Stroke Burden In Women Research Articles

Acute ischemic stroke profile in women attending Tanta University Hospital

Background Stroke has a higher negative effect on women than men. In developed countries, stroke has regressed to be the fifth cause of death in men but still the third cause in women. It is suggested that there will be an increase of stroke burden in women in the future. Aim The aim was to study clinical presentation, risk factors, and short-term outcome of acute ischemic stroke in women admitted to Tanta University hospitals. Patients and methods A cross-sectional study was conducted that included 386 patients admitted to the Department of Neuropsychiatry and Centre of Psychiatry, Neurology, and Neurosurgery at Tanta University Hospitals with first-ever ischemic stroke. We assessed stroke severity by National Institutes of Health Stroke Scale. Stroke type and etiology were assessed by Oxford Shire Community Stroke Project classification and Trial of org 10172 in acute stroke treatment classification. The authors assessed outcome on discharge by modified Rankin scale. Results Regarding type of stroke, cerebral venous thrombosis was more in females, with significant difference; arterial ischemic stroke in females was less than in males, with significant difference; and total anterior in females was more than in males, with significant difference. Predictors of unfavorable outcome in females were age above 60 years old, being unmarried, hypertension, diabetes, and cardiac disease. Conclusion Hypertension, mean duration of diabetes, and BMI increase the risk of ischemic stroke in women. Age above 60 years old, currently unmarried, hypertension, cardiac diseases, and diabetes mellitus increase unfavorable outcome in women.

Gender Differences in the Trends of Hospitalizations for Acute Stroke Among Patients With Atrial Fibrillation in the United States: 2005 to 2014

Female gender was included in stroke prediction algorithms in an attempt to improve anticoagulation rates in women with atrial fibrillation (AF). It is unclear if these efforts reduced stroke burden in women with AF. To bridge this literature gap, using the Nationwide Inpatient Sample, we assessed gender differences in the trends of hospitalizations for stroke among patients with AF in the United States in 2005 to 2014. International classification of diseases, 9th revision, clinical modification codes were used to abstract AF and stroke diagnoses. From 2005 to 2014, 18,413,291 hospitalizations of women with AF and 18,035,866 hospitalizations of men with AF were reported. Of these, 740,635 hospitalizations in women and 595,730 hospitalizations in men had stroke as the primary diagnosis. Age-adjusted stroke hospitalizations increased in women (443 per million in 2005 to 495 per million in 2014) as well as in men (351 per million in 2005 to 453 per million in 2014) (p trend < 0.001). Further, anticoagulation rates increased in women (11.5% in 2005 to 24.0% in 2014) as well as in men (11.7% in 2005 to 24.9% in 2014). Stroke hospitalizations involving anticoagulated patients with AF decreased in women (411 per million in 2005 to 347 per million in 2014) as well as in men (402 per million in 2005 to 311 per million in 2014) (p trend < 0.001). In conclusion, although we noted an increasing trend of stroke hospitalizations in both genders, it is reassuring to note that stroke hospitalizations involving anticoagulated patients with AF is decreasing in both genders and in particular among women.

Stroke in women - from evidence to inequalities.

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke - including diabetes mellitus and atrial fibrillation - are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials - despite governmental actions highlighting the need to include both men and women in clinical trials - resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women.

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

Stroke 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.

Physical Activity and Risk of Cerebrovascular Disease in the European Prospective Investigation Into Cancer and Nutrition-Spain Study

Large-scale prospective epidemiological data testing the association between physical activity (PA) and cerebrovascular diseases (CVDs) are scarce, particularly in Europe. The objective was to assess the risk of CVD according to PA levels in adults. We included a total of 13 576 men and 19 416 women aged 29 to 69 years and participating in the European Prospective Investigation into Cancer and Nutrition cohort in Spain, recruited between 1992 and 1996 and followed-up until 2006 to ascertain incident CVD events. The validated European Prospective Investigation into Cancer and Nutrition PA questionnaire was used to assess metabolic equivalent × hours per week dedicated to different types of PA. Hazard ratios of CVD by PA levels were estimated using multivariate Cox regression. Extensive baseline data collected on diet, lifestyle habits, medical history, and anthropometry were available to adjust for. A total of 210 transient ischemic attacks and 442 stroke cases (80% ischemic, 10% hemorrhagic, 7% subarachnoid hemorrhage, and 3% mixed or unspecified) were registered after 12.3 years of mean follow-up. Recreational activity was inversely associated with risk of CVD in women but not in men. Women walking for ≥3.5 hours per week were at lower risk of stroke than those who did not engage in regular walking. No significant associations were found for other leisure time activities or vigorous PA with CVD in either sex. Recreational PA of moderate intensity was inversely associated with stroke incidence in women, whereas PA showed no effect on CVD risk in men. Increasing time dedicated to activities such as walking would be expected to help to reduce the stroke burden in women.

Abstract 3357: Women Have Higher Odds of Dying within 3 Months of a Stroke than Men

Background: In recent years, the public health burden of stroke in women has become apparent. Due to their greater longevity, more women than men have strokes each year. Numerous studies have shown that women fare worse than men with regards to in-hospital treatment, vascular risk factor control, and disability after stroke; however, data regarding sex differences in stroke mortality are conflicting. Objective: To conduct a systematic review and meta-analysis investigating the relation of sex with short-term and long-term mortality after stroke. Methods: We performed a systematic search of Pubmed, Cochrane Library, MEDLINE, LILACS, review articles, and reference lists with the terms “ischemic stroke” or “cerebral ischemia” or “brain ischemia” crossed with “sex differences” or “gender differences” or “sex-specific” crossed with “case fatality” or “mortality” or “in-hospital mortality” or “outcome” or “survival” or “death.” We restricted our search to humans. There were no language restrictions. Entry criteria were as follows: (1) sex-specific rates of 1 of the following assessed: in-hospital, 1-month, or 90-day mortality; (2) ischemic stroke, and (3) adults (&gt;18 years). All data from eligible studies were abstracted by 3 independent investigators according to a standard protocol. Discrepancies were resolved by discussion with a 4 th investigator and by referencing the original report. Heterogeneity was assessed by the probability value of chi square statistics and I 2 . The primary endpoint was short-term mortality (at 0-3 months) and the secondary endpoint was long-term mortality (at 12-18 months). Results: The literature review yielded 21 studies which met entry criteria. Of these, 6 provided female to male odds ratios of short-term mortality (n=3,183,110) and 3 provided female to male odds ratios of long-term mortality (n=104,141). Overall, women had higher short-term (OR 1.11, 95% CI 1.03-1.19)( Figure1 ) and long-term (OR 1.12, 95% CI 0.97-1.28)( Figure 2 ) mortality compared to men, although the latter was not significant. Conclusion: Women are more likely than men to die within the first 3 months of an index stroke. Intensified efforts at mitigating post-stroke complications and improving vascular risk factor control among female stroke survivors may aid in reducing this disparity. Figure 1 Figure 2

Stroke prevention in women: Challenges and opportunities

Women have a 20% lifetime risk of stroke. In addition, the majority of stroke-related deaths occur in women. Reducing the burden of stroke in women through prevention would positively affect public health. Unfortunately, most of the data used to develop specific evidence-based guidelines for stroke prevention in women were derived from coronary heart disease studies. Stroke was a secondary and less common outcome, if it was included at all. In addition, women have traditionally been underrepresented in stroke prevention trial cohorts. Stroke prevention in women offers many challenges, not only related to data extrapolated from clinical trials primarily composed of men, but also because physicians may underestimate cardiovascular risk in women, and therefore prevention strategies may not be appropriately undertaken. The opportunities to improve stroke prevention in women include increasing patient and physician awareness of risk and optimizing management of key modifiable risk factors (eg, hypertension, hyperlipidemia, physical inactivity, obesity, and diabetes).