Williams Janice E, Chimowitz Marc I, Cotsonis George A, Lynn Michael J, Waddy Salina P
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Stroke. 2007 Jul;38(7):2055-62. doi: 10.1161/STROKEAHA.107.482240. Epub 2007 May 31.
There are limited and conflicting data on gender differences in clinical outcomes among patients with symptomatic intracranial arterial stenosis. This study examined gender differences in patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study.
Participants were 569 men and women with symptomatic intracranial arterial stenosis. They were followed-up for the occurrence of ischemic stroke and the combined end point of stroke or vascular death from February 1999 through July 2003 (mean follow-up, 1.8 years).
Two-year rates of the primary end point were 28.4% and 16.6% for women and men, respectively. Cumulative probabilities of the outcomes over time were estimated by the Kaplan-Meier product-limit method and were compared between men and women with the use of the log-rank test. Cox proportional hazards regression analyses were used to estimate the hazard ratio of gender (women to men) for ischemic stroke and for the primary end point. The probabilities of ischemic stroke (P=0.005) and of the combined end point of stroke or vascular death (P=0.017) over time were significantly higher in women than men. Women had a greater multivariate-adjusted risk for ischemic stroke (HR, 1.85; 95% CI, 1.14 to 3.01; P=0.013) and for the combined end point of stroke or vascular death (HR, 1.58; 95% CI, 1.01 to 2.48; P=0.045).
Women with symptomatic intracranial arterial stenosis are at significantly greater risk for ischemic stroke and for the combined end point of stroke or vascular death. These findings suggest the need for vigorous screening of risk factors and for aggressive management of risk factors and stroke in women. They also suggest the need to ensure adequate numbers of women in clinical trials designed to explore new and promising therapies for intracranial arterial stenosis.
关于有症状的颅内动脉狭窄患者临床结局的性别差异，现有数据有限且相互矛盾。本研究调查了参与华法林 - 阿司匹林治疗有症状颅内疾病（WASID）研究的患者的性别差异。
参与者为569例有症状的颅内动脉狭窄的男性和女性。从1999年2月至2003年7月对他们进行随访，观察缺血性卒中的发生情况以及卒中或血管性死亡的复合终点（平均随访时间为1.8年）。
女性和男性的主要终点两年发生率分别为28.4%和16.6%。采用Kaplan - Meier乘积限法估计结局随时间的累积概率，并使用对数秩检验比较男性和女性之间的差异。采用Cox比例风险回归分析来估计缺血性卒中和主要终点的性别风险比（女性与男性）。随着时间推移，女性发生缺血性卒中的概率（P = 0.005）和卒中或血管性死亡复合终点的概率（P = 0.017）显著高于男性。女性发生缺血性卒中的多因素调整风险更高（HR，1.85；95%CI，1.14至3.01；P = 0.013），发生卒中或血管性死亡复合终点的风险也更高（HR，1.58；95%CI，1.01至2.48；P = 0.045）。
有症状的颅内动脉狭窄女性发生缺血性卒中和卒中或血管性死亡复合终点的风险显著更高。这些发现表明需要积极筛查危险因素，并对女性的危险因素和卒中进行积极管理。它们还表明在旨在探索颅内动脉狭窄新的和有前景疗法的临床试验中，需要确保有足够数量的女性参与。
