Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Risk factors for ischemic stroke in men and women aged 45–74 years

https://doi.org/10.14412/2074-2711-2023-4-38-44

Full Text:

Abstract

Stroke is one of the leading causes of death and primary disability and contributes significantly to the global burden of disease. Identification of individuals at high risk of ischemic stroke (IS) is an important component of disease prevention. The differences between risk factors (RF) for stroke in men and women are not well understood.

Objective: to determine the predictive value of RF for the development of IS in men and women aged 45–74 years.

Material and methods. The study included 728 patients (380 men and 348 women) aged 45–74 years, including 392 patients (247 men and 145 women) with IS in the carotid artery basin (main group) and 336 patients (133 men and 203 women) with vascular cognitive impairment (comparison group). To build predictive models to assess the impact of RF on the development of IS in men and women, we used the logistic regression method with stepwise exclusion of variables according to the Wald algorithm.

Results. The predictive regression model of IS in men includes atherosclerotic stenosis of the internal carotid arteries [odds ratio (OR) 3.571; 95% confidence interval (CI) 1.792–7.114], in a predictive regression model in women – diabetes mellitus type 2 (OR 5.074; 95% CI 1.768–14.561) and a history of IS (OR 6.857; 95% CI 1.825–25.762). Other risk factors for the development of IS (atrial fibrillation, history of transient ischemic attack, arterial hypertension stage) affected both men and women.

Conclusion. Atherosclerotic stenosis of the internal carotid arteries was found to be a sex-specific prognostic factor for IS in men, and type 2 diabetes mellitus and a history of IS in women.

About the Authors

M. Yu. Maksimova
Research Center of Neurology
Russian Federation

Marina Yurievna Maksimova

80, Volokolamskoye Shosse, Moscow 125367



V. Yu. Sazonova
Research Center of Neurology
Russian Federation

80, Volokolamskoye Shosse, Moscow 125367



References

1. Parfenov VA, Khasanova DR. Ishemicheskiy insul’t [Ischemic stroke]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2012. 288 p. (In Russ.)].

2. Piradov MA, Tanashyan MM, Maksimova MYu, editors. Insul't: sovremennye tekhnologii diagnostiki i lecheniya [Stroke: modern technologies for diagnosis and treatment]. 3rd es. Moscow: MEDpress-inform; 2018. 360 p. (In Russ.)].

3. Petrea RE, Beiser AS, Seshadri S, et al. Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke. 2009;40(4):1032-7. doi: 10.1161/STROKEAHA.108.542894

4. Arnao V, Acciarresi M, Cittadini E, Caso V. Stroke incidence, prevalence and mortality in women worldwide. Int J Stroke. 2016;11(3):287301. doi: 10.1177/1747493016632245

5. Gulati M. Improving the Cardiovascular Health of Women in the Nation: Moving Beyond the Bikini Boundaries. Circulation. 2017;135(6):495-8. doi: 10.1161/CIRCULATIONAHA.116.025303

6. Jin X, Chandramouli C, Allocco B, et al. Women’s Participation in Cardiovascular Clinical Trials From 2010 to 2017. Circulation. 2020;141(7):540-8. doi: 10.1161/CIRCULATIONAHA.119.043594

7. Carcel C, Harris K, Peters SAE, et al. Representation of Women in Stroke Clinical Trials: A Review of 281 Trials Involving More Than 500,000 Participants. Neurology. 2021;97(18):e1768-e1774. doi: 10.1212/WNL.0000000000012767

8. O’Donnell MJ, Chin SL, Rangarajan S, et al; INTERSTROKE investigators. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761-75. doi: 10.1016/S0140-6736(16)30506-2

9. Alawneh KZ, Al Qawasmeh M, Raffee LA, et al. A snapshot of Ischemic stroke risk factors, sub-types, and its epidemiology: Cohort study. Ann Med Surg (Lond). 2020;59:101-5. doi: 10.1016/j.amsu.2020.09.016

10. Yuan BB, Luo GG, Gao JX, et al. Varianceof Serum Lipid Levels in Stroke Subtypes. Clin Lab. 2015;61(10):1509-14. doi: 10.7754/clin.lab.2015.150118

11. Gillis EE, Sullivan JC. Sex Differences inHypertension: Recent Advances. Hypertension. 2016;68(6):1322-7. doi: 10.1161/HYPERTENSIONAHA.116.06602

12. Demel SL, Kittner S, Ley SH, et al. Stroke Risk Factors Unique to Women. Stroke. 2018 Mar;49(3):518-23. doi: 10.1161/STROKEA-HA.117.018415

13. Li B, Wang T, Lou Y, et al. Sex Differencesin Outcomes and Associated Risk Factors after Acute Ischemic Stroke in Elderly Patients: A Prospective Follow-up Study. J Stroke Cerebrovasc Dis. 2015 Oct;24(10):2277-84. doi: 10.1016/j.jstrokecerebrovasdis.2015.06.007. Epub 2015 Jul 11.

14. Howard VJ, Madsen TE, Kleindorfer D.Sex and race differences in incident ischemic stroke and risk factors. JAMA Neurol. 2019;76:179-86. doi: 10.1001/jamaneurol.2018.3862

15. Kuk JL, Ardern CI. Age and sex differencesin the clustering of metabolic syndrome factors: association with mortality risk. Diabetes Care. 2010;33(11):2457-61. doi: 10.2337/dc10-0942

16. Davis SR, Castelo-Branco C, Chedraui P,et al; Writing Group of the International Menopause Society for World Menopause Day 2012.Understanding weight gain at menopause. Climacteric. 2012;15(5):419-29. doi: 10.3109/13697137.2012.707385

17. Shi Y, Guo L, Chen Y, et al. Risk factors for ischemic stroke: differences between cerebral small vessel and large artery atherosclerosis aetiologies. Folia Neuropathol. 2021;59(4):378-85. doi: 10.5114/fn.2021.112007

18. Giralt D, Domingues-Montanari S,Mendioroz M, et al. The gender gap in stroke: a meta-analysis. Acta Neurol Scand. 2012;125(2):83-90. doi: 10.1111/j.1600-0404.2011.01514.x

19. Arboix A, Marti-Vilalta JL. Lacunar stroke.Expert Rev Neurother. 2009;9(2):179-96. doi: 10.1586/14737175.9.2.179

20. Strozynska E, Fiszer U, Ryglewicz D,Zaborski J. The Impact of Risk Burden Differences between Men and Women on the Clinical Course of Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016 Apr;25(4):843-7. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.015. Epub 2016 Jan 18.

21. Wardlaw JM, Smith EE, Biessels GJ, et al;STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1). Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013 Aug;12(8):822-38. doi: 10.1016/S1474-4422(13)70124-8

22. McArdle PF, Kittner SJ, Ay H, et al; NINDS SiGN Study. Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study. Neurology. 2014 Oct 28;83(18):1653-60. doi: 10.1212/WNL.0000000000000942

23. Sachdev P, Kalaria R, O’Brien J, et al;Internationlal Society for Vascular Behavioral and Cognitive Disorders. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014;28(3):206-18. doi: 10.1097/WAD.0000000000000034

24. Maksimova MYu, Airapetova AS. Does gender influence the clinical characteristics of ischaemic stroke in patients aged 45–74 years? Annaly klinicheskoy i eksperimental'noy nevrologii = Annals of Clinical and Experimental Neurology. 2021;15(1):21-42. doi: 10.25692/ACEN.2021.1.4 (In Russ.)].

25. Rexrode KM, Madsen TE, Yu AYX, et al.The impact of sex and gender on stroke. Circ Res. 2022;130(4):512-28. doi: 10.1161/CIRCRESAHA.121.319915

26. Bushnell CD, Chaturvedi S, Gage KR, et al. Sex differences in stroke: Challenges and opportunities. Cereb Blood Flow Metab. 2018;38(12):2179-91. doi: 10.1177/0271678X18793324

27. Ullberg T, Zia E, Petersson J, Norrving B.Changes in functional outcome over the first year after stroke: an observational study from the Swedish stroke register. Stroke. 2015;46(2):389-94. doi: 10.1161/STROKEA-HA.114.006538

28. Emdin CA, Wong CX, Hsiao AJ, et al.Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ. 2016;532:h7013. doi: 10.1136/bmj.h7013

29. Nezu T, Hosomi N, Kondo K, et al; JapanStandard Stroke Registry Study Group. Greater severity of neurological defects in women admitted with atrial fibrillation-related stroke. Circ J. 2016;80(1):250-5. doi: 10.1253/circj.CJ-15-0873

30. Peters SA, Huxley RR, Woodward M.Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet. 2014;383(9933):1973-80. doi: 10.1016/S0140-6736(14)60040-4

31. Peters SA, Huxley RR, Woodward M.Comparison of the sex-specific associations between systolic blood pressure and the risk of cardiovascular disease: a systematic review and meta-analysis of 124 cohort studies, including 1.2 million individuals. Stroke. 2013;44(9):2394-401. doi: 10.1161/STROKEA-HA.113.001624

32. Peters SA, Singhateh Y, Mackay D, et al.Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. Atherosclerosis. 2016;248:123-31. doi: 10.1016/j.atherosclerosis.2016.03.016

33. Krauss RM, Eckel RH, Howard B, et al.AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Stroke. 2000;31(11):2751-66. doi: 10.1161/01.str.31.11.2751

34. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi: 10.1161/CIR.0000000000000678


Review

For citations:


Maksimova M.Yu., Sazonova V.Yu. Risk factors for ischemic stroke in men and women aged 45–74 years. Neurology, Neuropsychiatry, Psychosomatics. 2023;15(4):38–44. (In Russ.) https://doi.org/10.14412/2074-2711-2023-4-38-44

Views: 325


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)