Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

 

But this isn't about how much sex you need to have to prevent recurrent stroke, SO WHAT THE FUCK GOOD IS THIS?

Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

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Elora Basu, Setareh Salehi Omran, Hooman Kamel, ...

First Published November 9, 2021 Research Article 

https://doi.org/10.1177/23969873211058568

Article information

Abstract

Background

Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial.

Patients and methods

We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence.

Results

Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%–6.85%) compared to men (5.67%; 95% CI, 4.83%–6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80–1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42–1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk.

Discussion and Conclusion

Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.

Keywords

stroke/cerebrovascular disease, risk factors, epidemiology, sex/gender

Introduction

One in four strokes in the US is a recurrent stroke, and approximately 13% of patients with minor stroke/transient ischemic attack (TIA) face recurrent stroke, heart attack, or cardiovascular death within 5 years.^1,2 Sex differences in stroke outcomes have been noted, including both post-stroke mortality and patient-reported outcomes.^3,4 Further, several sex-specific stroke risk factors have been identified, such as migraine and oral contraceptive use for women and substance use for men.^5–9 Some conventional stroke risk factors, including hypertension, diabetes, and metabolic syndrome, may also have a stronger association with incident stroke risk in women than in men.^6,9,10 Whether these differences impact stroke recurrence risk has not been definitively assessed. Prior studies, which included a large proportion of stroke mimics¹¹ or used non-adjudicated administrative claims data,^12,13 did not find clear evidence of a sex difference in stroke recurrence.

Several challenges exist in studying sex differences and recurrent stroke risk using observational data. For example, women are less likely to be diagnosed with stroke despite presenting with similar symptoms as men.¹¹ Additionally, recurrent stroke is often early,^2,14 and early recurrent strokes can be misclassified as worsening stroke symptoms rather than new events. To circumvent these challenges, we studied sex differences in stroke recurrence using adjudicated clinical trial data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, in which substantial efforts were made to capture early stroke recurrence.¹⁵ First, we examined sex differences in recurrent ischemic stroke rates after minor stroke or TIA. Second, we evaluated sex differences in the strength of the association between common conventional stroke risk factors and recurrence.

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