Basu Elora, Salehi Omran Setareh, Kamel Hooman, Parikh Neal S
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
Department of Neurology, University of Colorado, Aurora, CO, USA.
Eur Stroke J. 2021 Dec;6(4):367-373. doi: 10.1177/23969873211058568. Epub 2021 Nov 9.
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.
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.
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.
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.
中风结局存在性别差异，但这种差异是否延伸至中风复发尚不清楚。我们利用血小板导向性抑制新发短暂性脑缺血发作和轻度缺血性中风（POINT）试验的数据，研究了复发性中风中的性别差异。
我们使用POINT试验的数据评估了女性与男性相比复发性中风的风险。年龄大于18岁的成年人在轻度缺血性中风或短暂性脑缺血发作（TIA）发作后12小时内被随机分组，并随访长达90天以观察缺血性中风，这是我们的主要结局。我们使用经人口统计学和中风危险因素调整的Cox比例风险模型来评估性别与中风复发之间的关联。我们使用交互项检验和预先设定的亚组分析来确定性别与复发性中风之间的关联在年龄（<60岁与>60岁）、地区（美国与非美国）以及索引事件类型（中风与TIA）方面是否存在差异。最后，我们评估了性别是否改变了常见中风危险因素对中风复发的影响。
在4881名患有轻度中风或高危TIA的POINT试验参与者中，2195名（45%）为女性。在90天的随访期内，发生了267例缺血性中风；女性121例，男性146例。与男性（5.67%；95%置信区间，4.83%-6.63%）相比，女性复发性缺血性中风的累积风险无显著差异（5.76%；95%置信区间，4.84%-6.85%）。在未调整模型或调整协变量后，女性与男性相比复发性缺血性中风的风险无差异（风险比[HR]，1.02；95%置信区间，0.80-1.30）。然而，年龄与性别存在显著交互作用（P=0.04）。在<60岁的患者中，女性与男性相比复发性中风的风险略低，但无统计学意义（HR 0.66；95%置信区间0.42-1.05）。最后，性别并未改变常见中风危险因素与复发性中风风险之间的关联。
在患有轻度中风或TIA的患者中，男性和女性复发性缺血性中风的风险以及常见中风危险因素的影响并无差异。
