Sex differences in risk for developing recurrence within one-year: a comparison of risk score, risk level, and risk factors among young adults women and men with ischemic stroke
Keywords:gender difference, risk factor, stroke in young adult patients, stroke recurrence
This retro-prospective descriptive study aimed to analyze the comparative relationship of risk score, risk for developing recurrence within one year and risk factors among female and male young adults with ischemic stroke. The secondary data were examined from stroke registry of the total 3,226 ischemic stroke patients who were admitted to Hat Yai Hospital during October 2011 to February 2016. The risk levels were assessed by using the Essen Stroke Risk Score (ESRS). Based on eight risk factors including age, hypertension, diabetes, previous stroke or transient ischemic attack, myocardial infarction, other cardiovascular diseases except for myocardial infarction and atrial fibrillation, peripheral vascular disease, and smoking, risk level was determined low and high. Logistic regression model was employed by using odds ratio (OR) and 95% confidence interval (95%CI).
It was found that females were more likely to have less total score on ESRS (p = <.001) than males. Females and males had differences risk levels (χ2 = 35.94, p = 0.000). The prevalence of risk factors were different in two factors, diabetes (χ2 = 5.754, p = 0.016) and smoking (χ2 = 35.94, p=0.000). Analyzing logistic regression model revealed that the prevalence of diabetes (OR 1.59, 95%CI 1.12-2.26, p = 0.009), and hypertension (OR 1.35, 95%CI 1.01-1.82, p = 0.017) of females were higher than the prevalence of males. However, the prevalence of smoking (OR 0.02, 95%CI 0.01-0.03, p = 0.000) of females was lower than the prevalence of males.
This research suggested that risk factors for recurrent ischemic stroke of female and male young adult patients were different. The risk factor assessment based on genders is a significant clinical data in order to consider risk prevention guidelines of recurrence within one year in young adult patients with ischemic stroke.
Suwanwela NC, Poungvarin N. for the Asian Stroke Advisory Panel. Stroke burden and stroke care system in Asia. Neurol India. 2016; 64(Suppl S1): 46-51.
Putaala J, Yesilot N, Waje-Andreassen U, Pitkäniemi J, Vassilopoulou S, Nardi K, et al. Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: the 15 Cities Young Stroke Study. Stroke. 2012; 43: 2624-30.
Rutten-Jacobs LCA, Arntz RM, Maaijwee NAM, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, de Leeuw FE. Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. 2013; 309(11): 1136-44.
Tan KS, Navarro JC, Wong KS, Huang YN, Chiu HC, Poungvarin N, et al. on behalf of the Asian Stroke Advisory Panel. Clinical profile, risk factors and aetiology of young ischaemic stroke patients in Asia: a prospective, multicentre, observational, hospital-based study in eight cities. Neurol. Asia. 2014; 19(2): 117-27.
Schneider S, Kornejeva A, Vibo R, Kõrv J. Risk Factors and Etiology of Young Ischemic Stroke Patients in Estonia. Stroke Res Treat. 2017; 2017: 8075697. doi.org/10.1155/2017/8075697
Barra M, Labberton AS, Faiz KW, Lindstrøm JC, Rønning OM, Viana J, et al. Stroke incidence in the young: evidence from a Norwegian register study. J. Neurol. 2019; 266: 68-84.
Griffiths D, Sturm J. Epidemiology and etiology of young stroke. Stroke Res Treat. 2011; 1: 209370. doi:10.4061/2011/209370
Maeda K, Toyoda K, Minematsu K, Kobayashi S, for the Japan Standard Stroke Registry Study Group. Effects of sex difference on clinical features of acute ischemic stroke in Japan. J Stroke Cerebrovasc Dis. 2013; 22(7): 1070-5.
Wang Z, Li J, Wang C, Yao X, Zhao X, Wang Y, et al. Gender differences in 1-year clinical characteristics and outcomes after stroke: results from the China National Stroke Registry. PLoS ONE. 2013; 8(2): e56459. doi:10.1371/ journal.pone.0056459
Yu C, An Z, Zhao W, Wang W, Gao C, Liu S, et al. Sex differences in stroke subtypes, severity, risk factors, and outcomes among elderly patients with acute ischemic stroke. Front. Aging Neurosci. 2015; 7: 174. doi: 10.3389/fnagi.2015.00174
Palm F, Urbanek C, Wolf J, Buggle F, Kleemann T, Hennerici MG, et al. Etiology, risk factors and sex differences in ischemic stroke in the Ludwigshafen Stroke Study, a population-based stroke registry. Cerebrovasc Dis. 2012; 33: 69-75.
Putaala J, Curtze S, Hiltunen S, Tolppanen H, Kaste M, Tatlisumak T. Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke: the Helsinki Young Stroke Registry. Stroke. 2009; 40: 2698-703.
Dharmasaroja PA, Muengtaweepongsa S, Lechawanich C, Pattaraarchachai J. Causes of ischemic stroke in young adults in Thailand: a pilot study. J Stroke Cerebrovasc Dis. 2011; 20(3): 247-50.
Lee JD, Hu YH, Lee M, Huang YC, Kuo YW, Lee TH. High risk of one-year stroke recurrence in patients with younger age and prior history of ischemic stroke. Curr Neurovasc Res. 2018; 16(3): 250-7.
Haast RAM, Gustafson DR, Kiliaan AJ. Sex differences in stroke. J Cereb Blood Flow Metab. 2012; 32(12): 2100-7.
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. for the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45: 2160-236.
Kauw F, Takx RAP, de Jong HWAM, Velthuis BK, Kappelle LJ, Dankbaar JW. Clinical and imaging predictors of recurrent ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2018; 45(5-6): 279-87.
Khanevski AN, Bjerkreim AT, Novotny V, Næss H, Thomassen L, Logallo N, et al. on behalf of the NORSTROKE study group. Recurrent ischemic stroke: Incidence, predictors, and impact on mortality. Acta Neurologica Scandinavica. 2019; 140(1): 3-8.
Weimar C, Diener HC, Alberts MJ, Steg PG, Bhatt DL, Wilson PWF, et al. on behalf of the REACH Registry Investigators. The Essen Stroke Risk Score predicts recurrent cardiovascular events: a validation within the REduction of Atherothrombosis for Continued Health (REACH) Registry. Stroke. 2009; 40(2): 350-4.
Weimar C, Benemann J, Michalski D, Müller M, Luckner K, Katsarava Z, et al. Prediction of recurrent stroke and vascular death in patients with transient ischemic attack or nondisabling stroke: a prospective comparison of validated prognostic scores. Stroke. 2010; 41(3): 487-93.
Liu J, Li M, Liu J. Evaluation of the ESRS and SPI-II scales for short-term prognosis of minor stroke and transient ischemic attack. Neurol. Res. 2012; 35(6): 568-72.
Chen P, Liu Y, Wang Y, Wang A, Zheng H, Zhao X, et al. A validation of the Essen Stroke risk score in outpatients with ischemic stroke. J Stroke Cerebrovasc Dis. 2016; 25(9): 2189-95.
Boulanger M, Li L, Lyons S, Lovett NG, Kubiak MM, Silver L, et al. Essen risk score in prediction of myocardial infarction after transient ischemic attack or ischemic stroke without prior coronary artery disease. Stroke. 2019; 50(12): 3393-9.
Kulshreshtha A, Anderson LM, Goyal A, Keenan NL. Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010. Neuroepidemiology 2012; 38: 123-9.
Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke: definition for use in a multicenter clinical trial. Stroke. 1993; 24: 35-41.
Meng X, Wang Y, Zhao X, Wang C, Li H, Liu L, et al. Validation of the ESSEN stroke risk score and the stroke prognosis instrument ii in Chinese patients. Stroke. 2011;42(12): 3619-20.
Field A. Discovering statistics using SPSS. 3rd ed. London: SAGE Publications Ltd; 2009.
Aekplakorn W, Puckcharern H, Thaikla K, Satheannoppakao W. Thai national health examination survey: NHES V. Nonthaburi: Health System Research Institute, Thailand; 2016. (in Thai)
Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch MA. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017; 48: 1744-51.
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