Sex modifies the relationship between age and neurovascular coupling in healthy adults

ContextIn‐stent restenosis (ISR) can lead to blood flow obstruction, insufficient blood supply to the brain, and may even result in serious complications such as stroke. Endothelial cell hyperproliferation and thrombosis are the primary etiologies, frequently resulting in alterations in intravascular metabolism. However, the metabolic changes related to this process are still undermined.ObjectiveWe tried to characterize the serum metabolome of patients with ISR and those with non‐restenosis (NR) using metabolomics and lipidomics, exploring the key metabolic pathways of this pathological phenomenon.ResultsWe observed that the cysteine and methionine pathways, which are associated with cell growth and oxidative homeostasis, showed the greatest increase in the ISR group compared to the NR group. Within this pathway, the levels of N‐formyl‐l‐methionine and L‐methionine significantly increased in the ISR group, along with elevated levels of downstream metabolites such as 2‐ketobutyric acid, pyruvate, and taurocholate. Additionally, an increase in phosphatidylcholine (PC) and phosphatidylserine (PS), as well as a decrease in triacylglycerol in the ISR group, indicated active lipid metabolism in these patients, which could be a significant factor contributing to the recurrence of blood clots after stent placement. Importantly, phenol sulfate and PS(38:4) were identified as potential biomarkers for distinguishing ISR, with an area under the curve of more than 0.85.ConclusionsOur study revealed significant metabolic alterations in patients with ISR, particularly in the cysteine and methionine pathways, with phenol sulfate and PS(38:4) showing promise for ISR identification.

Section: Discussioncontrasting

confidence: 80%

Alterations in metabolome and lipidome in patients with in‐stent restenosis

Xu,

Mou,

et al. 2024

“…Previous studies demonstrated that sexual dimorphism has been increasingly recognized in healthy population and patients as an important factors that might modify the response to therapies in neurovascular disorders. 19 , 20 , 21 However, the influence from sexual dimorphism was not found in the current study. On one hand, the result may be partially attributed to relatively unbalanced sample size between male and female patients in the analysis.…”

Section: Discussioncontrasting

confidence: 75%

Systolic blood pressure and early neurological deterioration in minor stroke: A post hoc analysis of ARAMIS trial

Cui,

Zhao,

Wang

et al. 2024

BackgroundSystolic blood pressure (SBP) was a predictor of early neurological deterioration (END) in stroke. We performed a secondary analysis of ARAMIS trial to investigate whether baseline SBP affects the effect of dual antiplatelet versus intravenous alteplase on END.MethodsThis post hoc analysis included patients in the as‐treated analysis set. According to SBP at admission, patients were divided into SBP ≥140 mmHg and SBP <140 mmHg subgroups. In each subgroup, patients were further classified into dual antiplatelet and intravenous alteplase treatment groups based on study drug actually received. Primary outcome was END, defined as an increase of ≥2 in the NIHSS score from baseline within 24 h. We investigated effect of dual antiplatelet vs intravenous alteplase on END in SBP subgroups and their interaction effect with subgroups.ResultsA total of 723 patients from as‐treated analysis set were included: 344 were assigned into dual antiplatelet group and 379 into intravenous alteplase group. For primary outcome, there was more treatment effect of dual antiplatelet in SBP ≥140 mmHg subgroup (adjusted RD, −5.2%; 95% CI, −8.2% to −2.3%; p < 0.001) and no effect in SBP <140 mmHg subgroup (adjusted RD, −0.1%; 95% CI, −8.0% to 7.7%; p = 0.97), but no significant interaction between subgroups was found (adjusted p = 0.20).ConclusionsAmong patients with minor nondisabling acute ischemic stroke, dual antiplatelet may be better than alteplase with respect to preventing END within 24 h when baseline SBP ≥140 mmHg.

“…Other studies showed that the effect of sexual dimorphism about age on the matching between local neuronal activity and regional cerebral blood flow only apparent in females but not males, it may be related to the loss of estrogen in postmenopausal women, which could lead to a greater decline in cerebral blood flow. 32,33 Similarly, others have found that patients with high BMI and diabetes have increased postoperative complications, 34 and that the risk of stroke was higher with vascular and neurosurgical operations. 28 Interestingly, the association of BMI > 22.64 kg/m 2 with perioperative ischemic stroke was also evident in the neurosurgical subgroup, calling for increased attention to patients in this subgroup that must undergo neurosurgery.…”

Section: Discussionmentioning

confidence: 96%

“…A previous study showed that female is associated with more than a threefold increased risk of perioperative stroke, 31 which may be related to the slower metabolism of female patients with increased BMI having, which is more likely to cause abnormal blood lipid metabolism, resulting in the weakening of the automatic regulation of cerebral blood flow. Other studies showed that the effect of sexual dimorphism about age on the matching between local neuronal activity and regional cerebral blood flow only apparent in females but not males, it may be related to the loss of estrogen in postmenopausal women, which could lead to a greater decline in cerebral blood flow 32,33 . Similarly, others have found that patients with high BMI and diabetes have increased postoperative complications, 34 and that the risk of stroke was higher with vascular and neurosurgical operations 28 .…”

Section: Discussionmentioning

confidence: 99%

High body mass index is associated with elevated risk of perioperative ischemic stroke in patients who underwent noncardiac surgery: A retrospective cohort study

Li,

Wang,

Liu

et al. 2024

BackgroundBody mass index (BMI) serves as a global metric for assessing obesity and overall health status. However, the impact of BMI, treated as a continuous variable, on the risk of perioperative stroke remains poorly understood. This retrospective cohort study aimed to elucidate the association between BMI and the risk of perioperative ischemic stroke in patients undergoing non‐cardiovascular surgery.MethodsA cohort of 223,415 patients undergoing noncardiac surgery at the First Medical Center of Chinese PLA General Hospital between January 1, 2008 and August 31, 2019 was screened. Preoperative high BMI, defined as BMI >22.64 kg/m2, was the primary exposure, and the outcome of interest was the new diagnosis of perioperative ischemic stroke within 30 days post‐surgery. Robust controls for patient and intraoperative factors were implemented to minimize residual confounding. Logistic regression and propensity score matching were employed, and patients were stratified into subgroups for further investigation.ResultsThe overall incidence of perioperative ischemic stroke was 0.23% (n = 525) in the cohort. After adjusting for patient‐related variables (OR 1.283; 95% CI, 1.04–1.594; p < 0.05), surgery‐related variables (OR 1.484; 95% CI, 1.2–1.849; p < 0.001), and all confounding variables (OR 1.279; 95% CI, 1.025–1.607; p < 0.05), patients with BMI >22.64 kg/m2 exhibited a significantly increased risk of perioperative ischemic stroke. This association persisted in the propensity score matched cohort (OR 1.577; 95% CI, 1.203–2.073; p < 0.01). Subgroup analyses indicated that preoperative BMI >22.64 kg/m2 correlated with an elevated risk of perioperative ischemic stroke in female patients, those with coronary heart disease, peripheral vascular diseases, and individuals undergoing neurosurgery.ConclusionWe first identified BMI >22.64 kg/m2 as a substantial and independent risk factor for perioperative ischemic stroke in Chinese noncardiac surgery patients. Normal BMI may not suffice as a universal preventive standard. Instead, a more stringent perioperative weight management approach is recommended, particularly for specific subgroups such as female patients, those with coronary heart disease and peripheral vascular disease, and individuals scheduled for neurosurgery.