Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

Background: Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes. Summary: Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as compared to women overall, the long- and short-term outcomes in Asian women tend to be poorer. Both conventional and gender-specific risk factors contribute to stroke risk. Oral contraceptive use and addictions such as tobacco and alcohol are less prevalent among Asian women due to socio cultural differences. There is however, a much higher preponderance of pregnancy-related stroke and cardio-embolic stroke secondary to rheumatic heart disease and heavy use of chewing tobacco. The overall outcome is poor due to poor access to health care and lack of resources. Key Messages: Our review exposed the gaps in our knowledge about stroke risk factors and differences in stroke care provided to Asian women. While there are sociocultural barriers that impede the provision of immediate care to these stroke patients, much needs to be done by way of prevention of recurrent stroke and treatment of risk factors.

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The Burden of Stroke in Pakistan

International Journal of Stroke ◽

10.1111/j.1747-4949.2008.00214.x ◽

2008 ◽

Vol 3 (4) ◽

pp. 293-296 ◽

Cited By ~ 10

Author(s):

Bhojo A. Khealani ◽

Mohammad Wasay

Keyword(s):

Risk Factors ◽

Stroke Risk ◽

Case Series ◽

Stroke Care ◽

Poor Control ◽

Stroke Incidence ◽

Treatment Practices ◽

Stroke Risk Factors ◽

The Subject ◽

Artery Disease

Epidemiologic literature on stroke burden, patterns of stroke is almost non existent from Pakistan. However, several hospital-based case series on the subject are available, mainly published in local medical journals. Despite the fact that true stroke incidence and prevalence of stroke in Pakistan is not known, the burden is assumed to be high because of highly prevalent stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, dyslipidemia and smoking) in the community. High burden of these conventional stroke risk factors is further compounded by lack of awareness, poor compliance hence poor control, and inappropriate management/treatment practices. In addition certain risk factors like rheumatic valvular heart disease may be more prevalent in Pakistan. We reviewed the existing literature on stroke risk factors in community, the risk factor prevalence among stroke patients, patterns of stroke, out come of stroke, availability of diagnostic services/facilities related to stroke and resources for stroke care in Pakistan.

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Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk

Stroke ◽

10.1161/strokeaha.119.027160 ◽

2020 ◽

Vol 51 (5) ◽

pp. 1563-1569 ◽

Cited By ~ 1

Author(s):

Adam Richards ◽

Nicholas J. Jackson ◽

Eric M. Cheng ◽

Robert J. Bryg ◽

Arleen Brown ◽

...

Keyword(s):

Risk Factors ◽

Risk Reduction ◽

Stroke Risk ◽

Care Delivery ◽

Recurrent Stroke ◽

Individual Risk ◽

Stroke Risk Factors ◽

Multiple Stroke ◽

Individual Risk Factors ◽

Delivery Models

Background and Purpose— Lowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke. Methods— We reviewed existing evidence of the efficacy of interventions addressing blood pressure reduction, cholesterol lowering, antiplatelet/antithrombotic use, and smoking cessation and extracted relative risks for each intervention. From this, we developed a tool to estimate reductions in recurrent stroke risk, using bootstrapping and simulation methods. We also calculated a modified Global Outcome Score representing the proportion of potential benefit (relative risk reduction) achieved if all 4 individual risk factors were optimally controlled. We applied the tool to estimate stroke risk reduction among 275 participants with complete 12-month follow-up data from a recently published randomized trial of a healthcare delivery model that targeted multiple stroke risk factors. Results— The recurrent stroke risk tool was feasible to apply, yielding an estimated reduction in the relative risk of ischemic stroke of 0.36 in both the experimental and usual care trial arms. Global Outcome Score results suggest that participants in both arms likely averted, on average, 45% of recurrent stroke events that could possibly have been prevented through maximal implementation of interventions for all 4 individual risk factors. Conclusions— A stroke risk reduction tool facilitates estimation of the combined impact on vascular risk of improvements in multiple stroke risk factors and provides a summary outcome for studies testing alternative care models to prevent recurrent stroke. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00861081.

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What is the effect of interrupting prolonged sitting with frequent bouts of physical activity or standing on first or recurrent stroke risk factors? A scoping review

PLoS ONE ◽

10.1371/journal.pone.0217981 ◽

2019 ◽

Vol 14 (6) ◽

pp. e0217981

Author(s):

Paul Mackie ◽

Ishanka Weerasekara ◽

Gary Crowfoot ◽

Heidi Janssen ◽

Elizabeth Holliday ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Scoping Review ◽

Stroke Risk ◽

Recurrent Stroke ◽

Stroke Risk Factors ◽

Prolonged Sitting

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Epidemiology and stroke risk factors

10.1093/med/9780198737889.003.0001 ◽

2017 ◽

Author(s):

Hugh Markus ◽

Anthony Pereira ◽

Geoffrey Cloud

Keyword(s):

Public Health ◽

Risk Factors ◽

Stroke Risk ◽

Relative Risk Reduction ◽

Stroke Care ◽

Modifiable Risk Factors ◽

Comprehensive Review ◽

Stroke Risk Factors ◽

The United Kingdom ◽

Numbers Needed To Treat

In this opening chapter on the epidemiology and risk factors for stroke, the ‘size of the problem’ in public health terms both in the United Kingdom and worldwide is set out. Incidence, prevalence, and mortality of stroke are discussed. Epidemiological terms and definitions as applied to stroke care are reviewed and illustrated, including absolute and relative risk reduction and numbers needed to treat. This chapter also discusses aetiological subtyping of stroke which represents a syndrome caused by multiple different underlying pathologies. It ends with a comprehensive review of the major and minor modifiable and non-modifiable risk factors for stroke disease.

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Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

Neurology Research International ◽

10.1155/2017/8215726 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Jittima Saengsuwan ◽

Pathitta Suangpho ◽

Somsak Tiamkao

Keyword(s):

Risk Factors ◽

Transient Ischaemic Attack ◽

Stroke Risk ◽

Recurrent Stroke ◽

Warning Signs ◽

High Risk Population ◽

Cross Sectional ◽

Stroke Risk Factors ◽

Ischaemic Attack ◽

Structured Interventions

Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack) have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females). Using an open-ended questionnaire, nearly one-third of patients (31.4%) could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%), dyslipidemia (28.6%), and diabetes (22.9%). Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%), sudden trouble with speaking (25.7%), and sudden trouble with walking, loss of balance, or dizziness (21.4%). Nineteen patients (13.6%) could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

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A Systematic Literature Review of Patients With Carotid Web and Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.118.021907 ◽

2018 ◽

Vol 49 (12) ◽

pp. 2872-2876 ◽

Cited By ~ 25

Author(s):

Andrew J. Zhang ◽

Parth Dhruv ◽

Philip Choi ◽

Caitlin Bakker ◽

Jonathan Koffel ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Literature Review ◽

Systematic Literature Review ◽

Stroke Risk ◽

Recurrent Stroke ◽

Stroke Recurrence ◽

Carotid Revascularization ◽

Stroke Risk Factors ◽

Patient Level

Background and Purpose— Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods— Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results— Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16–85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0–97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions— CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

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Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

European Stroke Journal ◽

10.1177/23969873211058568 ◽

2021 ◽

pp. 239698732110585

Author(s):

Elora Basu ◽

Setareh Salehi Omran ◽

Hooman Kamel ◽

Neal S Parikh

Keyword(s):

Risk Factors ◽

Sex Differences ◽

Ischemic Stroke ◽

Stroke Risk ◽

Recurrent Stroke ◽

Minor Stroke ◽

Stroke Recurrence ◽

Stroke Risk Factors ◽

Minor Ischemic Stroke ◽

Using Data

Background Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients and methods We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence. Results Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%–6.85%) compared to men (5.67%; 95% CI, 4.83%–6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80–1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42–1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk. Discussion and Conclusion Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.

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Differences in the role of black race and stroke risk factors for first vs recurrent stroke

Neurology ◽

10.1212/wnl.0000000000002376 ◽

2016 ◽

Vol 86 (7) ◽

pp. 637-642 ◽

Cited By ~ 20

Author(s):

George Howard ◽

Brett M. Kissela ◽

Dawn O. Kleindorfer ◽

Leslie A. McClure ◽

Elsayed Z. Soliman ◽

...

Keyword(s):

Risk Factors ◽

Stroke Risk ◽

Recurrent Stroke ◽

Black Race ◽

Stroke Risk Factors

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Quality of care for ischemic stroke in China vs India

Neurology ◽

10.1212/wnl.0000000000006291 ◽

2018 ◽

Vol 91 (14) ◽

pp. e1348-e1354 ◽

Cited By ~ 5

Author(s):

Zixiao Li ◽

Jeyaraj Pandian ◽

P.N. Sylaja ◽

Yilong Wang ◽

Xingquan Zhao ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Scale Score ◽

Stroke Risk ◽

Stroke Care ◽

Chinese Patients ◽

Stroke Severity ◽

Stroke Risk Factors ◽

Indian Patients

ObjectiveTo understand stroke risk factors, status of stroke care, and opportunities for improvement as China and India develop national strategies to address their disproportionate and growing burden of stroke.MethodsWe compared stroke risk factors, acute management, adherence to quality performance measures, and clinical outcomes among hospitalized ischemic stroke patients using data from the Indo-US Collaborative Stroke Project (IUCSP) and China National Stroke Registry-II (CNSR-II). The IUCSP included 5 academic stroke centers from different geographic regions (n = 2,066). For comparison, the CNSR-II dataset was restricted to 31 academic hospitals among 219 participating sites from 31 provinces (n = 1,973).ResultsIndian patients were significantly younger, had health insurance less often, and had significantly different risk factors (more often diabetes mellitus, dyslipidemia, and coronary heart disease; less often prior stroke, hypertension, atrial fibrillation, and smoking). Hospitalized Indian patients had greater stroke severity (median NIH Stroke Scale score 10 vs 4), higher rates of IV thrombolysis within 3 hours (7.5% vs 2.4%), greater in-hospital mortality (7.9% vs 1.2%), and worse outcome (3-month modified Rankin Scale score 0–2, 49.3% vs 78.1%) (all p < 0.001). The poorer clinical outcomes were attributable mainly to greater stroke severity in IUCSP patients. Chinese patients more often received antithrombotics, stroke education, and dysphagia screening during hospitalization.ConclusionThese data provide insights into the status of ischemic stroke care in academic urban centers within 2 large Asian countries. Further research is needed to determine whether these patterns are representative of care across the countries, to explain differences in observed severity, and to drive improvements.

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Hypertension Risk Factor Control Effort In Post Stroke Patients

ABDIMAS: Jurnal Pengabdian Masyarakat ◽

10.35568/abdimas.v4i2.1109 ◽

2022 ◽

Vol 4 (2) ◽

pp. 639-644

Author(s):

Yosi Suryarinilsih ◽

Hendri Budi ◽

Netti Netti ◽

Wiwi Sartika

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Health Education ◽

Stroke Risk ◽

Recurrent Stroke ◽

Stroke Patients ◽

Post Stroke ◽

Stroke Risk Factors ◽

Breathing Exercises ◽

Significant Difference

Post-stroke patients have risk factors for recurrent stroke. The main risk factor is hypertension. The purpose of this community service activity is to improve the ability of the community, especially post-stroke patients, to control hypertension as a risk factor for recurrent stroke through identification of risk factors, health education and the application of light activity and deep breathing exercises. Before education is given, post-stroke patients and their families are given prestest first and after education, posttest returns to evaluate the patient's understanding. The results of the activity, there was a significant difference between the knowledge before and after being given education to post-stroke patients and their families with p value <0.05. To the head of the room and the neuroscientific nurse, dr. M. Djamil Padang can continue the activity of identifying recurrent stroke risk factors and health education related to control of recurrent stroke risk factors in post-stroke patients by involving the Health Promotion (Promkes) department of Dr. M. Djamil Padang.

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