictoria Australia
| | - Ben Clissold
- Department of Neurology Geelong Hospital GeelongVictoria Australia
| | - Henry Ma
- Stroke and Ageing Research Department of Medicine School of Clinical Sciences at Monash Health Monash University Victoria Australia
- Department of Neurology Monash Medical Centre, Monash University Clayton Victoria Australia
| | - Karen Smith
- Ambulance Victoria Victoria Australia
- Department of Epidemiology and Preventive Medicine Monash University Victoria Australia
- Department of Paramedicine Monash University Victoria Australia
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Kasemsap N, Vorasoot N, Kongbunkiat K, Tiamkao S, Boonsawat W, Sawanyawisuth K. Factors associated with favorable outcomes in acute severe stroke patients: A real‑world, national database study. Biomed Rep 2022; 17:74. [PMID: 35950096 PMCID: PMC9353649 DOI: 10.3892/br.2022.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022] Open
Abstract
Thrombolytic therapy is useful in severe stroke, but it increases the risk of intracerebral hemorrhage. In addition, it may have limited use in resource-limited due to a lack of trained neurologists and equipment to perform CT scans. There are limited data available from studies of national databases on stroke outcomes and predictors of severe stroke. This study, therefore, aimed to evaluate acute severe ischemic stroke outcomes in a real-world setting. Additionally, predictors of favorable stroke outcomes were explored using a retrospective cohort. Data were extracted from the National Health Security Office (NHSO) in Thailand. The inclusion criteria were: Aged ≥18 years or older, diagnosis of acute severe ischemic stroke (defined by an admission National Institutes of Health Stroke Scale score of 15-24), and available data on stroke outcomes. Outcomes were evaluated at discharge using a modified Rankin score at discharge. Factors associated with good outcomes were determined using multivariate logistic regression analysis. During the study period, 268 severe stroke patients met the inclusion criteria. Of those, 38 (14.18%) had good outcomes at discharge. A total of 223 patients received intravenous recombinant tissue plasminogen activator (83.21%). Of those, 38 (17.04%) had favorable outcomes. A predictive model for good outcomes revealed two independent factors: Male sex and atrial fibrillation with adjusted odds ratios (95% confidence interval) of 2.30 (1.10-4.82) and 0.38 (0.16-0.91), respectively. Predictors for good stroke outcomes in severe stroke patients included rtPA treatment, atrial fibrillation, and male sex.
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Affiliation(s)
- Narongrit Kasemsap
- Department of Medicine and North‑Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Nisa Vorasoot
- Department of Medicine and North‑Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kannikar Kongbunkiat
- Department of Medicine and North‑Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Somsak Tiamkao
- Department of Medicine and North‑Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Watchara Boonsawat
- Department of Medicine and North‑Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine and North‑Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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27
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Lekoubou A, Wu EY, Bishu KG, Ovbiagele B. Prevalence, predictors, and prognosis of mortality among elderly stroke patients with convulsive status epilepticus in the United States. J Neurol Sci 2022; 440:120342. [PMID: 35908304 DOI: 10.1016/j.jns.2022.120342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/10/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Stroke is the most common cause of epilepsy in the elderly. However, despite the high mortality typically associated with convulsive status epilepticus (CSE), there is a dearth of nationwide data on the magnitude and association of CSE with mortality among hospitalized elderly with stroke in the United States. METHODS We analyzed the 2006-2014 National Inpatient Sample (NIS) to identify elderly patients (65+ years) with a primary discharge diagnosis of stroke using the International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM) codes 433.X1, 434.X1, 436, 430, 431, 432.0, 432.1, and 432.9. We examined a subgroup with a secondary discharge diagnosis of convulsive status epilepticus (ICD-9-CM: 345.3). We estimated the hospital mortality rate by CSE status and then evaluated the independent association of CSE and other key factors with mortality among hospitalized elderly with stroke. RESULTS A total of 1220 elderly patients (0.14%) had a secondary discharge diagnosis of CSE. Inpatient mortality rate was 25.8% among those with CSE vs. 7.7% for non-CSE patients. CSE was independently associated with a 4-fold increased odds of in-hospital death. Increased age, medical comorbidities, weekend admissions, being a Medicare beneficiary, and hospitalization in large urban teaching hospitals were also independently associated with a greater likelihood of in-hospital death. The small number of events did not allow analysis by stroke subtypes. CONCLUSION While CSE occurs in just 14 of 10,000 hospitalized elderly stroke patients in the United States, it is associated with a 4-fold higher odds of in-hospital death.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA.
| | - Emma Y Wu
- Penn State College of Medicine, Hershey, PA, USA.
| | - Kinfe G Bishu
- Department of Medicine, Medical University of South Carolina, Charleston, SC & Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, SC, USA.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA.
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28
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Hosman FL, Engels S, den Ruijter HM, Exalto LG. Call to Action for Enhanced Equity: Racial/Ethnic Diversity and Sex Differences in Stroke Symptoms. Front Cardiovasc Med 2022; 9:874239. [PMID: 35592405 PMCID: PMC9110690 DOI: 10.3389/fcvm.2022.874239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/04/2022] [Indexed: 01/02/2023] Open
Abstract
BackgroundFundamental aspects of human identity may play a role in the presentation of stroke symptoms and, consequently, stroke recognition. Strokes must be recognized and treated expeditiously, as delays result in poorer outcomes. It is known that sex plays a role in the presentation of symptoms, such that non-traditional symptoms are more commonly observed among women. However, factors such as geographical location and race/ethnicity, and the interactions between these various factors, need to be considered. This will provide an intersectional approach.MethodsA systematic review and meta-analysis of the literature was conducted to investigate differences in the presentation of stroke symptoms between sexes. Using PubMed and Embase, a search involving the components sex, symptoms and stroke was completed and yielded 26 full-text manuscripts.ResultsOur findings indicate that there is substantial overlap in stroke symptom presentation in men and women. Nonetheless, some differences in the clinical manifestations of stroke were observed. In addition, it was discovered that only three studies were conducted outside of North America and Europe. Furthermore, only two studies reported symptoms based on both sex and racial/ethnic group.ConclusionThese findings indicate a research gap and call for increased research in order to uncover the possible interactions between sex and race/ethnicity in an intersectional approach. Resultantly, stroke recognition could be improved and greater equity in healthcare can be achieved.
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Affiliation(s)
- Floortje L. Hosman
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sabine Engels
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hester M. den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lieza G. Exalto
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Lieza G. Exalto
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29
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Cao M, Li B, Rong J, Li Q, Sun C. Sex differences in global disability-adjusted life years due to ischemic stroke: findings from global burden of diseases study 2019. Sci Rep 2022; 12:6235. [PMID: 35422061 PMCID: PMC9010406 DOI: 10.1038/s41598-022-10198-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/01/2022] [Indexed: 12/28/2022] Open
Abstract
To investigate the sex differences in disability-adjusted life years (DALYs) due to ischemic stroke (IS) by year, location and age. We extracted sex-specific data on DALYs number, age-standardized DALYs rate (ASDR) and all-age DALYs rate of IS by year, location and age from the Global Burden of Diseases study 2019. The estimated annual percentage changes (EAPC) were calculated to evaluate the temporal trend of ASDR. For both sexes, although the ASDR of IS slightly decreased from 1990 to 2019, there has been an 60.3% increase in DALYs number worldwide. Sex difference in DALYs number (men minus women) decreased from − 2.83 million in 1990 to 0.14 million in 2019, while the men to women’s ASDR ratio slightly increased from 1.10 in 1990 to 1.21 in 2019. The sex differences in IS DALYs showed remarkable regional variation. The largest sex differences in DALYs number and ASDR were in China and Vietnam. Middle-aged men had a higher IS DALYs than their age-matched counterparts. High systolic blood pressure accounted for the highest DALYs number in 2019, but the top three attributable risk factors that had the greatest sex differences were tobacco, dietary risk, and alcohol use. Sex differences in IS DALYs varied by year, location and age, mostly attributed to the disproportion of cardiovascular risk factors between sexes. Considering the population growth and aging, it is necessary to monitor the sex difference in IS DALYs in different populations and thus provide evidence for local administration to improve current preventive and management strategies of IS.
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Affiliation(s)
- Miaomiao Cao
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Bolin Li
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Jie Rong
- Department of Encephalopathy, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Qian Li
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Chaofeng Sun
- Department of Cardiology, Institute of Cardiovascular Channelopathy, Key Laboratory of Molecular Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
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30
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Eddelien HS, Butt JH, Christensen T, Danielsen AK, Kruuse C. Sex and Age Differences in Patient-Reported Acute Stroke Symptoms. Front Neurol 2022; 13:846690. [PMID: 35386418 PMCID: PMC8978710 DOI: 10.3389/fneur.2022.846690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Identification of sex- and age-related differences in the presentation of atypical symptoms at stroke onset may reduce prehospital delay and improve stroke treatment if acknowledged at first contact. Aim To explore sex- and age-related differences in patient-reported typical and atypical symptoms of a stroke. Methods We used data from a cross-sectional survey at two non-comprehensive stroke units in the Capital Region of Denmark. Patient-reported symptoms, stroke knowledge, and behavioral response were analyzed by the Chi-square test or a Fisher's exact test separated by sex. Multivariable logistic regression adjusted for covariates were used to explore sex- and age-related differences according to each patient-reported typical or atypical symptoms. Results In total, 479 patients with acute stroke were included (median age 74 years [25th to 75th percentile: 64–80], and 40.1% were women). Female sex was associated with higher odds of presenting with atypical symptoms, such as loss of consciousness (OR 2.12 [95% CI 1.08–4.18]) and nausea/vomiting (OR 2.33 [95% CI 1.24–4.37]), and lower odds of presenting with lower extremity paresis (OR 0.59 [95% CI 0.39–0.89). With each year of age, the odds decreased of presenting with sensory changes (OR 0.95 [95% CI 0.94–0.97]) and upper extremity paresis (OR 0.98 [95% CI 0.96–0.99]), whereas odds of presenting with dysphagia (OR 1.06 [95% CI 1.02–1.11]) increased. Conclusions Patients of female sex and younger age reported on admission more frequently atypical stroke symptoms. Attention should be drawn to this possible atypical first presentation to facilitate correct identification and early stroke revascularization treatment to improve the outcome for both sexes.
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Affiliation(s)
- Heidi S. Eddelien
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Heidi S. Eddelien
| | - Jawad H. Butt
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Nordsjællands Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne K. Danielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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31
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Salmantabar P, Abzhandadze T, Viktorisson A, Reinholdsson M, Sunnerhagen KS. Pre-stroke Physical Inactivity and Stroke Severity in Male and Female Patients. Front Neurol 2022; 13:831773. [PMID: 35359627 PMCID: PMC8963352 DOI: 10.3389/fneur.2022.831773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Females experience more severe ischemic strokes than do males. A higher pre-stroke physical activity level is associated with less severe stroke. The primary aim of this study was to explore the association between pre-stroke physical inactivity and stroke severity in male and female patients. Methods This was a retrospective, registry-based study. The data were retrieved from two stroke registries from 2014 to 2019. The primary explanatory variable was physical activity level before the stroke, assessed using the Saltin-Grimby Physical Activity Level Scale. The outcome was moderate to severe stroke at hospital admission, assessed using the National Institutes of Health Stroke Scale (NIHSS). A moderate to severe stroke was defined as a NIHSS score of ≥6. Binary logistic regression analysis was performed to explore if physical inactivity before the stroke could explain stroke severity in male and female patients. Results In total, we included 4,535 patients with ischemic stroke. Female patients (n = 2,145) had a mean age of 76 years, 35% had a moderate to severe stroke, and 64% were physically inactive pre-stroke. Male patients (n = 2,390) had a mean age of 72 years, 25% had a moderate to severe stroke, and 49% were physically inactive pre-stroke. Physical inactivity was associated with higher odds for moderate to severe stroke in both sexes (females' odds ratio [OR], 2.7, 95% confidence interval [CI]: 2.2–3.3, p < 0.001 and males' OR, 2.06, 95% CI: 1.7–2.5, p < 0.001). The association remained significant in the adjusted models. Conclusions Physically inactive females and males had higher odds of experiencing a moderate to severe stroke. However, the OR of female patients was somewhat higher than that of male patients.
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Affiliation(s)
- Pegah Salmantabar
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- *Correspondence: Tamar Abzhandadze
| | - Adam Viktorisson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Reinholdsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Rehabilitation Medicine, Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
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32
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Wallace AN, Gibson DP, Asif KS, Sahlein DH, Warach SJ, Malisch T, Lamonte MP. Racial Disparity in Mechanical Thrombectomy Utilization: Multicenter Registry Results From 2016 to 2020. J Am Heart Assoc 2022; 11:e021865. [PMID: 35156390 PMCID: PMC9245822 DOI: 10.1161/jaha.121.021865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Previous studies on racial disparity in mechanical thrombectomy (MT) treatment of acute large vessel occlusion stroke lack individual patient data that influence treatment decision‐making. We assessed patient‐level data in a large US health care system from 2016 to 2020 for racial disparities in MT utilization and eligibility. Methods and Results A retrospective study was performed of 34 596 patients admitted to 43 hospitals from January 2016 to September 2020. Data included patient age, sex, race, residential zip code median income and population density, presenting hospital stroke certification, baseline ambulation, and National Institutes of Health stroke scale. The cohort included 26 640 White, non‐Hispanic (77.0%), and 7956 African American/Black (23.0%) patients. In multivariable logistic regression, Black patients were less likely to undergo MT (adjusted odds ratio [OR], 0.65; 95% CI, 0.54–0.76), arrive within 5 hours of “last known well” (adjusted OR, 0.73; 95% CI, 0.69–0.78), and have documented anterior circulation large vessel occlusion (adjusted OR, 0.78; 95% CI, 0.64–0.96). Race was not associated with MT rate among patients arriving within 5 hours of last known well with documented acute large vessel occlusion. Conclusions Black patients with stroke underwent MT less frequently than White patients, likely in part because of longer times from last known well to hospital arrival and a lower rate of documented acute large vessel occlusion. Further studies are needed to assess whether extending the MT time window and more aggressive large vessel occlusion screening protocols mitigate this disparity.
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Affiliation(s)
- Adam N. Wallace
- Neurointerventional Surgery Ascension Columbia St. Mary’s Hospital Milwaukee WI
| | - Daniel P. Gibson
- Neurointerventional Surgery Ascension Columbia St. Mary’s Hospital Milwaukee WI
| | - Kaiz S. Asif
- Neuroendovascular Surgery and Vascular Neurology Ascension Illinois and Alexian Brothers Medical Center Elk Grove Village IL
| | - Daniel H. Sahlein
- Interventional Neuroradiology Ascension St. Vincent Hospital Indianapolis IN
- Goodman Campbell Brain and Spine Indianapolis IN
| | - Steven J. Warach
- Department of Neurology Ascension Texas and Dell Medical School at The University of Texas at Austin Austin TX
| | - Timothy Malisch
- Interventional Neuroradiology Ascension Illinois and Alexian Brothers Medical Center Elk Grove Village IL
| | - Marian P. Lamonte
- Department of Neurology Ascension St. Agnes Hospital and University of Maryland School of Medicine Baltimore MD
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Huo N, Vemuri P, Graff-Radford J, Syrjanen J, Machulda M, Knopman DS, Jack CR, Petersen R, Mielke MM. Sex Differences in the Association Between Midlife Cardiovascular Conditions or Risk Factors With Midlife Cognitive Decline. Neurology 2022; 98:e623-e632. [PMID: 34987078 PMCID: PMC8829960 DOI: 10.1212/wnl.0000000000013174] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of midlife cardiovascular conditions and risk factors is higher in men than women. Associations between midlife cardiovascular conditions or risk factors and midlife cognitive decline have been reported, but few studies have assessed sex differences in these associations. METHODS We included 1,857 participants enrolled in the population-based Mayo Clinic Study of Aging who were 50 to 69 years of age at baseline. Participants were evaluated every 15 months by a coordinator, including neurologic evaluation and neuropsychological testing. The neuropsychological testing used 9 tests to calculate global cognitive and domain-specific (memory, language, executive function, and visuospatial skills) z scores. Nurse abstractors reviewed participant medical records to determine the presence of cardiovascular conditions (coronary heart disease, arrhythmias, congestive heart failure) and risk factors (hypertension, diabetes, dyslipidemia, obesity, ever smoking). Linear mixed-effect models evaluated the association between baseline cardiovascular conditions or risk factors and global and domain-specific cognitive decline. Multivariable models adjusted for demographics, APOE genotype, depression, and other medical conditions. Interactions between sex and each cardiovascular condition or risk factor were examined, and results were stratified by sex. RESULTS Overall, 1,465 (78.9%) participants had at least 1 cardiovascular condition or risk factor; the proportion of men was higher than women (767 [83.4%] vs 698 [74.5%], p < 0.0001). Cross-sectionally, coronary heart disease and ever smoking were associated with a lower visuospatial z score in multivariable models. Longitudinally, several cardiovascular conditions and risk factors were associated with declines in global and domain-specific z scores but not visuospatial z scores. Most cardiovascular conditions were more strongly associated with cognition among women: coronary heart disease and other cardiovascular conditions were associated with global cognitive decline only in women (all p < 0.05). In addition, diabetes, dyslipidemia, and coronary heart disease were associated with language z score decline only in women (all p < 0.05). However, congestive heart failure was associated with language z score decline only in men (all p < 0.05). DISCUSSION Midlife cardiovascular conditions and risk factors are associated with midlife cognitive decline. Moreover, specific cardiovascular conditions and risk factors have stronger associations with cognitive decline in midlife for women than men despite the higher prevalence of those conditions in men.
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Affiliation(s)
- Nan Huo
- From the Mayo Clinic, Rochester, MN
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Irie F, Matsuo R, Nakamura K, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Sex Differences in the Risk of 30-Day Death After Acute Ischemic Stroke. Neurol Clin Pract 2022; 11:e809-e816. [PMID: 34992963 DOI: 10.1212/cpj.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
Objective To examine sex differences in early stroke deaths according to cause of death. Methods We investigated 30-day deaths in patients with acute ischemic stroke enrolled in a multicenter stroke registry between 2007 and 2019 in Fukuoka, Japan. We estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of cause-specific deaths for women vs men using Cox proportional hazards models and competing risk models. The risk of acute infections during hospitalization and the associated case fatality rates were also compared between the sexes. Results Among 17,956 patients with acute ischemic stroke (women: 41.3%), the crude 30-day death rate after stroke was higher in women than men. However, adjusting for age and stroke severity resulted in a lower risk of death among women (HR [95% CI]: 0.76 [0.62-0.92]). Analyses using competing risk models revealed that women were less likely to die of acute infections (subdistribution HR [95% CI]: 0.33 [0.20-0.54]). Further analyses showed that women were associated with a lower risk of acute infections during hospitalization (OR [95% CI]: 0.62 [0.52-0.74]) and a lower risk of death due to these infections (subdistribution HR [95% CI]: 052 [0.33-0.83]). Conclusions When adjusting for confounders, the female sex was associated with a lower risk of 30-day death after stroke, which could be explained by a female survival advantage in poststroke infections. Sex-specific strategies are needed to reduce early stroke deaths. Classification of Evidence This is a Class I prognostic study because it is a prospective population-based cohort with objective outcomes. Female sex appears to be protective against early stroke deaths and post stroke infections.
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Affiliation(s)
- Fumi Irie
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
The goal of the current review is to examine the hazards and benefits of carotid interventions in women and to provide recommendations for the indications for carotid intervention in female patients. Stroke and cerebrovascular disease are prevalent in women. There are inherent biological and other differences in men and women, which affect the manifestations and outcome of stroke, with women experiencing worse disability and higher mortality following ischemic stroke than men. Due to the underrepresentation of female patients in most clinical trials, the ability to make firm but alternative recommendations for women specifically on the management of carotid stenosis is challenging. Although some data suggest that women might have worse periprocedural outcomes as compared to men following all carotid revascularization procedures, there is also an abundance of data to support a similar risk for carotid procedures in men and women, especially with carotid endarterectomy and transcarotid artery revascularization. Therefore, the indications for carotid revascularization are the same in women as they are in men. The choice of a carotid revascularization procedure in women is based upon the same factors as in men and requires careful evaluation of a particular patient's risk profile, anatomic criteria, plaque morphology, and medical comorbidities that might favor one technique over the other. When performing carotid revascularization procedures in women, tailored techniques and procedures to address the small diameter of the female artery are warranted.
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Affiliation(s)
- Caron Rockman
- Division of Vascular Surgery, NYU Grossman School of Medicine, New York, NY (C.R.)
| | - Valeria Caso
- Department of Cardiovascular Medicine, Santa Maria Della Misericordia Hospital, University of Perugia, Italy (V.C.)
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California San Francisco (P.A.S.)
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Stroke Disparities. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ali M, van Os HJA, van der Weerd N, Schoones JW, Heymans MW, Kruyt ND, Visser MC, Wermer MJH. Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis. Stroke 2021; 53:345-354. [PMID: 34903037 PMCID: PMC8785516 DOI: 10.1161/strokeaha.120.034040] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack. METHODS We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias. RESULTS We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11-1.39]; I2=75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19-1.61]; I2=95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25-1.55]; I2=27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94-0.97]; I2=0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04-1.24]; I2=48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13-1.34]; I2=44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54-0.97]; I2=72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70-0.99]; I2=62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias. CONCLUSIONS There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.
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Affiliation(s)
- Mariam Ali
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)
| | - Hendrikus J A van Os
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Nelleke van der Weerd
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, the Netherlands. (J.W.S.)
| | - Martijn W Heymans
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, the Netherlands (M.W.H.)
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Marieke C Visser
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
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Gasbarrino K, Di Iorio D, Daskalopoulou SS. Importance of sex and gender in ischaemic stroke and carotid atherosclerotic disease. Eur Heart J 2021; 43:460-473. [PMID: 34849703 DOI: 10.1093/eurheartj/ehab756] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/25/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of death and disability worldwide. Women are disproportionately affected by stroke, exhibiting higher mortality and disability rates post-stroke than men. Clinical stroke research has historically included mostly men and studies were not properly designed to perform sex- and gender-based analyses, leading to under-appreciation of differences between men and women in stroke presentation, outcomes, and response to treatment. Reasons for these differences are likely multifactorial; some are due to gender-related factors (i.e. decreased social support, lack of stroke awareness), yet others result from biological differences between sexes. Unlike men, women often present with 'atypical' stroke symptoms. Lack of awareness of 'atypical' presentation has led to delays in hospital arrival, diagnosis, and treatment of women. Differences also extend to carotid atherosclerotic disease, a cause of stroke, where plaques isolated from women are undeniably different in morphology/composition compared to men. As a result, women may require different treatment than men, as evidenced by the fact that they derive less benefit from carotid revascularization than men but more benefit from medical management. Despite this, women are less likely than men to receive medical therapy for cardiovascular risk factor management. This review focuses on the importance of sex and gender in ischaemic stroke and carotid atherosclerotic disease, summarizing the current evidence with respect to (i) stroke incidence, mortality, awareness, and outcomes, (ii) carotid plaque prevalence, morphology and composition, and gene connectivity, (iii) the role of sex hormones and sex chromosomes in atherosclerosis and ischaemic stroke risk, and (iv) carotid disease management.
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Affiliation(s)
- Karina Gasbarrino
- Vascular Health Unit, Research Institute of McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Glen Site, 1001 Decarie Boulevard, EM1.2230 Montreal, QC H4A 3J1, Canada
| | - Diana Di Iorio
- Vascular Health Unit, Research Institute of McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Glen Site, 1001 Decarie Boulevard, EM1.2230 Montreal, QC H4A 3J1, Canada
| | - Stella S Daskalopoulou
- Vascular Health Unit, Research Institute of McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Glen Site, 1001 Decarie Boulevard, EM1.2230 Montreal, QC H4A 3J1, Canada
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Abstract
Cognitive and behavioural outcomes in stroke reflect the interaction between two complex anatomically-distributed patterns: the functional organization of the brain and the structural distribution of ischaemic injury. Conventional outcome models—for individual prediction or population-level inference—commonly ignore this complexity, discarding anatomical variation beyond simple characteristics such as lesion volume. This sets a hard limit on the maximum fidelity such models can achieve. High-dimensional methods can overcome this problem, but only at prohibitively large data scales. Drawing on one of the largest published collections of anatomically-registered imaging of acute stroke—N = 1333—here we use non-linear dimensionality reduction to derive a succinct latent representation of the anatomical patterns of ischaemic injury, agglomerated into 21 distinct intuitive categories. We compare the maximal predictive performance it enables against both simpler low-dimensional and more complex high-dimensional representations, employing multiple empirically-informed ground truth models of distributed structure–outcome relationships. We show our representation sets a substantially higher ceiling on predictive fidelity than conventional low-dimensional approaches, but lower than that achievable within a high-dimensional framework. Where descriptive simplicity is a necessity, such as within clinical care or research trials of modest size, the representation we propose arguably offers a favourable compromise of compactness and fidelity.
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Mitta N, Sreedharan SE, Sarma SP, Sylaja PN. Women and Stroke: Different, yet Similar. Cerebrovasc Dis Extra 2021; 11:106-111. [PMID: 34628407 PMCID: PMC8543327 DOI: 10.1159/000519540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. Here, we analyzed the gender-related differences in etiology and outcome of ischemic stroke in South India. METHODS Patients with first ever ischemic stroke within 1 week of onset presenting to the Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India, were included in our study. Clinical and risk factor profile was documented. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at onset, and stroke subtype classification was done using Trial of Org 10172 in Acute Ischemic Stroke criteria. The 3-month functional outcome was assessed using the modified Rankin Scale (mRS) with excellent outcome defined as an mRS ≤2. RESULTS Of the 742 patients, 250 (33.7%) were females. The age, clinical profile, and rate of reperfusion therapies did not differ between the genders. Women suffered more severe strokes (mean NIHSS 9.5 vs. 8.4, p = 0.03). While large artery atherosclerosis was more common in men (21.3% vs. 14.8%, p = 0.03), cardioembolic strokes secondary to rheumatic heart disease were more common in women (27.2% vs. 19.7%, p = 0.02). Men had a better 3-month functional outcome compared to women (68.6% vs. 61.2%, p = 0.04), but was not statistically significant after adjusting for confounders. CONCLUSION Our data, from a single comprehensive stroke unit from South India, suggest that stroke in women are different, yet similar in many ways to men. Guideline-based treatment can result in comparable short-term outcomes, irrespective of admission stroke severity.
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Affiliation(s)
- Nandini Mitta
- Department of Neurology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Comprehensive Stroke Care Programme, Trivandrum, India
| | - Sapna Erat Sreedharan
- Department of Neurology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Comprehensive Stroke Care Programme, Trivandrum, India
| | - Sankara P Sarma
- Sree ChitraTirunal Institute for Medical Sciences and Technology, Achutha Menon Centre for Health Science Studies, Trivandrum, India
| | - Padmavathy N Sylaja
- Department of Neurology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Comprehensive Stroke Care Programme, Trivandrum, India
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Kelly J, Dowling A, Hillier S, Brown A, Kleinig T, Goldsmith K, McBride K, Pandian J, Castle S, Thrift AG. Perspectives on rehabilitation for Aboriginal people with stroke: a qualitative study. Top Stroke Rehabil 2021; 29:295-309. [PMID: 34180366 DOI: 10.1080/10749357.2021.1911771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (hereinafter respectfully termed Aboriginal) people have a greater incidence of stroke at a younger age than non-Indigenous people in Australia. The needs and preferences of Aboriginal people for rehabilitation and longer-term support remain largely unknown. OBJECTIVES To identify the long-term rehabilitation needs of Aboriginal people who have a stroke, from the perspectives of Aboriginal persons with stroke and health care providers. METHODS Aboriginal people who had experienced stroke in the previous three years were interviewed to obtain their experiences of rehabilitation care. Health professionals who provided care in each of six designated hospitals and nearby community health sites were involved in focus groups and individual interviews. Information obtained was thematically analyzed separately for Aboriginal people with stroke and health professionals, and compared using Nvivo. RESULTS Among six Aboriginal people with stroke and 78 healthcare providers, four main themes emerged: the importance of family; variable access to services; the impact of stroke on Aboriginal peoples' lives; and making positive choices. Communication and involvement of family was highlighted as essential for a shared understanding, particularly when making decisions about participating in short and long-term rehabilitation. Co-morbidities, conflicting priorities, and inadequate or inflexible services and transport compounded issues with changing life roles. Stories of resilience were also shared. CONCLUSIONS Aboriginal people report making positive lifestyle changes, but experience significant unmet rehabilitation needs. Addressing issues of communication, advocacy and flexible delivery should improve some of the shortfalls in service provision, particularly in regional and remote areas.
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Affiliation(s)
- Janet Kelly
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Nursing School, The University of Adelaide,Australia
| | - Anna Dowling
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University
| | - Susan Hillier
- Allied Health & Human Performance,University of South Australia, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Aboriginal Health, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Timothy Kleinig
- Department of Neurology, SA Health, Adelaide, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | | | - Katharine McBride
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health & Human Performance,University of South Australia, Adelaide, Australia
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Sally Castle
- Department of Neurology, SA Health, Adelaide, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Thomas Q, Crespy V, Duloquin G, Ndiaye M, Sauvant M, Béjot Y, Giroud M. Stroke in women: When gender matters. Rev Neurol (Paris) 2021; 177:881-889. [PMID: 34172293 DOI: 10.1016/j.neurol.2021.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
Stroke in women may be considered as a distinct entity due to numerous differences compared with men, including specific epidemiological, etiological, and outcome features along with unique pathophysiological mechanisms. Stroke is the second cause of death in women worldwide with sex-specific causes of stroke in youger women such as pregnancy, post-partum period, oral contraception and migraine. Substitutive hormone treatment in older women is no more recommended in regard of the increased thromboembolic risk it generates. Venous thrombolysis with rtPA and mechanical thrombectomy are now proven to be as efficacious in women as in men. After a stroke, women present poorer quality of life than men attributable to age, more severe stroke, pre-stroke dependency and depression. Recent data concerning the latest epidemiological surveys reveal a shift in trends with the rise of incidence of strokes in young women (≤55 years and 64 years) contrasting with the stability of incidence rates in older women. As science is unvealing sex-related differences in cardiovascular disorders, health policies need to be adapted accordingly to improve stroke prevention and pre-stroke health in women. In the meantime, therapeutical trials should include more women in order to be able to formulate adequate management.
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Affiliation(s)
- Q Thomas
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France.
| | - V Crespy
- Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - G Duloquin
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Ndiaye
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - M Sauvant
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - Y Béjot
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Giroud
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
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Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073659. [PMID: 33915785 PMCID: PMC8037293 DOI: 10.3390/ijerph18073659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022]
Abstract
Background: To analyze the incidence, use of therapeutic procedures, and in-hospital outcomes among patients suffering an ischemic stroke (IS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the existence of sex differences. Methods: Matched-pair analysis using the Spanish National Hospital discharge. Results: IS was coded in 92,524 men and 79,731 women (29.53% with T2DM). The adjusted incidence of IS (IRR 2.02; 95% CI 1.99–2.04) was higher in T2DM than non-T2DM subjects, with higher IRRs in both sexes. Men with T2DM had a higher incidence of IS than T2DM women (IRR 1.54; 95% CI 1.51–1.57). After matching patients with T2DM, those with other comorbid conditions, however, significantly less frequently received endovascular thrombectomy and thrombolytic therapy. In-hospital mortality (IHM) was lower among T2DM men than matched non-T2DM men (8.23% vs. 8.71%; p < 0.001). Women with T2DM had a higher IHM rate than T2DM men (11.5% vs. 10.20%; p = 0.004). After adjusting for confounders, women with T2DM had a 12% higher mortality risk than T2DM men (OR 1.12; 95% CI 1.04–1.21). Conclusions: T2DM is associated with higher incidence of IS in both sexes. Men with T2DM have a higher incidence rates of IS than T2DM women. Women with T2DM have a higher risk of dying in the hospital.
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Hagii J, Metoki N, Saito S, Shiroto H, Sasaki S, Takahashi K, Hitomi H, Baba Y, Yamada N, Seino S, Kamada T, Uchizawa T, Nakamura T, Yasujima M, Tomita H. Persistent or permanent atrial fibrillation is associated with severe cardioembolic stroke in patients with non-valvular atrial fibrillation. Thromb J 2021; 19:22. [PMID: 33789684 PMCID: PMC8011096 DOI: 10.1186/s12959-021-00276-9] [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: 11/23/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the difference in the severity of cardioembolic (CE) stroke between patients with paroxysmal atrial fibrillation (PAF) and persistent/permanent AF (PerAF). We assessed stroke severity in patients with CE stroke divided by the type of AF. METHODS Three hundred and fifty-eight consecutive patients with CE stroke within 48 h of onset and with a modified Rankin Scale (mRS) score ≤ 1 before onset were studied. We compared basic characteristics, stroke severity, and functional outcome between patients with PAF (n = 127) and PerAF (n = 231). RESULTS Patients with PerAF were more likely to take oral anticoagulants (OACs) than those with PAF (37% vs. 13%, P < 0.0001), even though still underuse of OAC in both patients. Regarding stroke severity on admission, patients with PerAF exhibited a tendency toward a higher score on the National Institutes of Health Stroke Scale (NIHSS) compared with patients with PAF (12 [5-20] vs. 9 [4-18]; P = 0.12). Mortality and mRS score at discharge were higher in the PerAF than in the PAF group (13% vs. 4%; P = 0.005, and 3 [1-5] vs. 2 [1-4]; P = 0.01, respectively). Multivariate analyses confirmed that PerAF was a significant determinant of severe stroke (NIHSS score > 8) on admission (odds ratio [OR] to PAF = 1.80; 95% confidence interval [CI] 1.08-2.98; P = 0.02) and of an mRS score ≥ 3 at discharge (OR = 2.07; 95% CI 1.24-3.46; P = 0.006). Patients with PerAF had three times more internal carotid artery occlusion evaluated by magnetic resonance angiography, which indicated a more severe cerebral embolism compared with patients with PAF. CONCLUSIONS We found underuse of OAC in high risk AF patients with CE stroke. PerAF is significantly associated with severe stroke on admission and an unfavorable functional outcome at discharge in Japanese patients with CE stroke.
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Affiliation(s)
- Joji Hagii
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Norifumi Metoki
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Shin Saito
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Hiroshi Shiroto
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Satoko Sasaki
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Koki Takahashi
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Hiroyasu Hitomi
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Yoshiko Baba
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Natsumi Yamada
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Satoshi Seino
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Takaatsu Kamada
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | | | - Taigen Nakamura
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Minoru Yasujima
- Hirosaki Stroke and Rehabilitation Center, Hirosaki, 036-8104, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. .,Department of Stroke and Cerebrovascular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan.
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Chen MQ, Shi WR, Wang HY, Sun YX. Sex Differences of Combined Effects Between Hypertension and General or Central Obesity on Ischemic Stroke in a Middle-Aged and Elderly Population. Clin Epidemiol 2021; 13:197-206. [PMID: 33732027 PMCID: PMC7956891 DOI: 10.2147/clep.s295989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
Background Hypertension and obesity are recognized as modifiable risk factors for stroke, but their combined effects are unknown. This study aimed to explore the combined effects of hypertension and general or central obesity on the risk of ischemic stroke in a middle-aged and elderly population. Methods The data of 11,731 participants (53.5 ± 10.5 years old) were analyzed from the Northeast China Rural Cardiovascular Health Study, 2012–2013. General obesity (GO) was defined by body mass index (BMI); central obesity (CO) was measured by waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHpR). Results The overall prevalence of ischemic stroke was 3.1%. After adjusting for age and sex, the odds ratios for having ischemic stroke were 4.31 (3.14–5.91) among subjects with hypertension, 1.79 (1.40–2.30) with GO, 1.94 (1.54–2.43), 1.98 (1.54–2.53), and 1.65 (1.33–2.06) with CO measured by WC, WHtR and WHpR, respectively. After full adjustment for potential confounders, the combinations of hypertension and obesity indices (including BMI, WC, WHtR and WHpR) were associated with the highest risk of ischemic stroke, especially in women, which were respectively 7.3-fold, 9.3-fold, 9.9-fold and 7.6-fold higher than that of individuals without both conditions. Conclusion Our study results suggest that women with both hypertension and obesity, no matter defined by BMI, WC, WHtR or WHpR, were more likely to have ischemic stroke. A better understanding of the combined effects of these risk factors can help promote primary prevention in susceptible subgroups.
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Affiliation(s)
- Meng-Qi Chen
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Wen-Rui Shi
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Hao-Yu Wang
- Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Ying-Xian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
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Phan HT, Gall S, Blizzard CL, Lannin NA, Thrift AG, Anderson CS, Kim J, Grimley R, Castley HC, Kilkenny MF, Cadilhac DA. Sex Differences in Causes of Death After Stroke: Evidence from a National, Prospective Registry. J Womens Health (Larchmt) 2021; 30:314-323. [DOI: 10.1089/jwh.2020.8391] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hoang T. Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Department of Public Health Management, Pham Ngoc Thach University of Medicine, Hồ Chí Minh, Vietnam
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Craig S. Anderson
- Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Rohan Grimley
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia
| | | | - Monique F. Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Bonkhoff AK, Karch A, Weber R, Wellmann J, Berger K. Female Stroke: Sex Differences in Acute Treatment and Early Outcomes of Acute Ischemic Stroke. Stroke 2021; 52:406-415. [PMID: 33493053 DOI: 10.1161/strokeaha.120.032850] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry. METHODS Analyses were based on the Stroke Registry of Northwestern Germany from 2000 to 2018. We focused on admission-stroke severity and disability, acute recanalization treatment, and early stroke outcomes. Potential sex divergences were investigated via odds ratio (OR) using logistic regression models. Covariates were introduced in 3 steps: (1) base models (age and admission year), (2) partially adjusted models (additionally corrected for acute stroke severity and recanalization treatment), (3) fully adjusted models (additionally adjusted for onset-to-admission time interval, prestroke functional status, comorbidities, and stroke cause). Models were separately fitted for the periods 2000 to 2009 and 2010 to 2018. RESULTS Data from 761 106 patients with AIS were included. In fully adjusted models, there were no sex differences with respect to treatment with intravenous thrombolysis (2000-2009: OR, 0.99 [95% CI, 0.94-1.03]; 2010-2018: OR, 1.0 [0.98-1.02]), but women were more likely to receive intraarterial therapy (2010-2018: OR, 1.12 [1.08-1.15]). Despite higher disability on admission (2000-2009: OR, 1.10 [1.07-1.13]; 2010-2018: OR, 1.09 [1.07-1.10]), female patients were more likely to be discharged with a favorable functional outcome (2003-2009: OR, 1.05 [1.02-1.09]; 2010-2018: OR, 1.05 [1.04-1.07]) and experienced lower in-hospital mortality (2000-2009: OR, 0.92 [0.86-0.97]; 2010-2018: OR, 0.91 [0.88-0.93]). CONCLUSIONS Female patients with AIS have a higher chance of receiving intraarterial treatment that cannot be explained by clinical characteristics, such as age, premorbid disability, stroke severity, or cause. Women have a more favorable in-hospital recovery than men because their higher disability upon admission was followed by a lower in-hospital mortality and a higher likelihood of favorable functional outcome at discharge after adjustment for covariates.
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Affiliation(s)
- Anna K Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (A.K.B.).,Institute of Epidemiology and Social Medicine, University of Muenster, Germany (A.K.B., A.K., J.W., K.B.)
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Muenster, Germany (A.K.B., A.K., J.W., K.B.)
| | - Ralph Weber
- Department of Neurology, Alfried Krupp Hospital Essen and Ruhr University Bochum, Germany (R.W.)
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Muenster, Germany (A.K.B., A.K., J.W., K.B.)
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Muenster, Germany (A.K.B., A.K., J.W., K.B.)
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Greige T, Norton C, Foster LD, Yeatts SD, Thornhill A, Griffin J, Wang J, Hrdlicka CM, Selim M. Why Are Women Less Represented in Intracerebral Hemorrhage Trials? Stroke 2021; 52:442-446. [PMID: 33493043 DOI: 10.1161/strokeaha.120.032166] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Fewer women than men tend to be enrolled in clinical trials of intracerebral hemorrhage. It is unclear whether this reflects lower prevalence of intracerebral hemorrhage in women, selection bias, or poor recruitment efforts. We undertook this study to examine differences between men and women in the reasons for exclusion from the iDEF trial (Intracerebral Hemorrhage Deferoxamine). METHODS The screen failure log included 29 different reasons for exclusion. Chi-square statistics were used to evaluate the differences in reasons for exclusion between men and women. RESULTS A total of 38.2% of participants in iDEF were women. Three thousand nine hundred eighty-two women (45.7%) and 4736 men (54.3%) were screen failures (P<0.0001). Similar proportions of women (1.28%) and men (1.73%) were excluded due to inability to obtain consent (P=0.1). Patients or families declined participation in 1.26% of women versus 1.31% of men (P=0.9). More women than men failed screening because of age>80 (22.40% versus 12.61%; adjusted P=0.0007) and preexisting do-not-resuscitate/do-not-intubate (3.69% versus 2.83%; adjusted P=0.067). CONCLUSIONS Lower rates of women enrollment in the iDEF trial may be attributed to older age. Inability to obtain consent or declining participation was similar between women and men, arguing against selection bias. Our findings should be confirmed in other intracerebral hemorrhage trials to determine best strategies to improve women's representation in future trials.
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Affiliation(s)
- Tatiana Greige
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Casey Norton
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Lydia D Foster
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Sharon D Yeatts
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Andre Thornhill
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Jessica Griffin
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Jeffrey Wang
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Courtney M Hrdlicka
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Magdy Selim
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
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Lambert C, Chaudhary D, Olulana O, Shahjouei S, Avula V, Li J, Abedi V, Zand R. Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States. Ther Adv Neurol Disord 2020; 13:1756286420971895. [PMID: 33414844 PMCID: PMC7750897 DOI: 10.1177/1756286420971895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men (p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.
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Affiliation(s)
- Clare Lambert
- Geisinger NeuroScience Institute, Geisinger Health System, Danville, PA, USA
| | - Durgesh Chaudhary
- Geisinger NeuroScience Institute, Geisinger Health System, Danville, PA, USA
| | - Oluwaseyi Olulana
- Geisinger NeuroScience Institute, Geisinger Health System, Danville, PA, USA
| | - Shima Shahjouei
- Geisinger NeuroScience Institute, Geisinger Health System, Danville, PA, USA
| | - Venkatesh Avula
- Geisinger NeuroScience Institute, Geisinger Health System, Danville, PA, USA
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, USA
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, USA
| | - Ramin Zand
- Geisinger NeuroScience Institute, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822, USA
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50
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Yu AYX, Hill MD, Asdaghi N, Boulanger JM, Camden MC, Campbell BCV, Demchuk AM, Field TS, Goyal M, Krause M, Mandzia J, Menon BK, Mikulik R, Moreau F, Penn AM, Swartz RH, Coutts SB. Sex Differences in Diagnosis and Diagnostic Revision of Suspected Minor Cerebral Ischemic Events. Neurology 2020; 96:e732-e739. [PMID: 33184228 DOI: 10.1212/wnl.0000000000011212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 09/21/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe sex differences in the presentation, diagnosis, and revision of diagnosis after early brain MRI in patients who present with acute transient or minor neurologic events. METHODS We performed a secondary analysis of a prospective multicenter cohort study of patients referred to neurology between 2010 and 2016 with a possible cerebrovascular event and evaluated with brain MRI within 8 days of symptom onset. Investigators documented the characteristics of the event, initial diagnosis, and final diagnosis. We used multivariable logistic regression analyses to evaluate the association between sex and outcomes. RESULTS Among 1,028 patients (51% women, median age 63 years), more women than men reported headaches and fewer reported chest pain, but there were no sex differences in other accompanying symptoms. Women were more likely than men to be initially diagnosed with stroke mimic (54% of women vs 42% of men, adjusted odds ratio (OR) 1.60, 95% confidence interval [CI] 1.24-2.07), and women were overall less likely to have ischemia on MRI (10% vs 17%, OR 0.52, 95% CI 0.36-0.76). Among 496 patients initially diagnosed with mimic, women were less likely than men to have their diagnosis revised to minor stroke or TIA (13% vs 20%, OR 0.53, 95% CI 0.32-0.88) but were equally likely to have acute ischemia on MRI (5% vs 8%, OR 0.56, 95% CI 0.26-1.21). CONCLUSIONS Stroke mimic was more frequently diagnosed in women than men, but diagnostic revisions were common in both. Early brain MRI is a useful addition to clinical evaluation in diagnosing transient or minor neurologic events.
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Affiliation(s)
- Amy Y X Yu
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada.
| | - Michael D Hill
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Negar Asdaghi
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Jean-Martin Boulanger
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Marie-Christine Camden
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Bruce C V Campbell
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Andrew M Demchuk
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Thalia S Field
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Mayank Goyal
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Martin Krause
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Jennifer Mandzia
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Bijoy K Menon
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Robert Mikulik
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Francois Moreau
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Andrew M Penn
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Richard H Swartz
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Shelagh B Coutts
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
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