Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses

Wang, Xia; Phan, Hoang; Li, Jingwei; Reeves, Mathew J.; Thrift, Amanda G; Cadilhac, Dominique A; Sturm, Jonathan; Vemmos, Konstantinos; Parmar, Priya; Krishnamurthi, Rita; Barker‐Collo, Suzanne; Feigin, Valery; Cabral, Norberto Luiz; Carolei, Antonio; Marini, Carmine; Sacco, Simona; Correia, Manuel; Appelros, Peter; Kõrv, Janika; Vibo, Riina; Yang, Sook Ching; Carcel, Cheryl; Woodward, Mark; Sandset, Else Charlotte; Anderson, Craig S.; Gall, Seana

doi:10.1089/whr.2020.0029

Cited by 6 publications

(7 citation statements)

References 60 publications

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“…In line with our results, previous reports from other countries also indicated that women ischemic stroke patients had older age and a higher prevalence of hypertension, diabetes mellitus, and atrial fibrillation. 3,[20][21][22] Previous surveys or registry data from China also draw similar conclusions. 10,11,23 In addition, the administration of in-hospital treatments was comparable between women and men patients.…”

Section: Discussionsupporting

confidence: 66%

Ten-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes of ischemic stroke in China: Analyses of a nationwide serial cross-sectional survey from 2005 to 2015

Wang

Zhang

et al. 2023

International Journal of Stroke

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Background: Women with stroke differ from men in risk factors, treatment, and outcomes. However, previous inconsistent results in China hampered the development of tailored sex-specific strategies for ischemic stroke management. We performed a nationwide serial cross-sectional survey to obtain national-level estimates to assess the ten-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes in China from 2005 to 2015. Methods: We used a two-stage random sampling design, economic-geographical region-stratified random sampling for hospitals first and then systematic sampling for patients, to obtain a nationally representative sample of ischemic strokes in China in 2005, 2010, and 2015. We extracted data on clinical characteristics, management measures (diagnostic tests, interventions, and secondary prevention treatments), in-hospital outcomes (all-cause in-hospital mortality, discharge against medical advice [DAMA], and a composite outcome of in-hospital death and DAMA), and comorbidities. We applied weights proportional to the inverse sampling fraction of hospitals within each stratum and the inverse sampling fraction of patients within each hospital. Results: A total of 28 277 ischemic stroke admissions were analyzed. Compared to men, women had a much lower prevalence of current smokers and a slightly higher prevalence of hypertension, diabetes, dyslipidemia, and atrial fibrillation at admission. Prevalence differences between sex in these cardiovascular risk factors were stable except for atrial fibrillation (decreased from 4.3% [95% CI, 3.1% to 5.5%] to 1.7% [95% CI, 0.7% to 2.7%]) and current smoker (increased from −17.6 [95% CI, −19.7 to −15.6] to −25.4 [95% CI, −26.4 to −24.4]). From 2005 to 2015, in-hospital management and outcomes were improved both for women and men, and sex differences in cardiovascular assessment, cervical vessels assessment and transthoracic echocardiography/transesophageal echocardiography were improved as well. However, women increased more slowly than men in the administration of clopidogrel (from 0.3% [95% CI, −0.9% to 1.4%) to −7.3% [95% CI, −8.7% to −6.0%]) and aspirin plus clopidogrel (0.3% [95% CI, −5.0% to 1.1%] to −5.0% [95% CI, −6.2% to −3.9%]). Conclusions: Compared to men, women patients with ischemic stroke had a steadily higher prevalence of cardiovascular risk factors, a slower increase rate in the administration of key secondary prevention drugs, and comparable in-hospital outcomes. More effort should be paid to the treatment and control of cardiovascular risk factors and also to the prescription of antiplatelets at discharge for women.

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Section: Discussionsupporting

confidence: 66%

Ten-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes of ischemic stroke in China: Analyses of a nationwide serial cross-sectional survey from 2005 to 2015

Wang

Zhang

et al. 2023

International Journal of Stroke

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“… 135 Among patients with ischaemic stroke, females more often present with atrial fibrillation, hypertension, obesity and T2D than males. 136 , 137 …”

Section: Sex Differences In the Association Of Hypertension With Cvdmentioning

confidence: 99%

Sex differences in arterial hypertension

Gerdts

Sudano

Brouwers

et al. 2022

European Heart Journal

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There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension.

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“…Prior findings from registry studies and meta-analyses across different countries showed that female ischemic stroke patients were older and a higher proportion had hypertension or atrial fibrillation. [6][7][8]10] A national survey in China reported that female stroke survivors had a significantly higher prevalence of hypertension, diabetes mellitus, and atrial fibrillation than male stroke survivors. [34] The INTERSTROKE case-control study consisting of participants from 32 countries in Asia, Africa, and the Middle East demonstrated using population-attributable risk that hypertension was the most impactful risk factor for stroke in women compared to men.…”

Section: In-hospital Outcomesmentioning

confidence: 99%

“…[1–5] Generally, while strokes are more common among men, several traditional cardiovascular risk factors (e.g., hypertension and atrial fibrillation) are more prevalent among women. [6–8] Women are also less likely to receive thrombolysis, more likely to be severely ill and more likely to have unfavorable outcomes. [9–12] With the recognition of sex disparities in health, American Heart Association's Go Red for Women Campaign was launched in the United States to close the gaps and eliminate disparities.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in vascular risk factors, in‐hospital management, and outcomes of patients with acute ischemic stroke in China

Wang

Yang

et al. 2021

Euro J of Neurology

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Background Previous assessments of sex differences for patients with acute ischemic stroke were limited in a specific region or population, narrow scope, or small sample size. Methods Patients with acute ischemic stroke hospitalized in the China Stroke Center Alliance hospitals were analyzed. Absolute standardized differences (ASDs) were used to assess sex differences in vascular risk factors, guideline‐recommended in‐hospital management measures and outcomes, including stroke severity (National Institutes of Health Stroke Scale≥16), death/discharge against medical advice, major adverse cardiovascular events, pneumonia, and disability (modified Rankin Scale≥3). Results Of 838,229 patients analyzed, 524351 (62.6%) were men and 313,878 (37.4%) were women. Compared with men, women were older (68.6 vs. 64.7 years), had higher prevalence of hypertension (67.7% vs. 62.4%), diabetes (24.7% vs. 19.5%), and atrial fibrillation (7.1% vs. 4.3%), but lower prevalence of smoking (4.5% vs. 56.6%) and drinking (2.6% vs 35.8%) (ASDs >10%). No sex differences were seen in guideline‐directed management measures, indicated by risk‐adjusted individual measures and the all‐or‐null summary measure (34.5% vs 34.9%, ASD = 1.0%). Compared to men, women tended to have strokes that were more severe at presentation (6.5% vs. 4.5%, ASD = 8.8%) and more disabilities at discharge (34.9% vs 30.5%, ASD =9.4%). However, all sex‐related differences in outcomes were attenuated to null after risk adjustments (ASDs<2%). Conclusions Compared to male patients, female patients had more vascular risk factors and received similar in‐hospital care. They had strokes that were more severe at presentation and more disabilities at discharge, both of which may be explained by worse vascular risk profiles.

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Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses

Cited by 6 publications

References 60 publications

Ten-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes of ischemic stroke in China: Analyses of a nationwide serial cross-sectional survey from 2005 to 2015

Ten-year trends in sex differences in cardiovascular risk factors, in-hospital management, and outcomes of ischemic stroke in China: Analyses of a nationwide serial cross-sectional survey from 2005 to 2015

Sex differences in arterial hypertension

Sex differences in vascular risk factors, in‐hospital management, and outcomes of patients with acute ischemic stroke in China

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