The gender gap in stroke: a meta-analysis

Giralt, Dolors; Domingues‐Montanari, Sophie; Mendioroz, Maite; Ortega, Laura; Maisterra, Olga; Perea-Gainza, Mila; Delgado, Pilar; Rosell, Antoni; Montaner, Joan

doi:10.1111/j.1600-0404.2011.01514.x

Cited by 74 publications

(68 citation statements)

References 23 publications

(23 reference statements)

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“…As for hypertension, the sex difference was no longer significant after BMI was added as a covariate [20]. These data are different from the meta-analysis, which suggested that cumulatively, hyperlipidemia appeared to be more common in men [17]. One could speculate that the Korean study illustrates unique geographic differences or differences in the criteria for hyperlipidemia from other studies.…”

Section: Sex Differences In Risk Factor Profiles Of Stroke Patientscontrasting

confidence: 53%

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Reducing Stroke in Women with Risk Factor Management: Blood Pressure and Cholesterol

Baghshomali

Bushnell

2014

Womens Health (Lond Engl)

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actorStroke is a major cause of death and disability in adults worldwide. Prevention focused on modifiable risk factors, such as hypertension and hyperlipidemia, has shown them to be of significant importance in decreasing the risk of stroke. Multiple studies have brought to light the differences between men and women with regards to stroke and these risk factors. Women have a higher prevalence of stroke, mortality and disability and it has been shown that preventive and treatment options are not as comprehensive for women. Hence, it is of great necessity to evaluate and summarize the differences in gender and stroke risk factors in order to target disparities and optimize prevention, especially because women have a higher lifetime risk of stroke. The purpose of this review is to summarize sex differences in the prevalence of hypertension and hyperlipidemia. In addition, we will review the sex differences in stroke prevention effectiveness and adherence to blood pressure and cholesterol medications, and suggest future directions for research to reduce the burden of stroke in women.

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Section: Sex Differences In Risk Factor Profiles Of Stroke Patientscontrasting

confidence: 53%

“…In a meta-analysis done specifically to focus on sex differences in stroke and risk factors, 45 articles with data from 673,935 patients were reviewed [17]. The cumulative analysis showed that women, on average, were 5.2 years older than men at the onset of stroke (p < 0.001).…”

Section: Sex Differences In Risk Factor Profiles Of Stroke Patientsmentioning

confidence: 99%

Reducing Stroke in Women with Risk Factor Management: Blood Pressure and Cholesterol

Baghshomali

Bushnell

2014

Womens Health (Lond Engl)

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“…A meta-analysis studying the sex disparities in stroke concluded that men had more atherothrombotic strokes and women were older than men at stroke onset with a mean difference of 5.2 years. 34 The sex differences in the relationship among PD, tooth loss, and atherosclerosis were reported by Desvarieux et al 35 They concluded that tooth loss and PD were related to subclinical atherosclerosis in men but not women, and the influence of sex on carotid artery plaque prevalence was most evident in the age group <59 years. A case-control study 33 reported that severe PD is a risk factor in men but not women.…”

Section: Discussionmentioning

confidence: 98%

Dental Prophylaxis and Periodontal Treatment Are Protective Factors to Ischemic Stroke

Lee

Huang

et al. 2013

Stroke

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Background and Purpose-A correlation has been found between periodontal disease (PD) and stroke. This study was conducted to investigate whether dental prophylaxis and periodontal treatment reduce the incidence rate (IR) of ischemic stroke. Methods-We identified 510 762 PD cases and 208 674 non-PD subjects from January 1, 2000, to December 31, 2010. The PD cases were divided into dental prophylaxis, intensive treatment, and no treatment groups. The stroke IRs were assessed among groups during follow-up. Cox regression analysis was used after adjustment for age, sex, and comorbidities to determine the relationship between periodontal treatment and incidence of ischemic stroke. Results-The stroke IR of the non-PD subjects was 0.32%/year. In the PD group, subjects who received dental prophylaxis had the lowest stroke IR (0.14%/year); subjects with intensive treatment or tooth extraction had a higher stroke IR (0.39%/year); and subjects without PD treatment had the highest stroke IR (0.48%/year; P<0.001). After adjustment for confounders, the dental prophylaxis and intensive treatment groups had a significant lower hazard ratios for stroke than the non-PD group (hazard ratio=0.78 and 0.95; 95% confidence interval=0.75-0.81 and 0.91-0.99, respectively), whereas the PD without treatment group had a significant higher hazard ratio for stroke (1.15; 95% confidence interval=1.07-1.24), especially among the youngest (20-44) age group (hazard ratio=2.17; 95% confidence interval=1.64-2.87) after stratifying for age. Conclusions-Maintaining periodontal health by receiving dental prophylaxis and PD treatment can help reduce the incidence of ischemic stroke.

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“…18 These findings are consistent with several prior publications including data from GWTG-Stroke. [19][20][21][22][23][24][25][26] Our current study includes more contemporary treatment data and more extensive adjustment for potential known confounders than many prior studies.…”

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confidence: 99%

Why are acute ischemic stroke patients not receiving IV tPA?

et al. 2016

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Objective: To determine patient and hospital characteristics associated with not providing IV tissue plasminogen activator (tPA) to eligible patients with acute ischemic stroke (AIS) in clinical practice.Methods: We performed a retrospective cohort study of patients with AIS arriving within 2 hours of onset to hospitals participating in Get With The Guidelines-Stroke without documented contraindications to IV tPA from April 2003 through December 2011, comparing those who received tPA to those who did not. Multivariable generalized estimating equation logistic regression modeling identified factors associated with not receiving tPA.Results: Of 61,698 eligible patients with AIS presenting within 2 hours of onset (median age 73 years, 51% female, 74% non-Hispanic white, median NIH Stroke Scale score 11, interquartile range 6-18), 15,282 (25%) were not treated with tPA within 3 hours. Failure to give tPA decreased over time from 55% in 2003 to 2005 to 18% in 2010 to 2011 (p , 0.0001). After adjustment for all covariates, including stroke severity, factors associated with failure to treat included older age, female sex, nonwhite race, diabetes mellitus, prior stroke, atrial fibrillation, prosthetic heart valve, NIH Stroke Scale score ,5, arrival off-hours and not via emergency medical services, longer onset-to-arrival and door-to-CT times, earlier calendar year, and arrival at rural, nonteaching, non-stroke center hospitals located in the South or Midwest.Conclusions: Overall, about one-quarter of eligible patients with AIS presenting within 2 hours of stroke onset failed to receive tPA treatment. Thrombolysis has improved dramatically over time and is strongly associated with stroke center certification. Additionally, some groups, including older patients, milder strokes, women, and minorities, may be undertreated.

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The gender gap in stroke: a meta-analysis

Abstract: Gender differences have been identified on the risk factors profile and diagnostic and therapeutic management of patients with ischemic stroke. Active measures should thus be taken to avoid bias in clinical practice.

Cited by 74 publications

References 23 publications

Reducing Stroke in Women with Risk Factor Management: Blood Pressure and Cholesterol

Reducing Stroke in Women with Risk Factor Management: Blood Pressure and Cholesterol

Dental Prophylaxis and Periodontal Treatment Are Protective Factors to Ischemic Stroke

Why are acute ischemic stroke patients not receiving IV tPA?

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