Impact of Sex Difference on Severity and Functional Outcome in Patients with Cardioembolic Stroke
Introduction
Female sex is a risk factor for thromboembolic events in patients of the Caucasian population with nonvalvular atrial fibrillation (NVAF).1 Accordingly, recent European and American guidelines recommend the congestive heart failure, hypertension, age [>75 years], diabetes, stroke/TIA, vascular disease, age [65-74 years], sex category [female] (CHA2DS2-VASc) score for thromboembolic risk stratification in patients with NVAF, which includes female sex (Sc) as a risk factor.2, 3 In contrast, female sex is not a risk factor for thromboembolic events in Japanese patients with NVAF.4 More importantly, when cardioembolic (CE) stroke occurs in patients with NVAF, it is still uncertain whether female sex is also a significant risk factor for severe stroke and unfavorable functional outcome. In the present study, we assessed this critical issue in Japanese patients with CE stroke.
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Study Patients
Hirosaki Stroke and Rehabilitation Center (HSRC) has both a stroke care unit for acute therapy and a stroke rehabilitation unit for further rehabilitation therapy. Accordingly, all patients with acute ischemic stroke admitted to HSRC receive consistent therapies in the acute phase and subsequently in the chronic phase during hospitalization.
During a 3-year period from April 2011 to March 2014, a total of 516 consecutive patients with CE stroke were admitted to the HSRC for acute therapy within
Patient Profiles
A comparison of the clinical characteristics of the female and male patients in this study is shown in Table 1. The mean age was significantly higher in female than in male patients. All female patients were menopausal. The CHADS2 score was similar between the two groups, whereas the CHA2DS2-VASc score was significantly higher in the female than in the male patients, because this score includes female sex (1 point) as a risk factor by definition. Congestive heart failure was found more in the
Major Findings
In the present study, we found that female sex in patients with CE stroke is a significant predictor of severe stroke on admission and unfavorable functional outcome at discharge. Although female sex is not a risk factor for thromboembolic events in Japanese patients with NVAF,4 the present findings may lead to sex-specific prevention and treatment of CE stroke, especially focused on female patients.
Severe Stroke and Unfavorable Functional Outcome in Female Patients with CE Stroke
A number of studies investigating sex difference in stroke severity and functional outcomes in
Conclusions
Female sex is not a risk factor for thromboembolic events in Japanese patients with NVAF,4 but a risk factor for stroke severity and unfavorable outcome in patients with CE stroke. It is of significant interest to determine whether there is a racial difference in this discrepancy. In view of the clinical setting, more sex-specific prevention and treatment of CE stroke, especially focused on female patients, are warranted.
Acknowledgment
We gratefully thank Ms. Hiroko Kogawa for excellent technical support.
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Cited by (0)
Sources of funding: Dr. Hirofumi Tomita received research funding from Bayer HealthCare; Dr. Joji Hagii received research funding from Bayer Healthcare, and Speakers' Bureau/Honorarium from Boehringer Ingelheim, Bayer Healthcare, Bristol-Myers Squibb, and Pfizer; Dr. Norifumi Metoki received Speakers' Bureau/Honorarium from Boehringer Ingelheim, Bayer Healthcare, Bristol-Myers Squibb, and Pfizer; Dr. Minoru Yasujima received Speakers' Bureau/Honorarium from Bristol-Myers Squibb and Pfizer; Dr. Ken Okumura received research funding from Boehringer Ingelheim, Bayer Healthcare, and Daiichi-Sankyo, and Speakers' Bureau/Honorarium from Boehringer Ingelheim, Bayer Healthcare, Bristol-Myers Squibb, Pfizer, and Eisai. The other authors have no disclosure.