Sex-Related Differences in Clinical Features, Neuroimaging, and Long-Term Prognosis After Transient Ischemic Attack.

Adult Aged Aged, 80 and over Cohort Studies Female Humans Ischemic Attack, Transient / diagnostic imaging Male Middle Aged Neuroimaging Prognosis Prospective Studies Recurrence Risk Factors Sex Characteristics Stroke / epidemiology
atherosclerosis incidence ischemic attack, transient prognosis risk factors

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
01 2021
Historique:
entrez: 25 1 2021
pubmed: 26 1 2021
medline: 15 12 2021
Statut: ppublish

Résumé

Differences in sex in the incidence, presentation, and outcome of events after ischemic stroke have been studied in depth. In contrast, only limited data are available after transient ischemic attack (TIA). We aim to assess sex-related differences in the presentation, cause, neuroimaging features, and predictors of long-term prognosis in patients with TIA. We carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. Nondefinitive TIA events were defined by the presence of isolated atypical symptoms. The risk of stroke recurrence (SR) and composite of major vascular events were stratified by sex after a median follow-up time of 6.5 (interquartile range, 5.0-9.6) years. Among the 723 patients studied, 302 (41.8%) were female and 79 (10.9%) suffered a nondefinitive TIA event. Vascular territory diffusion-weighted imaging patterns (odds ratio, 1.61 [95% CI, 0.94-2.77]), and nondefinitive TIA events (odds ratio, 2.66 [95% CI, 1.55-4.59]) were associated with women, whereas active smoking (odds ratio, 0.30 [95% CI, 0.15-0.58]) and large artery atherosclerosis causes (odds ratio, 0.50 [95% CI, 0.29-0.83]) were related to men. The risk of SR was similar in both sexes (12.6% [95% CI, 8.9-16.3] for women versus 14.3% [95% CI, 11.0-17.6] for men). In contrast, the risk of major vascular events was significantly lower in women than in men (17.5% [95% CI, 13.2-21.8] versus 23.8% [95% CI, 19.7-27.9]). In both sexes, after adjusting for age, large artery atherosclerosis was associated with SR (hazard ratio, 3.22 [95% CI, 1.42-7.24] and hazard ratio, 2.00 [95% CI, 1.14-3.51]). In a Kaplan-Meier analysis, females with positive diffusion-weighted imaging ( Despite similar risks of SR, there were sex-related differences in baseline characteristics, presenting symptoms, patterns of acute ischemic lesions, cause, and outcomes. These findings encourage further research into optimal preventive strategies that take into account these differences.

Sections du résumé

BACKGROUND AND PURPOSE
Differences in sex in the incidence, presentation, and outcome of events after ischemic stroke have been studied in depth. In contrast, only limited data are available after transient ischemic attack (TIA). We aim to assess sex-related differences in the presentation, cause, neuroimaging features, and predictors of long-term prognosis in patients with TIA.
METHODS
We carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. Nondefinitive TIA events were defined by the presence of isolated atypical symptoms. The risk of stroke recurrence (SR) and composite of major vascular events were stratified by sex after a median follow-up time of 6.5 (interquartile range, 5.0-9.6) years.
RESULTS
Among the 723 patients studied, 302 (41.8%) were female and 79 (10.9%) suffered a nondefinitive TIA event. Vascular territory diffusion-weighted imaging patterns (odds ratio, 1.61 [95% CI, 0.94-2.77]), and nondefinitive TIA events (odds ratio, 2.66 [95% CI, 1.55-4.59]) were associated with women, whereas active smoking (odds ratio, 0.30 [95% CI, 0.15-0.58]) and large artery atherosclerosis causes (odds ratio, 0.50 [95% CI, 0.29-0.83]) were related to men. The risk of SR was similar in both sexes (12.6% [95% CI, 8.9-16.3] for women versus 14.3% [95% CI, 11.0-17.6] for men). In contrast, the risk of major vascular events was significantly lower in women than in men (17.5% [95% CI, 13.2-21.8] versus 23.8% [95% CI, 19.7-27.9]). In both sexes, after adjusting for age, large artery atherosclerosis was associated with SR (hazard ratio, 3.22 [95% CI, 1.42-7.24] and hazard ratio, 2.00 [95% CI, 1.14-3.51]). In a Kaplan-Meier analysis, females with positive diffusion-weighted imaging (
CONCLUSIONS
Despite similar risks of SR, there were sex-related differences in baseline characteristics, presenting symptoms, patterns of acute ischemic lesions, cause, and outcomes. These findings encourage further research into optimal preventive strategies that take into account these differences.

Identifiants

DOI: 10.1161/STROKEAHA.120.032814 PMID: 33493055 PMC: PMC7834662
pubmed: 33493055
doi: 10.1161/STROKEAHA.120.032814
pmc: PMC7834662
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

424-433

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Auteurs

Francisco Purroy (F)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Mikel Vicente-Pascual (M)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Gloria Arque (G)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Mariona Baraldes-Rovira (M)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Robert Begue (R)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Yhovany Gallego (Y)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

M Isabel Gil (MI)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

M Pilar Gil-Villar (MP)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Gerard Mauri (G)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Alejandro Quilez (A)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Jordi Sanahuja (J)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

Daniel Vazquez-Justes (D)

Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.).

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sex-Related Differences in Clinical Features,...
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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Sex-Related Differences in Clinical Features,...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Sex-Related Differences in Clinical Features,...
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