Do Women With Atrial Fibrillation Experience More Severe Strokes?

Lang, Clemens; Seyfang, Leonhard; Ferrari, Julia; Gattringer, Thomas; Greisenegger, Stefan; Willeit, Karin; Toell, Thomas; Krebs, Stefan; Brainin, Michael; Kiechl, Stefan; Willeit, Johann; Lang, Wilfried; Knoflach, Michael

doi:10.1161/strokeaha.116.015900

Cited by 54 publications

(41 citation statements)

References 13 publications

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“…Despite the availability of adequate therapy, AF-related strokes are still estimated to cost US$ 8 billion annually in the USA29 30 or over 9000 GBP per stroke in the UK 31. The increased severity of AF-related strokes compared with other aetiologies32 may even increase the negative effect of general embolic events on quality of life 33. As a consequence, it is urgently necessary to ameliorate adherence to OAC therapy for AF.…”

Section: Discussionmentioning

confidence: 99%

Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study

Zweiker

Winkler

et al. 2017

BMJ Open

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ObjectiveOral anticoagulation (OAC) is state-of-the-art therapy for atrial fibrillation (AF), the most common arrhythmia worldwide. However, little is known about the perception of patients with AF and how it correlates with risk scores used by their physicians. Therefore, we correlated patients’ estimates of their own stroke and bleeding risk with the objectively predicted individual risk using CHA2DS2-VASc and HAS-BLED scores.DesignCross-sectional prevalence study using convenience sampling and telephone follow-up.SettingsEight hospital departments and one general practitioner in Austria. Patients’ perception of stroke and bleeding risk was opposed to commonly used risk scoring.ParticipantsPatients with newly diagnosed AF and indication for anticoagulation.Main outcome measuresComparison of subjective risk perception with CHA2DS2-VASc and HAS-BLED scores showing possible discrepancies between subjective and objective risk estimation. Patients’ judgement of their own knowledge on AF and education were also correlated with accuracy of subjective risk appraisal.ResultsNinety-one patients (age 73±11 years, 45% female) were included in this study. Subjective stroke and bleeding risk estimation did not correlate with risk scores (ρ=0.08 and ρ=0.17). The majority of patients (57%) underestimated the individual stroke risk. Patients feared stroke more than bleeding (67% vs 10%). There was no relationship between accurate perception of stroke and bleeding risks and education level. However, we found a correlation between the patients’ judgement of their own knowledge of AF and correct assessment of individual stroke risk (ρ=0.24, p=0.02). During follow-up, patients experienced the following events: death (n=5), stroke (n=2), bleeding (n=1). OAC discontinuation rate despite indication was 3%.ConclusionsIn this cross-sectional analysis of OAC-naive patients with AF, we found major differences between patients’ perceptions and physicians’ assessments of risks and benefits of OAC. To ensure shared decision-making and informed consent, more attention should be given to evidence-based and useful communication strategies.Trial registration numberNCT03061123.

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Section: Discussionmentioning

confidence: 99%

Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study

Zweiker

Winkler

et al. 2017

BMJ Open

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“…Women exhibit lower rates of stroke at premenopausal ages than male counterparts, but higher rates of stroke later in life (19,37). Furthermore, women experience more severe strokes, as well as higher rates of disability and mortality (3); while these differences are partially attributed to the fact that women are typically older at stroke onset (37), several studies have reported these trends independently of age (13,28,40), and similar sex-associated effects have been observed in animal models (19,43).…”

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confidence: 83%

“…Biologically, the mechanisms that drive these sex differences are not yet fully understood. While it is believed that these differences are at least in part driven by the direct physiological effects of estrogen (25), the fact that several sex differences persist following menopause (13,28,40) and independently of estrogen status (15) suggests additional mechanisms that have yet to be elucidated. Better characterization of these mechanisms has the potential to provide valuable insights into the molecular mediators that modify stroke risk and influence outcome.…”

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confidence: 99%

High-throughput profiling of the circulating proteome suggests sexually dimorphic corticosteroid signaling following ischemic stroke

O’Connell

Walsh

Burrage

et al. 2018

Physiological Genomics

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Increasing evidence suggests that there are innate differences between sexes with respect to stroke pathophysiology; however, the molecular mechanisms underlying these differences remain unclear. In this investigation, we employed a shotgun approach to broadly profile sex-associated differences in the plasma proteomes of a small group of male ( n = 6) and female ( n = 4) ischemic stroke patients. Peripheral blood was sampled during the acute phase of care, and liquid chromatography electrospray ionization mass spectrometry was used to quantify plasma proteins. We observed widespread differences in plasma composition, as 77 out of 294 detected proteins were significantly differentially expressed between sexes. Corticosteroid-binding globulin (CBG), a negative acute-phase reactant that inversely regulates levels of bioactive free cortisol, was the most dramatically differentially regulated, exhibiting 16-fold higher abundance in plasma from women relative to men. Furthermore, functional annotation analysis revealed that the remaining differentially expressed proteins were significantly enriched for those involved in response to corticosteroid signaling. Plasma CBG levels were further examined in an additional group of male ( n = 19) and female ( n = 28) ischemic stroke patients, as well as a group of male ( n = 13) and female ( n = 18) neurologically normal controls. CBG levels were significantly reduced in male stroke patients relative to male controls; however, no differences were observed between female stroke patients and female controls, suggesting that women may exhibit an attenuated cortisol response to stroke. Collectively, our findings reinforce the idea that there are sex-associated differences in stroke pathophysiology and suggest that cortisol signaling should be investigated further as a potential molecular mediator.

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“…Before simple and multiple linear regression analyses, admission hematoma volume was cube root transformed for each patient to satisfy statistical assumptions about normality of distribution 20. Similarly, admission NIHSS scores were square transformed for each patient to satisfy statistical assumptions about normality of distribution 21. In all univariable analyses, a threshold of P <0.1 was used to identify candidate variables for inclusion in multiple linear regression models that tested statistical significance hypothesis with an α value of 0.05 22.…”

Section: Methodsmentioning

confidence: 99%

Serum Magnesium Levels and Outcomes in Patients With Acute Spontaneous Intracerebral Hemorrhage

Goyal

Tsivgoulis

Malhotra

et al. 2018

JAHA

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BackgroundMagnesium (Mg) has potential hemostatic properties. We sought to investigate the potential association of serum Mg levels (at baseline and at 48 hours) with outcomes in patients with acute spontaneous intracerebral hemorrhage (ICH).Methods and ResultsWe reviewed data on all patients with spontaneous ICH with available Mg levels at baseline, over a 5‐year period. Clinical and radiological outcome measures included initial hematoma volume, admission National Institutes of Health Stroke Scale and ICH scores, in‐hospital mortality, favorable functional outcome (modified Rankin Scale scores, 0–1), and functional independence (modified Rankin Scale scores, 0–2) at discharge. Our study population consisted of 299 patients with ICH (mean age, 61±13 years; mean admission serum Mg, 1.8±0.3 mg/dL). Increasing admission Mg levels strongly correlated with lower admission National Institutes of Health Stroke Scale score (Spearman's r, −0.141; P=0.015), lower ICH score (Spearman's r, −0.153; P=0.009), and lower initial hematoma volume (Spearman's r, −0.153; P=0.012). Higher admission Mg levels were documented in patients with favorable functional outcome (1.9±0.3 versus 1.8±0.3 mg/dL; P=0.025) and functional independence (1.9±0.3 versus 1.8±0.3 mg/dL; P=0.022) at discharge. No association between serum Mg levels at 48 hours and any of the outcome variables was detected. In multiple linear regression analyses, a 0.1‐mg/dL increase in admission serum Mg was independently and negatively associated with the cubed root of hematoma volume at admission (regression coefficient, −0.020; 95% confidence interval, −0.040 to −0.000; P=0.049) and admission ICH score (regression coefficient, −0.053; 95% confidence interval, −0.102 to −0.005; P=0.032).ConclusionsHigher admission Mg levels were independently related to lower admission hematoma volume and lower admission ICH score in patients with acute spontaneous ICH.

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Do Women With Atrial Fibrillation Experience More Severe Strokes?

Abstract: Women with AF do not only have an increased risk of stroke when compared with men but also experience more severe strokes.

Cited by 54 publications

References 13 publications

Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study

Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study

High-throughput profiling of the circulating proteome suggests sexually dimorphic corticosteroid signaling following ischemic stroke

Serum Magnesium Levels and Outcomes in Patients With Acute Spontaneous Intracerebral Hemorrhage

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