Original Article
Sex Differences in Outcomes and Associated Risk Factors After Acute Ischemic Stroke in Elderly Patients: A Prospective Follow-up Study

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.007Get rights and content

Stroke has a greater effect on women. However, sex differences in outcome and factors associated with outcome among elderly patients are unknown. From January 2009 to December 2011, 810 patients with acute ischemic stroke aged 75 years or older were recruited in China. Clinical profile and risk factors were recorded. Outcomes and associated risk factors at 12 and 36 months after stroke were assessed by sex. Hypertension, diabetes mellitus, dyslipidemias, and obesity prevalence rates were higher in women than in men; opposite trends were found for smoking and alcohol consumption. The mortality rate at 12 months after stroke was significantly greater in men than in women (23.3% versus 16.6%, P = .015). Large-artery atherothrombotic and cardioembolic stroke subtypes were risk factors for mortality, recurrence, and dependency in both sexes. In men, atrial fibrillation was a risk factor of mortality at 12 months after stroke (relative ratio [RR], 2.12; 95% confidence interval [CI], 1.38-3.27), but obesity was a protective factor of mortality at 36 months after stroke (RR, .30; 95% CI, .10-.94). However, in women, atrial fibrillation was a risk factor of recurrence at 12 months (RR, 2.32; 95% CI, 1.31-4.12) and dependency at 36 months after stroke (RR, 7.68; 95% CI, 1.60-36.82). We assessed sex differences in stroke outcomes and associated risk factors at 12 and 36 months after stroke in a large hospital-based stroke registry of elderly patients from Northern China. Thus, it is crucial to emphasize risk management to elderly patients to reduce mortality, recurrence, and dependency after stroke.

Section snippets

Materials and Methods

From January 2009 to December 2011, we recruited consecutive patients with AIS who were hospitalized in the Stroke Unit of Tianjin Medical University General Hospital and Tianjin Haibin People's Hospital, China, within 72 hours after stroke onset. Stroke was defined according to the World Health Organization's criteria, and a diagnosis of AIS was confirmed in all patients based on the evidence of neuroimaging (including computed tomography and magnetic resonance imaging).9 Patients with

Results

During the study period, 871 consecutive AIS patients were hospitalized in the stroke unit of the Tianjin Medical University General Hospital, China. Of these, 750 patients (86.1%) were interviewed in the outpatient department, 60 patients (6.9%) by telephone visiting, and 61 patients (7%) were excluded because they were lost to follow-up at 12 months; 810 patients (93%) were analyzed for outcomes at 12 months. Similarly, 317 patients (71.4%) were interviewed in the outpatient department, 88

Discussion

In the present study, we evaluated sex differences in stroke outcomes and related risk factors at 12 and 36 months after AIS among patients aged 75 years and older in China.

Previous studies have demonstrated significant sex differences in stroke outcomes; women have worse outcomes after stroke compared with men. Women had greater functional impairments at 3 and 12 months after stroke,11, 13, 14 but no sex difference in mortality rate was observed.11 A study from China reported that compared

Conclusions

We assessed the sex differences in stroke outcomes and associated risk factors at 12 and 36 months after stroke in a large hospital-based stroke registry of elderly patients with ischemic stroke in Northern China. LAA and CE (by TOAST classification) were risk factors found to affect mortality, recurrence, and dependency rates in both sexes. However, AF increased the risk of mortality in men and recurrence and dependency in women. Simultaneously, obesity was a protective factor against

References (25)

  • Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders

    Stroke

    (1989)
  • H.P. Adams et al.

    Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial: TOAST: Trial of Org 10172 in Acute Stroke Treatment

    Stroke

    (1993)
  • Cited by (0)

    This work was supported partly by Local Key Project of Binhai New District and The Project of Prevention and Treatment System on Cerebrovascular Disease in Dagang Oilfield.

    View full text