Female sex as a risk factor for ischaemic stroke varies with age in patients with atrial fibrillation

Heart ◽  
2019 ◽  
Vol 106 (7) ◽  
pp. 534-540 ◽  
Author(s):  
Victor Chien-Chia Wu ◽  
Michael Wu ◽  
Victor Aboyans ◽  
Shang-Hung Chang ◽  
Shao-Wei Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Heart Disease ◽  
Ischaemic Stroke ◽  
Stroke Risk ◽  
Research Database ◽  
Stroke Risk Factor ◽  
Female Sex ◽  
Included Patient ◽  
History Of

ObjectivesFemale sex is an inconsistent ischaemic stroke risk factor in patients with atrial fibrillation (AF). We hypothesised that the ischaemic stroke risk varies with age among women compared with men.MethodsWe retrieved the patients with newly diagnosed AF during 2001–2013 from Taiwan’s National Health Insurance Research Database. Patients with missing information, age <20 years, history of valvular heart disease and surgery, rheumatic heart disease, hyperthyroidism or anticoagulation and/or antiplatelet use were excluded. Propensity score matching (PSM) included patient comorbidities, medications and index date stratified by age and sex groups. Primary outcome was defined as ischaemic stroke at follow-up.ResultsAfter exclusion criteria, 87 369 men and 71 853 women remained for analysis (aged 73.1±14.4 years). After 1:1 PSM, we included 59 583 men (aged 73.5±13.7 years) and 59 583 women (aged 73.4±13.8 years) for analysis. We also stratified patients by age. The ischaemic stroke risk varied with age in women compared with men: lower in the ≤55 years (subdistribution HR (SHR)=0.75, 95% CI 0.62 to 0.90) and 56–65 years (SHR=0.87, 95% CI 0.78 to 0.98) groups, neutral in the 66–75 years group (SHR=1.01, 95% CI 0.94 to 1.08) and adverse in the >75 years group (SHR=1.14, 95% CI 1.09 to 1.19).ConclusionsThe female/male ischaemic stroke risk ratio varied with age. Only women aged >75 years had a higher risk, whereas women aged <65 years had a lower risk compared with men. These findings challenge the ‘sex category’ component of the CHA2DS2-VASc score, used to make decision regarding anticoagulation treatment in AF patients.

Female sex as an independent risk factor for stroke in atrial fibrillation: Possible mechanisms

2014 ◽  
Vol 111 (03) ◽  
pp. 385-391 ◽  
Author(s):  
Christine Albert ◽  
Felicita Andreotti ◽  
Lina Badimon ◽  
Isabelle Van Gelder ◽  
Elaine Hylek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sex Differences ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Stroke Risk ◽  
Thrombus Formation ◽  
Blood Stasis ◽  
Stroke Risk Factor ◽  
Female Sex ◽  
Increased Risk

SummaryAtrial fibrillation (AF) is an independent risk factor for thromboembolism and stroke. Women with AF are at a higher overall risk for thromboembolic stroke when compared to men with AF. Recent evidence suggests that female sex, after adjusting for stroke risk profile and sex differences in utilisation of anticoagulation, is an independent stroke risk factor in AF. The inclusion of female sex has improved the accuracy of the CHADS2 stroke risk stratification schema (Congestive heart failure, Hypertension, Age 75 years or greater, Diabetes mellitus, and prior Stroke or TIA). The newly revised and validated schema, CHA2DS2-VASc, dichotomises age and incorporates female sex and vascular disease history. The pathophysiological mechanisms to explain this increased risk in women are not well understood. According to Virchow’s triad, thrombosis that leads to stroke in AF should arise from three co-existing phenomena: structural abnormalities, blood stasis, and a hypercoagulable state. Herein, we explore the sex differences in the biological processes that lead to thrombus formation as applied to Virchow’s Triad. The objective of this review is to describe the potential mechanisms behind the increased risk of stroke in AF associated with female sex.

scholarly journals Stroke Factors Associated with Thrombolysis Use in Hospitals in Singapore and US: A Cross-Registry Comparative Study

2019 ◽  
Vol 47 (5-6) ◽  
pp. 291-298 ◽  
Author(s):  
Sheryl Hui-Xian Ng ◽  
Alex W.K. Wong ◽  
Cynthia Huijun Chen ◽  
Chuen Seng Tan ◽  
Falk Müller-Riemenschneider ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cognitive Rehabilitation ◽  
Stroke Risk ◽  
Minority Status ◽  
Stroke Risk Factor ◽  
Stroke Registry ◽  
Factors Associated ◽  
Younger Age ◽  
History Of

Background and Objectives: This paper aims to describe and compare the characteristics of 2 stroke populations in Singapore and in St. Louis, USA, and to document thrombolysis rates and contrast factors associated with its uptake in both populations. Methods: The stroke populations described were from the Singapore Stroke Registry (SSR) in ­Singapore and the Cognitive Rehabilitation Research Group Stroke Registry (CRRGSR) in St. Louis, MO, USA. The registries were compared in terms of demographics and stroke risk factor history. Logistic regression was used to determine factors associated with thrombolysis uptake. Results: A total of 39,323 and 8,106 episodes were recorded in SSR and CRRGSR, respectively, from 2005 to 2012. Compared to CRRGSR, patients in SSR were older, male, and from the ethnic majority. Thrombolysis rates in SSR and CRRGSR were 2.5 and 8.2%, respectively, for the study period. History of ischemic heart disease or atrial fibrillation was associated with increased uptake in both populations, while history of stroke was associated with lower uptake. For SSR, younger age and males were associated with increased uptake, while having a history of smoking or diabetes was associated with decreased uptake. For CRRGSR, ethnic minority status was associated with decreased uptake. Conclusions: The comparison of stroke populations in Singapore and St Louis revealed distinct differences in clinicodemographics of the 2 groups. Thrombolysis uptake was driven by nonethnicity demographics in Singapore. Ethnicity was the only demographic driver of uptake in the CRRGSR population, highlighting the need to target ethnic minorities in increasing access to thrombolysis.

Abstract NS6: Family History of Stroke: Invisibility of a Key Stroke Risk Factor among High Risk African Americans

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Dawn M Aycock ◽  
Kenya D Kirkendoll ◽  
Kisha C Coleman ◽  
Karen C Albright ◽  
Anne W Alexandrov
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Family History ◽  
Perceived Control ◽  
Stroke Risk ◽  
Perceived Threat ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors ◽  
History Of ◽  
Physiologic Data

Background & Purpose: Young to middle aged African Americans (AA) are at greater risk for a first-ever stroke, severe neurologic disability, and stroke-related mortality, than Caucasians of similar age; however, it remains unclear what role a family history of stroke (FHS) plays in promoting adoption of healthier lifestyles in this cohort. The purpose of this study was to explore differences between rural Stroke Belt AA with a FHS (e.g. parent/grandparent/sibling) on modifiable stroke risk factors, knowledge, perceived threat and perceived control of stroke, and exercise behaviors to AA without a FHS. Methods: A cross-sectional study was conducted recruiting AA aged 19-54 from the Black Belt region of Alabama via a mobile health clinic. Participants’ perceptions, knowledge, exercise history/intent, physiologic data, and health history were recorded. Results: Participants (N=66) averaged 43.3+9.4 years, were 71% female, with at least 12 years of school (89%), and unemployed (62%). Common risk factors were insufficient exercise (76%), obesity (59%), hypertension (53%; blood pressure M=145+17.6/88.3+12.9), and cigarette smoking (38%). Participants with a FHS (n=33) did not differ on average number of risk factors compared to those without a FHS (FHS 2.8+1.4 vs. 2.2+1.5; t(64)= 1.73, p=.089), nor did they differ on physiologic data. However, participants with a FHS were more likely to report a history of hypertension (67%) compared to those without a FHS (33%; χ2 =4.93, p <.05). There were no significant differences between groups for knowledge of stroke risk factors, perceived threat and perceived control of stroke, or recent exercise performance, although participants with a FHS (3.4+1.2) had significantly lower future intentions to exercise compared to those without a FHS (3.9+0.8); t(64)=2.45, p<.05). Conclusions: Although FHS is a significant non-modifiable risk factor for stroke and was common in this young to middle-aged AA cohort, FHS did not drive perceived stroke risk, risk factor control, or current/future intentions to exercise. Identification of interventions designed to personalize FHS as a key stroke risk factor, while promoting lifestyle change and self-management, may play an important role in future primary stroke prevention.

Abstract TMP50: Antihypertensive Medication Trends Among Individuals With History of Stroke and Hypertension: The National Health and Nutrition Examination Survey (NHANES) 2005 - 2016

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Santos ◽  
Mandip S Dhamoon
Keyword(s):  
Risk Factor ◽  
National Health ◽  
Stroke Risk ◽  
Beta Blockers ◽  
Stroke Survivors ◽  
Nutrition Examination Survey ◽  
Stroke Risk Factor ◽  
Health And Nutrition ◽  
History Of ◽  
Over Time

Background: Hypertension (HTN) is a well-established, modifiable stroke risk factor. National HTN management trends among stroke survivors may provide important insight into secondary preventive treatment gaps. We investigated the adequacy of blood pressure (BP) control among stroke survivors and national antihypertensive (ATH) treatment trends. Methods: The National Health and Nutrition Examination Survey (NHANES) is a large, nationally representative cross-sectional survey conducted in 2-year cycles in the U.S. Evaluations include interviews, medication lists, physical examinations, and blood samples. We included participants aged >=20 years with HTN and history of stroke from 2005 to 2016. HTN was defined by self-report, ATH use, or uncontrolled HTN (BP >140/90) on physical examination. ATH medications were classified into calcium channel blockers, beta blockers, diuretics, and ACE inhibitors/angiotensin receptor blockers (ACE/ARBs). We report weighted frequencies and means using NHANES methodology, estimating the proportion of those with stroke with HTN. For all other analyses we examined those with stroke and HTN, summarizing number and classes of ATH, frequency of uncontrolled HTN, and associations between ATH classes and BP control. We examined trends in ATH use over time. Results: Among an estimated 6.4 million adults with history of stroke from 2005-2016, 78.2% had HTN but only 69.6% reported having been prescribed ATH medication. Among those with history of stroke and HTN (n=4971136), 37.1% (33.5-40.8%) had uncontrolled HTN on examination with 80.4% taking ATH. Most commonly used ATH medications were beta blockers (43.8%, 40.3-47.3%) and diuretics (41.5%, 37.2-45.8%). ATH classes associated with uncontrolled HTN included ACE/ARB (56.0%) and beta blockers (42.6%). Examining trends over time, diuretics have become less commonly used (49.4% in 2005-2006 vs. 35.7% in 2015-2016) whereas other classes remain more constant. Conclusion: Using a national survey, we found significant under-treatment of HTN in those with history of stroke, and >1/3 had uncontrolled HTN. Since HTN is a major stroke risk factor, this data demonstrates a significant missed opportunity nationally for secondary stroke prevention.

scholarly journals Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Mariacarla Gallù ◽  
Giulia Marrone ◽  
Jacopo Maria Legramante ◽  
Antonino De Lorenzo ◽  
Nicola Di Daniele ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Stroke Risk ◽  
Current Knowledge ◽  
Oral Anticoagulants ◽  
Optimal Time ◽  
Complete Evaluation ◽  
Thromboembolic Risk ◽  
Female Patients ◽  
Female Sex

Sex-specific differences have been definitively demonstrated in cardiovascular (CV) diseases. These differences can also impact on the effects of CV therapies. Female sex is recognized as an independent predictor of thromboembolic risk, particularly in older patients. Most of strokes are due to atrial fibrillation (AF). Women affected by AF have higher stroke risk compared to men. The introduction of novel oral anticoagulants (NOACs) for long-term anticoagulation completely changed the anticoagulant therapeutic approach and follow-up of patients affected by nonvalvular atrial fibrillation (NVAF). CHA2DS2-VASc stroke risk scoring in use in the current international guidelines attributes 1 point to “female sex”. Besides, no anticoagulation is indicated for AF female patients without other risk factors. Interestingly, NOACs seem to normalize the differences between males and females both in terms of safety and efficacy, whereas residual higher stroke risk and systemic embolism persist in AF women treated with vitamin K antagonist anticoagulants VKA with optimal time in therapeutic range. Based on the CHA2DS2-VASc score, NOACs represent the preferred choice in NVAF patients. Moreover, complete evaluation of apparently lower risk factor along with concomitant clinical conditions in AF patients appears mandatory, particularly for female patients, in order to achieve the most appropriate anticoagulant treatment, either in male or in female patients. The present review was performed to review sex differences in AF-related thromboembolic risk reported in the literature and possibly highlight current knowledge gaps in prevention and management that need further research.

scholarly journals Different implication in dementia between patients with atrial flutter and atrial fibrillation: a national cohort study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
YL Chen
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Research Database ◽  
Funding Sources ◽  
Valvular Surgery ◽  
Previous Stroke ◽  
Included Patient ◽  
National Cohort ◽  
History Of ◽  
The Difference

Abstract Funding Acknowledgements Type of funding sources: None. Importance Atrial fibrillation (AF) has been reported with increasing the risk of stroke and dementia. Atrial flutter (AFL) is also a risk of stroke with different discrepancies in clinical outcome. Little is known about the difference in the risk of dementia between AF and AFL. Objective To investigate if the risk of dementia is difference between AF and AFL. Methods The patients with newly diagnosed AF and AFL during 2001–2013 was retrieved from Taiwan’s National Health Insurance Research Database. Patients with missing information, aged &lt;20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. Propensity score matching (PSM) between AF and AFL was performed, which included patient comorbidities, past medical history, medications, and index date stratified by age. Primary outcome was defined as dementia at follow-up. Results A total of 232,425 AF and 7,569 AFL were eligible for analysis. After 4:1 PSM, we included 30,276 AF (aged 67.3 ± 15.7 years) and 100,065 AFL (aged 67.4 ± 16.0 years) for analysis. The risk of dementia was higher in AF patients compared with AFL patients (subdistribution HR (SHR)=1.52, 95% CI 1.39 - 1.66; p &lt;0.0001) before PSM and still higher in AF patients (SHR = 1.14, 95% CI 1.04 to 1.25; p = 0.0064). The risk was higher in AF patients without previous stroke after PSM and there was no difference between AF and AFL patients with previous stroke history. Conclusions and relevance Our finding supports that risk of dementia is higher in AF patients than AFL patients. However, the risk of dementia between patients with AF and AFL varies depending on whether there is a previous stroke history.

Abstract 2199: Ultra Rapid Brain Attack Team MRI Useful in Selecting Patients with Acute Stroke-like Symptoms for Intravenous Thrombolysis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Stephanie Paolini ◽  
Roxanne D Poole ◽  
Kelly Hawsey ◽  
Blease C Graham ◽  
Souvik Sen
Keyword(s):  
Atrial Fibrillation ◽  
South Carolina ◽  
Risk Factor ◽  
Stroke Risk ◽  
Statistical Significance ◽  
Brain Magnetic Resonance Imaging ◽  
Categorical Variables ◽  
Stroke Risk Factor ◽  
Conversion Disorders ◽  
Iv Tpa

Introduction: In acute ischemic stroke (AIS), intravenous tissue plasminogen activator (IV TPA), if administered appropriately can be beneficial; however, with stroke misdiagnosis, it can expose patients to unnecessary bleeding risks. Thus, accurate diagnosis is critical. Brain Magnetic Resonance Imaging (MRI) is sensitive to detect AIS; however, a complete exam may consume 30-45 minutes. At the University of South Carolina Palmetto Health Richland Stroke Center, an ultra-rapid, 10 minute MRI called the Brain Attack Team MRI (BAT MRI) was designed to accurately and expeditiously diagnose AIS. Hypothesis: BAT MRI is a useful clinical tool to select or exclude patients for IV TPA who present acutely with stroke-like symptoms. Clinical correlates are not an effective substitution for BAT MRI to confirm AIS. Methods: In an ongoing study, conducted in 2010-11, 31 consecutive patients were identified who presented <4.5 hours from symptom onset and received a BAT MRI. They were 43-90 years in age; 48.4% White, 48.4% African American, and 3.2% unknown. BAT MRIs included diffusion weighted imaging, T2 gradient echo, T2 axial, and FLAIR sequences. The algorithm for BAT MRI use is shown in Figure 1. BAT MRIs were evaluated for ischemia, hemorrhage and other central nervous system (CNS) pathologies. Stroke risk factor correlates of abnormal BAT MRIs were assessed using t-test for continuous variables and Fisher's Exact Test for categorical variables. Results: Of the 31 BAT MRIs, 13 were read as abnormal (11-acute ischemia, 1-hemorrhage, 1-ischemia with hemorrhage). The hemorrhage was in the pons on BAT MRI and was not detected by CT. This finding excluded using IV TPA in this patient. Two cases where BAT MRI demonstrated AIS met NINDS/ECASS-III criteria and received IV TPA. Of the 18, in whom BAT MRI was read as normal, 9 had a discharge diagnosis of TIA, 2 MRI negative strokes, 3 conversion disorders, 1 CNS neoplasm, 1 respiratory failure and 1 peripheral vertigo. Stroke risk factor analysis yielded no significant correlation between BAT MRI findings and gender, race, prior stroke/TIA, coronary artery disease, diabetes, hyperlipidemia, hypertension, or smoking. Patients with AIS on BAT MRI were older (68.2 ± 17.5) than those without (58.6 ± 9.7); although, it bordered statistical significance (p=0.08). Atrial fibrillation correlated with AIS on BAT MRI (p=0.02). Conclusion: In patients with AIS-like symptoms, BAT MRI may be used to confirm AIS, exclude stroke mimics and assess candidacy for IV TPA. Atrial fibrillation correlated with AIS on BAT MRI; therefore, these patients may be more likely to be IV TPA candidates.

scholarly journals Associations of serum n-3 and n-6 PUFA and hair mercury with the risk of incident stroke in men: the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD)

2016 ◽  
Vol 115 (10) ◽  
pp. 1851-1859 ◽  
Author(s):  
Roya Daneshmand ◽  
Sudhir Kurl ◽  
Tomi-Pekka Tuomainen ◽  
Jyrki K. Virtanen
Keyword(s):  
Risk Factor ◽  
Heart Disease ◽  
Ischaemic Stroke ◽  
Stroke Risk ◽  
Disease Risk ◽  
Disease Risk Factor ◽  
Risk Factor Study ◽  
Factor Study ◽  
Heart Disease Risk ◽  
Long Chain

AbstractPUFA have been associated with lower risk of CVD, but less is known about their association with stroke risk. Fish, a major source of n-3 PUFA, may also contain methylmercury, which has been associated with higher risk of CVD and attenuation of the benefits of long-chain n-3 PUFA. We investigated the associations of serum n-3 and n-6 PUFA and hair Hg with risk of stroke in men. A total of 1828 men from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42–60 years and free of CVD at baseline in 1984–1989 were studied. Cox regression models were used for the analyses. During the mean follow-up of 21·2 years, 202 stroke cases occurred, of which 153 were ischaemic strokes. After adjustment for age and examination year, the only statistically significant association among the n-3 and n-6 PUFA was observed between the n-3 PUFA α-linolenic acid and risk of haemorrhagic stroke (hazard ratio in the highest v. the lowest quartile 0·33; 95 % CI 0·13, 0·86; Ptrend=0·03). However, further adjustments attenuated the association to statistically non-significant. Hair Hg was not associated with stroke risk, but among those with hair Hg above the median level, higher serum long-chain n-3 PUFA concentrations were associated with a higher risk of ischaemic stroke. In our cohort of men, serum n-3 or n-6 PUFA or hair Hg were not associated with stroke risk; however, the interaction between Hg and long-chain n-3 PUFA with regard to ischaemic stroke risk warrants further investigation.

Sign in / Sign up

Export Citation Format

Share Document