Sex differences in the evaluation and treatment of acute ischaemic stroke

Bushnell, Cheryl; Howard, Virginia J.; Lisabeth, Lynda D.; Caso, Valeria; Gall, Seana; Kleindorfer, Dawn; Chaturvedi, Seemant; Madsen, Tracy E.; Demel, Stacie L; Lee, Seung‐Jae; Reeves, Mathew J.

doi:10.1016/s1474-4422(18)30201-1

Cited by 109 publications

(108 citation statements)

References 80 publications

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“…1 Studies showing differences in the results of endovascular therapy and thrombectomy according to sex are limited and have not been systematically explored. 2 In fact, those studies have not explored the impact of sex in relation to the speed of accessing reperfusion therapies. Moreover, stroke care differs between community and tertiary hospitals, mainly due to difficult access to health resources.…”

Section: Dear Sirmentioning

confidence: 99%

“…The clinical outcome of stroke differs between sexes, representing the first cause of death in women globally [ 1 ]. Studies showing differences in the results of endovascular therapy and thrombectomy according to sex are limited and have not been systematically explored [ 2 ]. In fact, those studies have not explored the impact of sex in relation to the speed of accessing reperfusion therapies.…”

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confidence: 99%

“…One of the underlying reasons for this fact may be that nonspecific symptoms are more common in women, which makes the diagnosis of stroke more difficult to perform, even more in centers without specialists stroke physicians. These delays in women have been published previously but there are no well-designed studies to elucidate the reasons behind that fact [ 2 ]. However, whether less attention is paid to women arriving with such symptoms to the emergency department remains a plausible explanation.…”

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confidence: 99%

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Sex Differences by Hospital-Level in Performance and Outcomes of Endovascular Treatment for Acute Ischemic Stroke

et al. 2020

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Sex Differences by Hospital-Level in Performance and Outcomes of Endovascular Treatment for Acute Ischemic Stroke

et al. 2020

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“…In Brazil, aging is the strongest non-modifiable risk factor for ischemic stroke, and elderly stroke patients have higher mortality and morbidity and worse functional recovery than younger patients [ 23 ]. Although high cerebrovascular accident rates occur in individuals older than 70 years, in 2016, both stroke in general and hemorrhagic subtype present higher mortality indicators in individuals aged 15–49 years [ 24 ].…”

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confidence: 99%

The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings

et al. 2018

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ObjectiveTo analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database.ResultsThe highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9–60.5%) followed by that in men (52.9%; 95% CI 52.6–53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5–62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae.

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“…Stroke, including ischemic stroke caused by the block of cerebral blood vessel and hemorrhagic stroke with ruptured cerebral blood vessel, is a medical emergency that causes the devastating neurological function deficit (Zhou et al 2018). With the treatment of acute stroke and world population health having improved substantially, the incidence and case fatality rates have declined over the past 10 years (Bushnell et al 2018;Go et al 2014), but stroke is still the major cause of death and adult disability worldwide (Zhou et al 2018). Furthermore, in contrast with the declining incidence of stroke Qiu Liu, Zhiquan Jin and Zhiliang Xu contributed equally to this work.…”

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confidence: 99%

Antioxidant effects of ginkgolides and bilobalide against cerebral ischemia injury by activating the Akt/Nrf2 pathway in vitro and in vivo

Qiu

Jin

et al. 2019

Cell Stress and Chaperones

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Ginkgolide terpenoid lactones, including ginkgolides and bilobalide, are two crucial bioactive constituents of extract of Ginkgo biloba (EGb) which was used in the treatment of cardiovascular and cerebrovascular diseases. The aims of this study were to investigate the antioxidant effects and mechanism of ginkgolides (ginkgolide A (GA), ginkgolide B (GB), ginkgolide K (GK)) and bilobalide (BB) against oxidative stress induced by transient focal cerebral ischemia. In vitro, SH-SY5Y cells were exposed to oxygen-glucose deprivation (OGD) for 4 h followed by reoxygenation with ginkgolides and BB treatments for 6 h, and then cell viability, superoxide dismutase (SOD), and ROS were respectively detected using kit. Western blot was used to confirm the protein levels of hemeoxygenase-1 (HO-1), quinone oxidoreductase l (Nqo1), Akt, phosphorylated Akt (p-Akt), nuclear factor-E2-related factor2 (Nrf2), and phosphorylated Nrf2 (p-Nrf2). GB combined with different concentrations of LY294002 (PI3K inhibitor) were administrated to SH-SY5Y cells for 1 h after OGD, and then p-Akt and p-Nrf2 levels were detected by western blot. In vivo, 2 h of middle cerebral artery occlusion (MCAO) model was established, followed with reperfusion and GB treatments for 24 and 72 h. The infarct volume ratios were confirmed by TTC staining. The protein levels of HO-1, Nqo1, SOD1, Akt, p-Akt, Nrf2, and p-Nrf2 were detected using western blot and immunohistochemistry (IHC). Experimental data in vitro confirm that GA, GB, GK, and BB resulted in significant decrease of ROS and increase of SOD activities and protein levels of HO-1 and Nqo1; however, GB group had a significant advantage in comparison with the GA and GK groups. Moreover, after ginkgolides and BB treatments, p-Akt and p-Nrf2 were significantly upregulated, which could be inhibited by LY294002 in a dose-dependent manner, meanwhile, GB exhibited more effective than GA and GK. In vivo, TTC staining indicated that the infarct volume ratios in MCAO rats were dramatically decreased by GB in a dose-dependent manner. Furthermore, GB significantly upregulated the protein levels of HO-1, Nqo1, SOD, p-Akt, p-Nrf2, and Nrf2. In conclusion, GA, GB, GK, and BB significantly inhibited oxidative stress damage caused by cerebral ischemia reperfusion. Compared with GA, GK, and BB, GB exerts the strongest antioxidant stress effects against ischemic stroke. Moreover, ginkgolides and BB upregulated the levels of antioxidant proteins through mediating the Akt/Nrf2 signaling pathway to protect neurons from oxidative stress injury.

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Sex differences in the evaluation and treatment of acute ischaemic stroke

Cited by 109 publications

References 80 publications

Sex Differences by Hospital-Level in Performance and Outcomes of Endovascular Treatment for Acute Ischemic Stroke

Sex Differences by Hospital-Level in Performance and Outcomes of Endovascular Treatment for Acute Ischemic Stroke

The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings

Antioxidant effects of ginkgolides and bilobalide against cerebral ischemia injury by activating the Akt/Nrf2 pathway in vitro and in vivo

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