Gender Differences In Stroke Research Articles

RISK FACTORS AND PREDICTORS OF SEVERITY FOR ISCHEMIC STROKE IN THE RURAL SOUTH INDIAN POPULATION

Introduction: Stroke is a leading cause of death and disability worldwide. The risk factors contributing to stroke vary among geographical locations, ethnic populations, and also among genders. This study aims to identify the prevalence of risk factors among patients admitted for ischemic stroke, correlate the stroke severity, and identify risk factors in the rural South Indian population. Methods: One hundred and thirty patients admitted with acute ischemic stroke formed the study population. The demographic details and neurological examination at admission were noted. The presence of comorbidities such as diabetes mellitus, systemic hypertension, coronary artery disease, smoking, and quantity of alcohol consumed was documented. All patients underwent a series of investigations including computed tomography brain, fasting blood sugar, fasting lipid profile, complete blood count, and carotid Doppler. Stroke severity was graded as per the National Institutes of Health Stroke Scale. Results: This study of 130 stroke patients (65.4% male and 34.6% female) with a mean age of 61.10 years examined risk factors and their associations with stroke severity. Hypertension and diabetes mellitus were prevalent (51.5% and 50%, respectively). Significant associations were found between age, sex, and alcohol consumption with stroke severity. Overall, age emerged as a critical determinant of stroke severity. Conclusion: Tremendous research gaps persist despite significant progress in researching gender differences in stroke as well as particular factors impacting risk and outcomes which need to be addressed in future studies. Urgent health-care policies are needed to arrest the rapidly rising epidemic of metabolic diseases and combat alcoholism.

Stroke in women: experience in a developing country

BackgroundSeveral studies have addressed gender differences in stroke. Yet, results are diverse, and research is still required in different populations. So, this study investigates variation in stroke according to gender in a developing country.MethodsThis is a registry-based, retrospective observational cross-sectional study comparing men and women as regards age, risk factors, stroke severity, quality of services, and stroke outcome.ResultsData analyzed comprised 4620 patients. It was found that men outnumbered women, while women had an older age, more prevalence of hypertension and atrial fibrillation, with severer strokes and worse outcomes. However, there was no gender difference in promptness nor frequency of administration of revascularization therapies.ConclusionDespite the gender difference in risk factors and stroke severity, we could not detect any significant disparity in acute stroke services provided to either gender. Among age categories in women, we identified differences in acute ischemic stroke subtypes, and acute management in favor of older age.

Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care.

There are several controversies regarding the role of sex and gender in the pathophysiology and management of acute stroke. Assessing the role of sex, i.e., biological/pathophysiological factors, and gender, i.e., sociocultural factors, in isolation is often not possible since they are closely intertwined with each other. To complicate matters even more, the functional baseline status of women and men at the time of their first stroke is substantially different, whereby women have, on average, a poorer reported/ascertained baseline function compared to men. These differences in baseline variables account for a large part of the differences in post-stroke outcomes between women and men. Adjusting for these baseline differences is difficult, and in many cases, residual confounding cannot be excluded. Despite these obstacles, a better understanding of how patient sex and gender differences influence acute stroke and stroke care pathways is crucial to avoid biases and allow us to provide the best possible care for all acute stroke patients. Disregarding patient sex and gender on one hand and ignoring potential confounding factors in sex- and gender-stratified analyses on the other hand, may cause researchers to come to erroneous conclusions and physicians to provide suboptimal care. This review outlines sex- and gender-related factors in key aspects of acute stroke, including acute stroke epidemiology, diagnosis, access to care, treatment outcomes, and post-acute care. We also attempt to outline knowledge gaps, which deserve to be studied in further detail, and practical implications for physicians treating acute stroke patients in their daily practice.

Abstract P710: Using Dictionary Learning to Determine Differences in Vasculature Between Males and Females to Understand Gender Differences in Stroke

Introduction: Between males and females, there is a variation in stroke incidence, with males having a stroke incidence 33% higher than women. This difference may be partly due to gender differences in vascular regions between males and females. We hypothesize that statistically significant population differences in vasculature may be identified and measured through image analysis methods. Methods: We have developed and verified a scalable big data image-processing pipeline for magnetic resonance angiography (MRA), without relying on a MRI registration intermediary, and allowing for multi-modality analysis. Our approach uses dictionary learning to find differences between groups by comparing projections of 3D images from each individual. It enables the degree of regional variation between population groups to be visualized as a color map overlaid on a representative template of the Circle of Willis (CoW). Results: Analyzing a dataset of MRA images from 42 patients (25 female, 17 male), we found the group of females to have larger ICA and more likely to have a complete CoW. The figure presents a heat map of differences between male and female patients from our analysis. Conclusion: The gender differences we found with this new method are consistent with previous research. This multi-modality population level analysis tool may be used to analyze stroke imaging data and extract key global differences. With big data available today, it can be used to quantify statistical differences in vasculature between populations, to gain insight for better stroke diagnosis or treatment.

Stroke in women: Is it different?

In the last decades, there has been great progress in the field of stroke. With the introduction of acute therapies (intravenous thrombolysis and intra-arterial treatment), the outcome after stroke has improved significantly. Better prevention, improved acute therapy, and acute rehabilitation improved the morbidity and mortality rate after stroke. Gender differences in risk factors and epidemiology have been known for a long time, but lately attention to gender differences in stroke has increased. The aim of this mini-review is to demonstrate gender disparities in stroke with a focus on epidemiology, specific risk factors (gender-specific and unspecific), and outcomes. The influence of some risk factors for stroke is stronger in women (atrial fibrillation and hypertension) and there are risk factors exclusive to women such as pregnancy, pregnancy-associated hypertensive disorders, oral contraceptives, and hormonal replacement treatment. Data on the impact of other risk factors are inconsistent. The worse outcome after a stroke is mainly caused by demographic characteristics in women. Specific gender research is needed to better understand gender disparities in stroke to improve prevention strategies and treatment for women.

5716Age and gender differences in stroke and bleeding risks in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants

5716Age and gender differences in stroke and bleeding risks in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants

Special Considerations for Primary and Secondary Stroke Prevention in Women

AbstractThere are gender differences in stroke in several areas. Overall, the incidence of stroke is greater in women because of the increased risk of stroke with increasing age and the longer life expectancy of women. However, gender-specific risk factors for stroke include hormonal changes during pregnancy and exogenous hormonal therapies. Also, cerebral venous thrombosis, thrombophilia, and migraine are more prevalent in women. These gender differences are the subject of this review.

Gender Differences in the Colorado Stroke Registry

Gender differences in stroke are matters of increasing interest. The American Stroke Association's patient management tool, Get with the Guidelines-Stroke (GGS) is widely used to increase adherence to quality indicators in stroke care, but it also provides an opportunity to analyze gender differences in the acute stroke setting. We used a state-wide database, based on GGS, to explore gender differences in stroke in Colorado. We analyze demographics, risk factors, lifestyles, treatments, and responses to treatment. Of 126 data elements examined, statistically significant gender differences were noted for 47 (37%). As compared to men, women in Colorado were older and more significantly impacted by acute stroke. Risk factor profiles differed between the 2 genders, with men having a higher incidence of coronary artery disease, dyslipidemia, diabetes, carotid stenosis and tobacco smoking, while women had a higher incidence of atrial fibrillation and hypertension. Lipids were less aggressively treated and antithrombotics were less commonly used in women. Overall, acute stroke treatment of women appeared "less aggressive" than for men. GGS may be used not only for quality improvement initiatives in individual hospitals. It can also give an overview of clinical aspects of stroke at a state level, and may shed light on gender differences.

Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital

Studies suggest that women with stroke are investigated less aggressively and receive tissue plasminogen activator less frequently than men. We tested whether gender differences in the investigation, treatment, and outcome of stroke are due to confounding factors. Gender differences in the use of investigations, trial enrollment, treatment with intravenous tissue plasminogen activator, and in-hospital outcomes were examined in data from our prospective registry using multivariate analysis to adjust for age, prestroke functional status, stroke subtype and severity, and atrial fibrillation. Of 2725 consecutive hospitalized patients (1996 to 2006), 88% had ischemic stroke and 48% were women. Women were older (median age, 77 versus 70 years), had more severe strokes, and were less likely to be independent prestroke (78% versus 87%) compared with men (all P<0.001). The proportion of women, but not men, aged >or=80 years, increased significantly between 1996 to 1997 and 2005 to 2006. After adjustment for confounding, women were less likely to have infratentorial strokes (OR, 0.78; 95% CI, 0.62 to 0.97), be able to walk unaided on admission (OR, 0.69; 95% CI, 0.54 to 0.87), be treated with tissue plasminogen activator (OR, 0.51; 95% CI, 0.35 to 0.72), experience pneumonia (OR, 0.38; 95% CI, 0.26 to 0.55), achieve a discharge Barthel Index of >or=95 (OR, 0.75; 95% CI, 0.61 to 0.94, and were more likely to experience a urinary tract infection (OR, 2.06; 95% CI, 1.61 to 2.64). There was no gender difference in adjusted use of investigations. The majority of the gender differences in stroke were explained by confounding. More research is required to understand gender differences in stroke pathophysiology and the utilization of thrombolytic therapy.