 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2023, vol. 29, issue1
Subject Area: Medicine
-
DOI: 10.5272/jimab.2023291.4793
Published online: 03 February 2023
Original article
J of IMAB. 2023 Jan-Mar;29(1):4793-4799
GENDER-RELATED DIFFERENCES IN MODIFIABLE RISK FACTORS AND ISCHEMIC STROKE SUBTYPE IN YOUNG AND MIDDLE-AGED PATIENTS – A PROSPECTIVE STUDY
Georgi Tz. Dimitrov1, 2
, Maya P. Danovska1, 2, Diana L. Marinova1, 2, Plamen G. Stoev1, 2, Yoana I. Simeonova3,
1) Department of Neurology and Neurosurgery, Faculty of Medicine, Medical University - Pleven, Bulgaria.
2) UMHAT "Dr Georgi Stranski", Medical University - Pleven, Bulgaria.
3) Department of Social Medicine, Faculty of Public Health, Medical University, Sofia, Bulgaria.
ABSTRACT:
Background: Male and female patients differ in their risk factors (RFs) and ischemic stroke (IS) subtype. A better understanding of the gender–related differences an important approach to successful prevention strategies for reducing the impact and burden of IS in young adults.
Objective: To compare the gender–related differences in the prevalence of modifiable RFs and IS subtypes in young and middle-aged patients.
Material and Methods: In the study were included 80 patients with acute IS, aged 18 – 59 years, admitted to the Neurology Clinic of UMHAT "Dr Georgi Stranski" Pleven. The following RFs were analyzed: arterial hypertension (AH), diabetes mellitus (DM), dyslipidemia, atrial fibrillation (AF), current smoking, number of cigarettes smoked per day, alcohol abuse, low physical activity, body overweight and chronic psychosocial stress. IS subtype was identified according to the Org 10172 Trial of Acute Stroke (TOAST). The statistical analysis was performed with the Statistical Package for Social Sciences, version 26.0 (SPSS).
Results: Of all the 80 patients, 46 (57,5%) were males with a mean age 48,15±7,42 years, and 34 (42,5%) were females with a mean age 47,38±8,56. Male patients had higher rates of AH (80,4%), DM (47.8%), AF (4,3%), current smoking (73,9%), number of cigarettes smoked per day (60,9%), alcohol abuse (41,3%) and chronic psychosocial stress (52,2%), while the female ones showed higher rates of low physical activity (61,8%) and body overweight (38,2%). A statistical significance was found only for AH (p=0,004), DM (p=0,026), current smoking (p=0,007), number of cigarettes smoked per day (p=0,025) and alcohol abuse (p=0,031). The most common subtype of IS in males was large artery atherosclerosis (47,8%) and small vessel occlusion (28,3%). The female patients demonstrated a higher frequency of IS with other determined etiology (38,2%) and undetermined etiology (26,5%).
Conclusion: Our data contribute to a better understanding of the gender–related differences of modifiable RFs and IS subtype in young and middle-aged patients with acute IS. The above findings definitely imply the necessity of developing additional specific therapeutic strategies for the effective control of modifiable RFs and lifestyle improvement in order to reduce the incidence of the most common subtypes of IS.
Keywords: Ischemic stroke, risk factors, gender-related differences, subtype ischemic stroke, young and middle – age patients,
- Download FULL TEXT /PDF 793 KB/
Please cite this article as: Dimitrov GT, Danovska MP, Marinova DL, Stoev PG, Simeonova YI. Gender-Related Differences in Modifiable Risk Factors and Ischemic Stroke Subtype in Young and Middle-aged Patients – a prospective study. J of IMAB. 2023 Jan-Mar;29(1):4793-4799.
DOI: 10.5272/jimab.2022281.4793
Correspondence to: Georgi Dimitrov, Department of Neurology and Neurosurgery, Faculty of Medicine, Medical University – Pleven; 1, St. Kliment Ohridski Str., 5800 Pleven, Bulgaria; E-mail: georgi.cdimitrov.09@gmail.com
REFERENCES:
1. Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019 Oct 10;5(1):70. [PubMed]
2. Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry. 2020 Apr;91(4):411-417. [PubMed]
3.Saini V, Guada L, Yavagal DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology.2021 Nov 16;97(20 Suppl 2):S6-S16. [PubMed]
4. Titianova E, Velcheva I, Andonova S. Stroke in Bulgaria: Recent Problems. Neurosonology and Cerebral Hemodynamics. 2015 May;11(1):7-13. [Internet]
5. Norman K, Eriksson M, von Euler M. Sex Differences in Ischemic Stroke Within the Younger Age Group: A Register-Based Study. Front Neurol. 2022 Feb 14;13:793181. [PubMed]
6. Putaala J. Ischemic Stroke in Young Adults. Continuum (Minneap Minn). 2020 Apr;26(2):386-414. [PubMed]
7. O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, 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 Aug 20;388(10046):761-75. [PubMed]
8. Chang BP, Wira C, Miller J, Akhter M, Barth BE, Willey J, et al. Neurology Concepts: Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department. Acad Emerg Med. 2018 Jan;25(1):54-64. [PubMed]
9. Roy-O'Reilly M, McCullough LD. Age and Sex Are Critical Factors in Ischemic Stroke Pathology. Endocrinology. 2018 Aug 1;159(8):3120-3131. [PubMed]
10. 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 Jul;48(7):1744-1751. [PubMed]
11. Smajlovic D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015 Feb 24;11:157-64. [PubMed]
12. Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res.2017 Feb 3;120(3):472-495. [PubMed]
13. Tang M, Yao M, Zhu Y, Peng B, Zhou L, Ni J. Sex differences of ischemic stroke in young adults-A single-center Chinese cohort study. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105087. [PubMed]
14. Wu X, Zou Y, You S, Zhang Y. Distribution of risk factors of ischemic stroke in Chinese young adults and its correlation with prognosis. BMC Neurol.2022 Jan 14;22(1):26. [PubMed]
15. Rexrode KM, Madsen TE, Yu AYX, Carcel C, Lichtman JH, Miller EC. The Impact of Sex and Gender on Stroke. Circ Res.2022 Feb 18;130(4):512-528. [PubMed]
16. Tun NN, Arunagirinathan G, Munshi SK, Pappachan JM. Diabetes mellitus and stroke: A clinical update. World J Diabetes.2017 Jun 15;8(6):235-248. [PubMed]
17. Šaňák D, Hutyra M, Král M, Bártková A, Zapletalová J, Fedorco M, et al. Atrial fibrillation in young ischemic stroke patients: an underestimated cause? Eur Neurol. 2015;73(3-4):158-63. [PubMed]
18. von Sarnowski B, Putaala J, Grittner U, Gaertner B, Schminke U, Curtze S, et al. Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study. Stroke. 2013 Jan;44(1):119-25. [PubMed]
19. Ramírez-Moreno JM, MuñozVega P, Espada S, BartoloméAlberca S, Aguirre J, Peral D.Association between self-perceived psychological stress and transitory ischaemic attack and minor stroke: A case-control study. Neurologia (Engl Ed).2020 Oct;35(8):556-562. [PubMed]
20. Kotlęga D, Gołąb-Janowska M, Masztalewicz M, Ciećwież S, Nowacki P. The emotional stress and risk of ischemic stroke. Neurol Neurochir Pol. 2016 Jul-Aug;50(4):265-70. [PubMed]
21. Graber M, Baptiste L, Mohr S, Blanc-Labarre C, Dupont G, Giroud M, et al. A review of psychosocial factors and stroke: A new public health problem. Rev Neurol (Paris).2019 Dec;175(10):686-692. [PubMed]
22. Kloska A, Malinowska M, Gabig-Cimiсska M, Jakуbkiewicz-Banecka J. Lipids and Lipid Mediators Associated with the Risk and Pathology of Ischemic Stroke. Int J Mol Sci.2020 May 20;21(10):3618. [PubMed]
23. Gu X, Li Y, Chen S, Yang X, Liu F, Li Y, Li J. et al. Association of Lipids With Ischemic and Hemorrhagic Stroke: A Prospective Cohort Study Among 267 500 Chinese. Stroke. 2019 Dec;50(12):3376-3384. [PubMed]
24. Samai AA, Martin-Schild S. Sex differences in predictors of ischemic stroke: current perspectives. Vasc Health Risk Manag. 2015 Jul 27;11:427-36. [PubMed]
25. Wang Y, Dai Y, Zheng J, Xie Y, Guo R, Guo X, et al. Sex difference in the incidence of stroke and its corresponding influence factors: results from a follow-up 8.4 years of rural China hypertensive prospective cohort study. Lipids Health Dis.2019 Mar 25;18(1):72. [PubMed]
26.Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun;75(6):1334-1357. [PubMed]
27. Geng C, Lin Y, Tang Q, Tang Y, Wang X, Zhou JS. Et al. Sex differences in clinical characteristics and 1-year outcomes of young ischemic stroke patients in East China. TherClin Risk Manag.2018 Dec 19;15:33-38. [PubMed]
28. Putaala J, Haapaniemi E, Metso AJ, Metso TM, Artto V, Kaste M, et al. Recurrent ischemic events in young adults after first-ever ischemic stroke. Ann Neurol. 2010 Nov;68(5):661-71. [PubMed]
29. Vibo R, Schneider S, Kõrv L, Mallene S, Torop LA, Kõrv J. Estonian young stroke registry: High burden of risk factors and high prevalence of cardiomebolic and large-artery stroke. Eur Stroke J. 2021 Sep;6(3):262-267. [PubMed]
30. Yahya T, Jilani MH, Khan SU, Mszar R, Hassan SZ, Blaha MJ, et al. Stroke in young adults: Current trends, opportunities for prevention and pathways forward. Am J PrevCardiol. 2020 Sep 9;3:100085. [PubMed]
31. Kono Y, Terasawa Y, Sakai K, Iguchi Y, Nishiyama Y, Nito C, et al. Risk factors, etiology, and outcome of ischemic stroke in young adults: A Japanese multicenter prospective study. J Neurol Sci. 2020 Oct 15;417:117068. [PubMed]
32. Yesilot Barlas N, Putaala J, Waje-Andreassen U, Vassilopoulou S, Nardi K, Odier C, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013 Nov;20(11):1431-9. [PubMed]
33. Dash D, Bhashin A, Pandit AK, Tripathi M, Bhatia R, Prasad K, et al. Risk factors and etiologies of ischemic strokes in young patients: a tertiary hospital study in north India. J Stroke. 2014 Sep;16(3):173-7. [PubMed].
Received: 29 August 2022
Published online: 03 February 2023