Sex Differences in Short-Term and Long-Term Outcomes Among Patients With Acute Ischemic Stroke in China

Abstract

Background: Sex differences in stroke outcomes are crucial to secondary prevention but previous reports showed inconsistent results. We aimed to explore the sex differences in stroke outcomes in the Third China National Stroke Registry, a prospective multi-center registry study. Methods: Among the 15166 patients enrolled between 2015 and 2018, 9038 patients with acute ischemic stroke (AIS) were included. The primary outcomes were stroke recurrence, mortality, and unfavorable functional outcome (modified Rankin Scale [mRS] > 2) at 3, 6, and 12 months. Cox regression model was used for stroke recurrence and mortality and logistic regression was used for the unfavorable functional outcome, and adjusted as follows: (1) Model 1: without adjustment; (2) Model 2: adjusted for potential risk factors, National Institutes of Health Stroke Scale (NIHSS) at admission, pre-stroke mRS, tissue plasminogen activator (TPA) treatment, TOAST classification, and onset-to-door time; (3) Model 3: adjusted for covariates from model 2 in addition to blood pressure and blood serum covariates. Multiple imputation was used for missing values, and sensitivity analyses were conducted to describe sex differences by age groups. Results: One-third (2802/9038) of the patients were women. Women were significantly older than men (64.78±10.84 vs. 61.26±11.42, p<0.001). In the fully adjusted model, female patients were more likely to have unfavorable functional outcomes at 3 months (odds ratio [OR], 1.28 [1.09, 1.50]), especially among patients aged 65 years or older (OR, 1.39 [1.14, 1.70]), but no difference was discovered in patients aged < 65 years. There were no sex differences in stroke recurrence and mortality at 3, 6, or 12 months or unfavorable functional outcomes at 6 or 12 months after adjustment. Conclusions: Compared to men, women with AIS were less likely to have favorable outcomes at three months in China, especially among those over 65 years of age. Experts should aim to tailor secondary prevention strategies for high-risk patients.

Association of admission neutrophil serine proteinases levels with the outcomes of acute ischemic stroke: a prospective cohort study

“…These results are consistent with previous literature. Of note, a disproportion of gender exists in our study, male sex accounts for over two-thirds (253/342) of the whole population, which is much higher than generally expected [50]. In the present study, we find no difference between male and female in the clinical outcome after stroke, and gender disproportion does not modify the results, which is consistent with several randomized controlled trials reporting that sex did not modify treatment effect [51].…”

Sex-based differences in long-term outcomes after stroke: A meta-analysis

“…Fifteen of the remaining articles were excluded due to a lack of long-term outcome data based on sex-based differences. In total, 22 studies [ 8 , 9 , 20 – 39 ] comprising a total of 84538 patients (42431 and 42107 in the male and female groups, respectively) comparing long-term clinical outcomes after stroke were included in the present analysis. A flowchart of the search strategy is shown in Fig 1 .…”

“…These findings are largely based on studies that have assessed stroke outcomes at discharge or within the first few months post-onset [ 4 , 5 , 7 ]. However, data on the long-term outcomes after stroke remain scarce [ 8 , 9 ].…”

“…Understanding sex-based differences in stroke epidemiology and outcomes is important for reducing potential disparities and the excess burden of disability [ 8 ]. However, despite increasing evidence and interest in sex-based disparities in health, the available data on sex-related differences in long-term outcomes after stroke are limited [ 8 , 9 ]. Therefore, this meta-analysis was performed to compare various long-term stroke outcomes between males and females to investigate whether there is a sex-based disparity in long-term stroke outcomes and provide insights for improving stroke care and management.…”

Sex as a biological variable in determining the metabolic changes influencing acute ischemic stroke outcomes—Where is the data: A systematic review

“…In humans, ischemic stroke is most prevalent in elderly populations with one or more vascular comorbidities such as hyperglycemia, hypertension, dyslipidemia, and obesity-in fact, over 91% of stroke risk can be attributed to modifiable risk factors (6). Women typically live longer resulting in higher lifetime risk for stroke and are more likely to have an unfavorable outcome from stroke even after adjusting for age, potential risk factors, NIHSS at admission, prestroke mRS, tPA use, onset-to-door times, and stroke subtype (35)(36)(37). Thus, including aged mice of both sexes must undergird stroke models that inform the understanding of stroke in humans.…”