Sex Differences in Short-Term Outcomes After Acute Ischemic Stroke

Abstract

Stroke is a major cause of long-term disability and death worldwide.1 Previous studies seemed to converge on the higher likelihood of poststroke disability in women than in men. [2][3][4][5][6][7][8][9][10] Because women have a longer life expectancy and the stroke incidence increases in older age groups, poststroke disability in women can become an important public health problem in many aging societies. 8 The reasons for sex differences in stroke outcomes remain unclear. Stroke characteristics and risk factors were shown to differ between women and men, 7,8 and these are probably underlying the differences in clinical outcomes. In addition, some studies indicated that medical management before and after stroke differed by sex. 3,10,11 If the differences are caused by insufficient medical management, the quality of care is important to reduce the sex differences in the functional outcome post stroke. However, if biological sex itself were a risk of poor functional outcome, a sex-specific strategy for stroke prevention would be needed.Accurate data on possible confounders are needed to elucidate whether sex differences in stroke outcomes result from background differences or there truly exist biological differences among the sexes in response to stroke. Moreover, to prove the generalizability, sex differences should be confirmed in different cohorts in the world because lifestyle, social environment, and healthcare systems are different depending on ethnic groups and countries. However, previous studies have been performed mainly in Europe and North America, and paucity of data from other parts of the world has been highlighted. 8Background and Purpose-Variable sex differences in clinical outcomes after stroke have been reported worldwide. This study aimed to elucidate whether sex is an independent risk factor of poor functional outcome after acute ischemic stroke. Methods-Using the database of patients with acute stroke registered in the Fukuoka Stroke Registry in Japan from 1999 to 2013, 6236 previously independent patients with first-ever ischemic stroke who were admitted within 24 hours of onset were included in this study. Baseline characteristics were assessed on admission. Study outcomes included neurological improvement, neurological deterioration, and poor functional outcome (modified Rankin Scale score, 3-6 at discharge). Logistic regression analyses were performed to evaluate the association between sex and clinical outcomes. Results-Overall, 2398 patients (38.5%) were women. Severe stroke (National Institutes of Health Stroke Scale score, ≥8)on admission was more prevalent in women than in men. The frequency of neurological improvement or deterioration during hospitalization was not different between the sexes. After adjusting for possible confounders, including age, stroke subtype and severity, risk factors, and poststroke treatments, it was found that female sex was independently associated with poor functional outcome at discharge (odds ratio, 1.30; 95% confidence interval, 1.08-1.57). There was h...

Subjective health complaints predict functional outcome six months after stroke

“…A basic question, especially concerning age, is whether the apparent associations are due to ageing itself or secondary to other causes. Regarding sex, previous researchers have generally reported a negative effect of female sex on functional outcome 5, 19, 20, 21, 22, 23, 24, 25, 26, 27. This is seen also in the present study (for details, see11).…”

“…This has been demonstrated universally and it is also a main finding in our study. In addition higher age,3, 5, 8, 9 female sex,5, 19, 21, 22, 23, 24, 25, 26, 27 prior cerebrovascular disease,3, 5, 8 peripheral artery disease,7 arm paresis,5 diabetes,5, 7 fever,5 TOAST‐classification 4, 28 and infarct location,5, 6, 28 among others, have been reported to be negative predictors. The main results in our study thus are consistent with previous findings, emphasising especially stroke severity and prior cerebrovascular disease in addition to age and sex.…”

THE EFFICACY OF LONG-TERM WARFARIN THERAPY: THE IMPACT ON THE INCIDENCE OF ISCHEMIC CEREBROVASCULAR DISORDERS AND CLINICAL PREDICTORS OF DEVELOPING SUCH DISORDERS. (Results of a prospective 10-year follow-up study)

“…Несмотря на меньшую частоту инсультов в группе варфарина, продемонстрированную в клинических исследованиях [11][12][13], когорт-ные исследования и регистры, выполненные в реальной клинической практике, демонстри-руют схожую с нашими данными частоту со-бытий при длительном наблюдении [8,10,[15][16][17]. Так, в исследовании [16], включавшем па-циентов с ФП, подвергнутых плановым чре-скожным коронарным вмешательствам, часто-та ИИ составила 2,6% в год, что согласуется с нашими данными.…”

“…Действительно, ИИ на фоне адекват-ной антикоагулянтной терапии, характеризу-ются меньшей тяжестью и лучшим прогнозом [10,[17][18], что позволяет говорит о том, что варфарин способен не только снизить частоту развития инсульта, но и уменьшить тяжесть его проявлений.…”

“…К сожалению, даже при отработан-ной системе патронажа достичь целевых зна-чений удается не всегда, т. к. стабильность зна-чений МНО зависит от многих объективных и субъективных факторов [10,17,30,[39][40][41][42]. В крупных РКИ, посвященных изучению прямых пероральных антикоагулянтов [11][12][13], в груп-пах больных, принимающих варфарин, сред-нее значение TTR составляло 58-67%.…”