Differences in stroke outcome based on sex

Shobha, Nandavar; Sylaja, P.N.; Kapral, Moira K.; Fang, Jiming; Hill, Michael D.

doi:10.1212/wnl.0b013e3181d5275c

Cited by 54 publications

(38 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increased assignment of tPA therapy to women should be encouraged as treatment outcomes do not differ between tPA treated men and women, while in non-tPA administered groups, males were more likely to have a better neurologic score as compared to women (Shobha et al 2010). This conclusion is also supported by data from endovascular intervention trials, where mechanical removal of the clot is performed to reestablish circulation in large vessel occlusion stroke.…”

Section: Stroke Therapeutics - Clinicalmentioning

confidence: 99%

Sex differences in stroke therapies

Sohrabji

Park

Mahnke

2016

J of Neuroscience Research

View full text Add to dashboard Cite

Stroke is the 5th leading cause of death and acquired disability in aged populations. Women are disproportionally affected by stroke, having a higher incidence and worse outcomes than men. Numerous preclinical studies have discovered novel therapies for the treatment of stroke, but almost all of these were found to be unsuccessful in clinical trials. Despite known sex differences in occurrence and severity of stroke, few therapeutics, both preclinically and clinically, take into account possible sex differences in treatment. Reanalysis of data from the only currently FDA-approved stroke therapy, tPA, has shown to not only improve stroke outcomes for both sexes, but to also show sexual dimorphism by more robust improvement in stroke outcome in females. Experimental evidence supports the inclusion of sex as a variable in the study of a number of novel stroke drugs and therapies, including preclinical studies of anti-inflammatory drugs (minocycline), stimulators of cell survival (IGF-1), and inhibitors of cell death pathways (pharmacological inhibition of PARP-1, NO production, and caspase activation), as well as in current clinical trials of stem cell therapy and cortical stimulation. Overall, study design and analyses in clinical trials, as well as in preclinical studies, must include both sexes equally, consider possible sex differences in the analyses, and report the differences/similarities in more systemized/structured way to translate promising therapies to both sexes and increase stroke recovery.

show abstract

Section: Stroke Therapeutics - Clinicalmentioning

confidence: 99%

Sex differences in stroke therapies

Sohrabji

Park

Mahnke

2016

J of Neuroscience Research

View full text Add to dashboard Cite

show abstract

“…Previous reports have suggested that the impact of acute stroke thrombolysis on functional outcome is stronger in women than men [1,3,4,13], which if true, would have important clinical implications, as well as impact the design of future stroke treatment trials. However, this investigation, conducted in an observational population-based stroke study using PS methods to consider the influence of confounding factors by sex, found that the association of tPA with functional outcome was not different for women and men, partly due to sex differences in the confounding roles of age and stroke severity.…”

Section: Discussionmentioning

confidence: 99%

“…First, we fitted a conventional multivariable linear regression model regressing functional outcome (ADL/IADL score) on sex, tPA treatment status, the interaction between sex and tPA treatment status, age and NIHSS (Secondary Analysis 1). This model most closely reflects the multivariable approach used to address this research question in the existing observational literature [13]. Second, to evaluate the impact of our PS model approach to control for sex-specific confounding, we compared our results to those obtained from fitting the PS model but without any interactions with sex (only the sex main effect).…”

Section: Methodsmentioning

confidence: 99%

Sex differences in the impact of acute stroke treatment in a population-based study: a sex-specific propensity score approach

Lisabeth

Baek

Morgenstern

et al. 2017

Annals of Epidemiology

View full text Add to dashboard Cite

Purpose We investigated whether sex modifies the association of acute stroke treatment on functional outcome using propensity score (PS) methods to minimize confounding and to explore the differential effects of confounders by sex. Methods We included tissue plasminogen activator (tPA) treated (n = 84) and nontreated ischemic stroke cases (n = 143) from a population-based stroke study (2008–2013). The PS model that estimated the probability of receiving tPA included interactions between sex and treatment predictors. The outcome model included sex, tPA, and their interaction. In addition, sex-specific PS values were included as a continuous covariate and modeled using splines. We compared the results with conventional methods of statistical adjustment. Results Conventional methods of adjustment suggested that women receive greater benefit from tPA than men. After taking into consideration that the influence of confounders, specifically age and stroke severity, differed by sex, we found no sex difference in the tPA-functional outcome association (P= .94). Conclusions Using PS methods that considered confounding of the sex × treatment interaction, we did not find that the association of tPA with functional outcome differed for women and men. Our findings may have implications for the methodologic approaches used to address confounding in studies that seek to compare stroke treatment effects by sex.

show abstract

“…Although men and women may have comparable outcomes after treatment with tissue plasminogen activator, if untreated, women have poorer outcomes after acute stroke than men [63,64]. Women have a higher rate of cardioembolic strokes than thrombotic and lacunar strokes, with a higher frequency of atrial fibrillation as the etiology of their ischemic strokes.…”

Section: Acute Stroke Treatment and Outcomementioning

confidence: 99%

Stroke in Women: What is Different?

Jamieson

Skliut

2010

Curr Atheroscler Rep

View full text Add to dashboard Cite

Stroke, a major cause of morbidity and mortality in the general population, varies in incidence in men and women of different age groups: more boys than girls have strokes; the incidence of stroke is greater in men in their 60s and 70s; and stroke is more common in women after age 80 years. These differences are attributed to hormonal (sex-related) changes and variable risk factors in women, as well as lifestyle and environmental (gender-related) co-morbid conditions. A woman, who is more likely to have a stroke in her lifetime than a myocardial infarction, has a different response to primary and secondary prevention as compared with a man. Although response to thrombolysis is similar, older age and more severe strokes in women lead to poorer outcomes in female stroke survivors.

show abstract

Differences in stroke outcome based on sex

Cited by 54 publications

References 24 publications

Sex differences in stroke therapies

Sex differences in stroke therapies

Sex differences in the impact of acute stroke treatment in a population-based study: a sex-specific propensity score approach

Stroke in Women: What is Different?

Contact Info

Product

Resources

About