Hypertension as a Risk Factor for Ischemic Stroke in Women

Gorgui, Jessica; Gorshkov, M P; Khan, Nadia; Daskalopoulou, Stella S.

doi:10.1016/j.cjca.2014.01.007

Cited by 61 publications

(42 citation statements)

References 78 publications

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“…22 The Framingham Heart Study also suggested an overall higher lifetime stroke susceptibility in women. 23 Estrogen and estrogen-progestogen therapy can reduce homocysteine levels in menopausal women.…”

Section: Discussionmentioning

confidence: 99%

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Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients

Han

Wang

et al. 2015

Stroke

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Stroke is the leading cause of permanent disability in China, 1 and ischemic stroke (IS) accounts for almost 80% of all strokes, 2 whereas coronary heart disease (CHD) is a major worldwide health threat. In tandem with the economic success of China, the number of individuals in China with IS and CHD has increased significantly in recent years, with stroke resulting in 301 million disability-adjusted life-years. 3CHD in Chinese adults aged 35 to 84 years is predicted to increase by 64% during the period 2020-2029. 4 Although numerous epidemiology studies have researched the association between hyperhomocysteinemia and IS or CHD, the results have been conflicting. Most studies have been retrospective and focused on healthy populations in the developed world, whereas data from developing countries remains limited.Vitamins B12 and B6 and folate are involved in the metabolism of methionine, and deficiency of these B vitamins can cause elevation of total homocysteine (tHcy) levels.5 Deficiencies in these nutrients are more prevalent in developing countries. A meta-analysis of randomized trials demonstrated that homocysteine-lowering interventions for stroke seem not to have a significant effect in geographic regions with high dietary folate intake, but may have a substantial effect in regions with low folate intake, such as Asia. 6 Regarding public health guidelines,Background and Purpose-Total homocysteine level (tHcy) is a risk factor of ischemic stroke (IS) and coronary heart disease. However, the results are conflicting and mainly focused on healthy individuals in developed countries. Methods-A prospective, population-based cohort study was conducted among 5935 participants from 60 communities in the city of Shenzhen, China. A Cox regression analysis was applied to evaluate the contribution of tHcy to the risk of IS and coronary heart disease. The effect of folic acid supplementation on tHcy levels was also evaluated among 501 patients with essential hypertension, who received an average of 2.5 years of folic acid supplementation. Results-After adjustment for confounding factors, the hazard ratios (95% confidence intervals) of IS caused by hyperhomocysteinemia were 2.18 (1.65-2.89), 2.40 (1.56-3.67), and 2.73 (1.83-4.08) in the total, male, and female participants, respectively. Compared with normal levels of tHcy (<15 μmol/L), the hazard ratios (95% confidence intervals) for IS in the highest tHcy category (≥30 μmol/L) were 4.96 (3.03-8.12), 6.11 (3.44-10.85), and 1.84 (0.52-6.46) in the total, males, and females participants, respectively. However, we did not observe a significant relationship between tHcy and the risk of coronary heart disease. The 2.5 years of folic acid supplementation reduced tHcy levels by 6.7 μmol/L (27.92%) in patients with essential hypertension. Conclusions-Hyperhomocysteinemia in Chinese hypertensive patients is significantly associated with IS risk but not coronary heart disease susceptibility, and folic acid supplementation can efficiently reduce tHcy levels.

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Section: Discussionmentioning

confidence: 99%

“…Strategies for the prevention and treatment of hypertension, including folic acid supplementation, are necessary to prevent stroke. 22 …”

Section: Discussionmentioning

confidence: 99%

Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients

Han

Wang

et al. 2015

Stroke

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“…It was composed of 19 questions covering five functional dimensions of social support: material (questions 1 to 4), affection (questions 5 to 7), emotional aspects (questions 8 to 11), information (questions 12 to 15) and positive social interaction (questions 16 to 18). The possible responses for each question and their respective scores were: never (1), rarely (2), sometimes (3), almost always (4) and always (5). The presence of common mental disorders was considered positive for men that scored greater than or equal to six and for women greater than or equal to eight.…”

Section: Collected Datamentioning

confidence: 99%

“…This has been attributed to hormonal climacteric changes that occur due to the menopause which can expose women to cardiovascular problems. Continuing on this vein, a study involving the research of journals showed a direct linked between high blood pressure in women and a high risk of encephalic vascular accident (5) . In spite of all of the knowledge and evidence on the importance of early diagnosis and treatment of arterial hypertension, the levels of control of this disease is still proving to be a major challenge for health care professionals.…”

Section: Introductionmentioning

confidence: 98%

The control of hypertension in men and women: a comparative analysis

Silva

Oliveira

Pierin

2016

Rev. esc. enferm. USP

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Objective:To compare men and women who have hypertension with reference to the following: high blood pressure, biosocial variables, habits and life styles, mental disorders, and social support networks. Method: 290 hypertensive patients (women, 62.1%) were evaluated. The assessments involved the following: measuring blood pressure with an automatic measuring device, evaluating social status through the Social Support Scale, and the use of a Self-Report Questionnaire (SRQ-20) to identify common mental disorders. A value of p<0.05 was considered statistically significant. Results: Women were found to be different to men (p<0.05) in the following areas having: better control of their blood pressure (64.4% vs 52.7%), less salary incomes, less diabetes, higher total cholesterol, higher body mass index and wider abdominal circumferences. They also had lower systolic blood pressure, lower levels of alcohol consumption and a greater prevalence for mental disorders. The social support assessment revealed that hypertensive women received less help with preparing meals but had more company from people which allowed them to engage in enjoyable activities. Conclusion: Women had more control over their blood pressure than men, despite the presence of negative biopsychosocial factors that may have influenced their adherence to the treatments. DESCRIPTORS

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“…As far as we are aware, no reports have applied DTI to hypertensive rats that have been subjected to MCAO. Hypertension is a major risk factor for human stroke (19,40) and hypertensive rats can have an increased susceptibility to focal ischemic injury relative to normotensive strains (13,16,17). In this report, we have utilized DTI to examine white matter injury following transient focal ischemia in spontaneously hypertensive rats (SHRs).…”

Section: █ Introductionmentioning

confidence: 99%

Monitoring ischemic cerebral injury in spontaneously hypertensive rats by diffusion tensor imaging

Kujoth

Neves²,

Çıkla³

et al. 2015

Turkish Neurosurgery

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AIM:We have applied diffusion tensor imaging (DTI) to interrogate microstructural changes in white matter integrity in a widely used middle cerebral artery occlusion (MCAO) model of cerebral ischemia. MATERIAL and METHODS:We performed ex vivo DTI 35 days after 60 minutes transient focal ischemia in male spontaneously hypertensive rats and generated fractional anisotropy (FA), mean, axial and radial diffusivity maps. Regions of interest corresponding to external capsule (EC), corpus callosum (CC) and internal capsule (IC) were compared among sham and stroked rats. We compared tractographic projections of white matter fiber patterns and examined white matter integrity by Luxol fast blue histological analysis. We also determined infarct lesion volumes at 24 hours post-ischemia by T2-weighted magnetic resonance imaging (MRI) or at 35 days by histological staining with cresyl violet. RESULTS:We found alterations in EC and IC, but not CC, as represented by decreased FA and increased mean, axial and radial diffusivities. The size of the ischemic lesion detected subacutely by T2-weighted MRI or at 35 days by histological staining correlated with the decline in FA in the affected structures. Tractography revealed disruption of fiber trajectories through the EC and reorientation of fibers within the caudate/putamen of rats subjected to MCAO. Similarly, loss of white matter integrity in the EC and increased white matter density in the caudate/putamen along the infarct border zone was evidenced by Luxol fast blue staining. CONCLUSION:Diffusion tensor imaging therefore allows for monitoring of white matter injury and reorganization in hypertensive rats.

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Hypertension as a Risk Factor for Ischemic Stroke in Women

Cited by 61 publications

References 78 publications

Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients

Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients

The control of hypertension in men and women: a comparative analysis

Monitoring ischemic cerebral injury in spontaneously hypertensive rats by diffusion tensor imaging

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