Etiology, Risk Factors and Sex Differences in Ischemic Stroke in the Ludwigshafen Stroke Study, a Population-Based Stroke Registry

Abstract

Background: Stroke etiology in ischemic stroke guides preventive measures and etiological stroke subgroups may show considerable differences between both sexes. In a population-based stroke registry we analyzed etiological subgroups of ischemic stroke and calculated sex-specific incidence and mortality rates. Methods: The Ludwigshafen Stroke Study is a prospective ongoing population-based stroke registry. Multiple overlapping methods of case ascertainment were used to identify all patients with incident stroke or transient ischemic attack. Modified TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria were applied for subgroup analysis in ischemic stroke. Results: Out of 626 patients with first-ever ischemic stroke in 2006 and 2007, women (n = 327) were older (73.5 ± 12.6 years) than men (n = 299; 69.7 ± 11.5 years; p < 0.001). The age-adjusted incidence rate of ischemic stroke was significantly higher in men (1.37; 95% CI 1.20–1.56) than in women (1.12; 95% CI 0.97–1.29; p = 0.04). Cardioembolism (n = 219; 35.0%), small-artery occlusion (n = 164; 26.2%), large-artery atherosclerosis (n = 98; 15.7%) and ‘probable atherothrombotic stroke’ (n = 84; 13.4%) were common subgroups of ischemic stroke. Stroke due to large-artery atherosclerosis (p = 0.025), current smoking (p = 0.008), history of smoking (p < 0.001), coronary artery disease (p = 0.0015) and peripheral artery disease (p = 0.024) was significantly more common in men than in women. Overall, 1-year survival was not different between both sexes; however, a significant age-sex interaction with higher mortality in elderly women (>85 years) was detected. Conclusions: Cardioembolism is the main source for ischemic stroke in our population. Etiology of ischemic stroke differs between sexes, with large-artery atherosclerotic stroke and associated diseases (coronary artery disease and peripheral artery disease) being more common in men.

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“…The aetiology of stroke is influenced by sex, race and age, as well as by cultural and geographic factors 1, 2, 3, 4, 5, 6. Stroke subtypes are commonly categorized as large‐artery atherosclerosis (LAA), cardioembolism (CE), small‐vessel occlusion (SVO), stroke of other determined cause (SOC) and stroke of undetermined cause (SUC) (TOAST criteria) 7.…”

Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study

“…The age-adjusted incidence of CE stroke ranges from 17 to 40 per 100,000 person-years 4,5 . As the prevalence of AF increases, due partly to the aging population 6 , we would expect more AF-related CE strokes in the future 7 .…”

Atrial fibrillation in patients with ischaemic stroke: clinical characteristics and in-hospital outcomes. A pilot study

“…German Ludwigshafen Stroke Study evaluated 1,231 patients hospitalized due to ischaemic stroke or transient ischaemic attack (TIA). AF was newly detected in 36% of these patients [12]. In our study, all patients had resting ECG recorded on admission, and most patients underwent Holter monitoring.…”

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