Stroke Risk Factors Unique to Women

Demel, Stacie L; Kittner, Steven J.; Ley, Sylvia H.; McDermott, Mollie; Rexrode, Kathryn M.

doi:10.1161/strokeaha.117.018415

Cited by 78 publications

(66 citation statements)

References 78 publications

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“…97 Some stroke risk factors are unique for females, such as different composition of sex hormones, estrogen intake and factors associated with pregnancy and the post-partum state. 98 Because of these sex-specific factors, women have a higher stroke risk at younger age than men. 99…”

Section: Sexmentioning

confidence: 99%

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Khanevski

Kvistad

Novotný

et al. 2019

Stroke

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Background and Purpose— Stroke mimics (SM) pose a common clinical challenge, but the burden of SM in patients with previous ischemic stroke (IS) or transient ischemic attack is unknown. The objective of this study was to calculate the incidence of SM in IS survivors, compare it with the incidence of recurrent stroke in the same population, and explore the time-dependent patterns of SM etiologies. Methods— This prospective cohort study registered SM events and etiologies among 1872 IS and transient ischemic attack survivors diagnosed with index stroke at Haukeland University Hospital stroke unit from 2007 to 2013 by review of medical records. Cumulative incidences of SM were estimated with a competing risks Cox model and compared with incidence of recurrent stroke in the same population. Results— During 8172 person-years of follow-up, 339 patients had 480 SM events. The cumulative incidence rate of SM during follow-up was 58.7 per 1.000 person-years (95% CI, 53.7–64.2) compared with 34.0 per 1.000 person-years (95% CI, 30.2–38.2) for recurrent stroke in the same time period. The risks of SM and recurrent stroke were highest the first year after index IS or transient ischemic attack. The most frequent SM diagnoses were sequelae of cerebral infarction (19.8%), medical observation, and evaluation for suspected cerebrovascular disease (15.6%) and infections (14.0%). The 2 most frequent and unspecific diagnoses (sequelae of cerebral infarction and medical observation) were clustered in the first months after index stroke. Conclusions— SM after IS or transient ischemic attack are more frequent than recurrent stroke and the risk is especially high in the early period. SMs are multietiological and unspecific diagnoses are most frequent early after index stroke.

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Section: Sexmentioning

confidence: 99%

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Khanevski

Kvistad

Novotný

et al. 2019

Stroke

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“…Outside of pregnancy, both endogenous and exogenous hormones largely influence women's stroke risk in young adulthood. Demel et al 13 found no convincing evidence that endogenous estrogen or testosterone levels predict stroke risk, whereas the endogenous adrenal hormone DHEAS (dehydroepiandrosterone sulfate) is inversely related to both stroke incidence and severity. This is in contrast to exogenous estrogen in oral contraception, which demonstrates a dose-dependent association with the risk of major adverse cardiovascular events and stroke.…”

Section: Strokementioning

confidence: 99%

“…In this edition of Stroke, the papers by McDermott et al, 7 Demel et al, 13 Madsen et al, 17 and Gall et al 21 argue for further recognition of the factors causing stroke in women and for systematic intensification of treatments. Sex differences in stroke burden are most influenced by differences in cardiovascular risk factor burden; thus, the greatest gains in stroke prevention will come from increased screening and treatment of these primary risk factors in women early in life, especially in the obese, during pregnancy, and those from high-risk ethnoracial groups.…”

Section: Strokementioning

confidence: 99%

Stroke in Women

Kaplovitch

Anand

2018

Stroke

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Progress continues, however, with both women-exclusive randomized control trials 3 and observational prospective studies currently being conducted. 4 The information generated from this research has increased our understanding of the determinants of and medical therapies to prevent stroke in women, yet some questions remain, and ongoing surveillance of stroke incidence and outcomes after stroke is required.In high-income countries, like the United States, women have a greater lifetime risk of stroke than men. Further, stroke rates differ by ethnoracial origin with a higher stroke rate occurring in Black and Hispanic women living in the United States. The major risk factors for stroke and the strength of association of the risk factors are similar in women and men, with preeclampsia, pregnancy, and use of exogenous hormones as the few exceptions. However, the frequency of each risk factor, and therefore the population attributable risk, differs between the sexes. As shown in the international INTERSTROKE case-control study, 5 hypertension, abdominal obesity, and adverse lipid profile are the most impactful causes of stroke in women worldwide, with smoking, cardiac causes, and lifestyle factors (ie, diet quality, exercise, alcohol use) remaining as important, but not as frequent, risk factors. It is through screening and treatment of these common risk factors where the greatest gains in stroke prevention can occur. After a stroke occurs, ensuring equal access to health care and evidence-based stroke management will equalize stroke outcomes by sex. Although progress has been made, with the first guideline specifically targeted to stroke in women recently published, 6 implementation of the optimal screening and treatment for women at risk for stroke is urgently needed.In today's edition of Stroke, a series of 4 articles present aspects of stroke physiology and epidemiology unique to women: the vascular biology of preeclampsia and its relationship to stroke; hormonal risk factors for stroke in women; an update on classical stroke risk factors in women; and sex/gender differences in stroke outcomes. Underscoring all of these sex-and gender-specific differences is a call for more intensive risk factor modification throughout the entirety of a woman's life course.Pregnancy is often the first major stroke risk factor experienced by young women. As McDermott et al 7 attest, stroke affects ≈30 women for every 100 000 pregnancies. Although hormonal factors, peripartum illness, and hemodynamic factors play a role, the majority of events are mediated through the spectrum of hypertensive disorders in pregnancy, particularly preeclampsia/toxemia. A systemic, multiorgan endotheliopathy, preeclampsia both predisposes to the malignant edema in posterior reversible encephalopathy syndromes and confers a 40-fold risk increase for true ischemic stroke. The most important prevention strategy is early detection, which should be emphasized with frequent antenatal blood pressure measurements and screening for signs and symptoms of toxemi...

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“…However, effective therapeutic drugs and methods are very limited. Even in high-income countries, stroke remains a common cause of death and disability [ 4 ], and women experience more stroke over their lifetime and more deaths from stroke [ 5 , 6 ], compared with men. The management of patients who suffer from acute ischemic stroke at an early stage is crucial and existing drugs are limited [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Schisandra chinensis Fructus and Its Active Ingredients as Promising Resources for the Treatment of Neurological Diseases

Zhang

Yang

2018

IJMS

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Neurological diseases (NDs) are a leading cause of death worldwide and tend to mainly affect people under the age of 50. High rates of premature death and disability caused by NDs undoubtedly constrain societal development. However, effective therapeutic drugs and methods are very limited. Schisandra chinensis Fructus (SCF) is the dry ripe fruit of Schisandra chinensis (Turcz.) Baill, which has been used in traditional Chinese medicine for thousands of years. Recent research has indicated that SCF and its active ingredients show a protective role in NDs, including cerebrovascular diseases, neurodegenerative diseases, or depression. The key neuroprotective mechanisms of SCF and its active ingredients have been demonstrated to include antioxidation, suppression of apoptosis, anti-inflammation, regulation of neurotransmitters, and modulation of brain-derived neurotrophic factor (BDNF) related pathways. This paper summarizes studies of the role of SCF and its active ingredients in protecting against NDs, and highlights them as promising resources for future treatment. Furthermore, novel insights on the future challenges of SCF and its active ingredients are offered.

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Stroke Risk Factors Unique to Women

Cited by 78 publications

References 78 publications

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Stroke in Women

Schisandra chinensis Fructus and Its Active Ingredients as Promising Resources for the Treatment of Neurological Diseases

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