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Title: Sex differences in risk factor profile, clinical presentation, stroke subtype and outcome in acute ischemic stroke
Authors: Mitta Nandini
Issue Date: Dec-2019
Publisher: SCTIMST
Abstract: Stroke is currently the second leading cause of death worldwide. Ischemic heart disease and stroke together accounted for 15.2 million deaths (15–15.6 million) in 2015(1). Stroke is the commonest cause of chronic adult disability(2). Stroke affects 33 million individuals worldwide each year(3). The lifetime risk of stroke after 55 years of age is 1 in 5 for women and 1 in 6 for men. More than four-fifths of all strokes occur in developing countries(4). Women are more likely to have hypertension and atrial fibrillation(AF). Men are more likely to have coronary artery disease, dyslipidemia, diabetes, peripheral artery disease, tobacco and alcohol use(5). Although men have a higher incidence of AF at all age groups, women with nonvalvular AF have double the risk of stroke than men with the same condition(6).Women with stroke were more likely to present with ―nontraditional‖ stroke symptoms and, in particular, altered mental status, compared with men. ―Traditional‖ stroke symptoms of imbalance and hemiparesis were more frequently reported by men(7). Stroke severity measured by the National Institutes of Health stroke scale (NIHSS) has been found in studies to be consistently more in women compared to men(8). In terms of the TOAST (Trial of Org 10172 in Acute Ischemic Stroke) subtype etiological classification, four European based studies showed higher frequency of cardioembolic stroke in women compared to men (9)(10)(11)(12). In men, large artery atherosclerosis was found to be more common than women. Lacunar strokes were found to be more common in men than women (13).Studies have shown delay in women reaching hospital than men because of increased nontraditional stroke symptoms compared with men and women are more likely than men to be living alone.Several studies have shown that women are less likely to receive alteplase than are men. A female stroke patient’s overall chances of receiving thrombolysis are 13% less than a male’s(14). Women were more likely than men to demonstrate substantial neurological improvement in the first 24 h after IV tPA treatment(15). Overall studies from Europe and North America have shown that women have less favourable outcomes after stroke and lower Quality of life (QOL) than do men(8). The Swedish Risks-Stroke Registry showed that 54% of women versus 67% of men were independent in primary ADL at 3 months’ follow-up(16). Overall from all these studies, it is evident that significant differences exist in stroke with regard to incidence, risk factor profile, clinical presentation, stroke subtype and outcome between men and women. Since all studies on sex differences in stroke are from Western world and there are few studies aimed at studying gender differences in stroke in India, this study is planned to analyse the sex differences in risk factor profile, clinical presentation, stroke subtype and outcome in our population and for understanding whether same gender differences exist in our population.
Appears in Collections:Neurology

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