Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients

Abstract

Men and women differ in their clinical risk factors with respect to various predictors of severity in acute ischemic stroke (AIS). High cholesterol is a risk factor for AIS and the mechanism by which high cholesterol levels lead to an AIS is well established. However, the specific relationship between demographic, clinical risk factors, total cholesterol, and the resulting gender difference in AIS patients is yet to be investigated. This study recruited AIS patients between January 2000 and June 2016 classified into normal, borderline or high total cholesterol (TC). Normal was defined as ≤200 mg/dl, borderline 200 to 239 mg/dl and high ≥240 mg/dl based on Adult Treatment Panel III (ATP III) Guidelines for the classification of TC levels. The logistic regression model was used to predict clinical risk factors associated within men and women AIS patients with different levels of TC. A total of 3532 AIS patients presented with normal TC, 760 patients with borderline TC and 427 patients with high TC. The high total cholesterol group was more likely to be women with increasing age (OR = 1.028, 95% CI, 1.006–1.052, P = .014), body mass index (BMI) (OR = 1.052, 95% CI, 1.004–1.102, P = .033), and high-density lipoprotein cholesterol (HDL-C) (OR = 1.039, 95% CI, 1.019–1.060, P < .001), while those with coronary artery disease (OR = 0.435, 95% CI, 0.234–0.809, P = .003), history of drug or alcohol abuse (OR = 0.261, 95% CI, 0.079–0.867, P = .028), increasing INR (OR = 0.187, 95% CI, 0.047–0.748, P = .018), and elevated diastolic blood pressure (OR = 0.982, 95% CI, 0.970–0.995, P = .006) were associated with being a male AIS patient. There were disparities in demographic and clinical risk factors associated with high TC levels in men when compared to women and more clinical risk factors were associated with high TC levels in men when compared to women with AIS. It is important to take into account specific clinical risk factors associated with gender-related differences in total cholesterol in AIS population to facilitate personalizing their therapeutic actions.

Stroke Severity in Ischemic Stroke Patients with a History of Diastolic Blood Pressure Treated in a Telestroke Network

“…In previous studies, lower BP levels were associated with improved prognosis in patients treated with AIS, while higher BP levels were associated with poor treatment outcomes [ 28 , 29 ]. Our results extend beyond previous reports on elevated BP and stroke severity in the non-telestroke setting [ 22 , 23 , 30 , 31 ]. Most studies did not report specific risk factors associated with stroke severity in AIS patients with elevated DBP.…”

“…Several risk factors, such as diabetes, hypertension, atrial fibrillation, coronary and peripheral artery disease, heart failure, and age, have been associated with stroke severity [ 22 , 23 , 24 ]. In addition, the severity conferred by the different risk factors often clusters among those with pre-existing hypertension and may significantly contribute to stroke severity [ 25 ].…”

Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

“…[ 31 32 33 ] Findings indicate that women were more likely to have a poor outcome than men. While hormonal factors and comorbid function are known to contribute to the poor functional recovery in older women, our study reveals that well-established factors including previous stroke,[ 34 35 ] AF,[ 36 ] heart failure,[ 37 ] antidepressant use,[ 38 ] higher blood glucose level,[ 39 ] higher heart rate,[ 40 ] and rtPA administration[ 41 ] are all linked to worsening outcome in the elderly patient population. After adjusting for the effect of confounding variables, our findings reveal that several clinical risk factors contribute to the continuous decline in neurologic outcome in older female AIS patients, which suggests that long-term management strategies are needed for older stroke populations.…”

Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network

“…Women are more likely to present with hypertension, diabetes mellitus, and obesity [ 12 , 35 ]. In contrast, men are more likely to present with a history of heart disease, myocardial infarction, peripheral arterial disease, current smoking, and alcohol consumption [ 5 , 6 , 36 , 37 ]. Our current study found that women presenting with AIS with increased heart rate treated in the telestroke network were associated with worsening neurologic functions.…”