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First-Ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93 627 Older Women and Men.
Stroke ( IF 7.8 ) Pub Date : 2020-01-09 , DOI: 10.1161/strokeaha.119.028066
Luciano A Sposato 1, 2, 3, 4, 5 , Melody Lam 6 , Britney Allen 6 , Salimah Z Shariff 6, 7 , Gustavo Saposnik 8, 9, 10, 11 ,
Affiliation  

Background and Purpose- Stroke risk is sex-specific, but little is known about sex differences of poststroke major adverse cardiovascular events (MACEs). Stroke-related brain damage causes autonomic dysfunction and inflammation, sometimes resulting in cardiac complications. Sex-specific cardiovascular susceptibility to stroke without the confounding effect of preexisting heart disease constitutes an unexplored field because previous studies focusing on sex differences in poststroke MACE have not excluded patients with known cardiovascular comorbidities. We therefore investigated sex-specific risks of incident MACE in a heart disease-free population-based cohort of patients with first-ever ischemic stroke and propensity-matched individuals without stroke. Methods- We included Ontario residents ≥66 years, without known cardiovascular comorbidities, with first-ever ischemic stroke between 2002 and 2012 and propensity-matched individuals without stroke. We investigated the 1-year risk of incident MACE (acute coronary syndrome, myocardial infarction, incident coronary artery disease, coronary revascularization procedures, incident heart failure, or cardiovascular death) separately for females and males. For estimating cause-specific adjusted hazard ratios, we adjusted Cox models for variables with weighted standardized differences >0.10 or those known to influence MACE risk. Results- We included 93 627 subjects without known cardiovascular comorbidities; 21 931 with first-ever ischemic stroke and 71 696 propensity-matched subjects without stroke. Groups were well-balanced on propensity-matching variables. There were 53 476 women (12 421 with and 41 055 without ischemic stroke) and 40 151 men (9510 with and 30 641 without ischemic stroke). First-ever ischemic stroke was associated with increased risk of incident MACE in both sexes. The risk was time-dependent, highest within 30 days (women: adjusted hazard ratio, 25.1 [95% CI, 19.3-32.6]; men: aHR, 23.4 [95% CI, 17.2-31.9]) and decreasing but remaining significant between 31 and 90 days (women: aHR, 4.8 [95% CI, 3.8-6.0]; men: aHR, 4.2 [95% CI, 3.3-5.4]), and 91 to 365 days (aHR, 2.1 [95% CI, 1.8-2.3]; men: aHR, 2.0 [95% CI, 1.7-2.3]). Conclusions- In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE in both sexes.

中文翻译:

93 627名老年妇女中的首次缺血性中风和突发心血管事件。

背景和目的-中风风险是针对性别的,但对中风后主要不良心血管事件(MACE)的性别差异知之甚少。中风相关的脑损伤会导致植物神经功能紊乱和炎症,有时会导致心脏并发症。没有先前存在的心脏病的混杂效应的对中风的性别特异性心血管易感性构成了一个尚未开发的领域,因为先前针对卒中后MACE性别差异的研究并未排除患有已知心血管合并症的患者。因此,我们研究了有史以来首次缺血性卒中和无卒中倾向匹配人群的无心脏病人群队列研究中发生MACE的性别特异性风险。方法-我们纳入了≥66岁的安大略省居民,没有已知的心血管合并症,在2002年至2012年间首次发生缺血性中风,并且倾向匹配的人群中无中风。我们分别调查了男性和女性发生MACE的1年风险(急性冠状动脉综合征,心肌梗塞,冠状动脉疾病,冠状动脉血运重建手术,事件性心力衰竭或心血管死亡)。为了估计特定原因的调整后的危险比,我们针对加权标准差> 0.10或已知会影响MACE风险的变量调整了Cox模型。结果-我们纳入了93627名无已知心血管合并症的受试者;首次发生缺血性卒中的患者为21 931,没有卒中的倾向匹配受试者为71 696。各组在倾向匹配变量上保持平衡。有53 476名女性(无缺血性卒中的12 421名和41 055名)和40 151名男性(无缺血性卒中的9510名和30 641名)。首次缺血性卒中与男女发生MACE的风险增加有关。风险是随时间变化的,在30天内最高(女性:调整后的危险比,25.1 [95%CI,19.3-32.6];男性:aHR,23.4 [95%CI,17.2-31.9]),但在降低之间保持显着性31和90天(女性:aHR,4.8 [95%CI,3.8-5.4];男性:aHR,4.2 [95%CI,3.3-5.4])和91至365天(aHR,2.1 [95%CI, 1.8-2.3];男性:aHR,2.0 [95%CI,1.7-2.3]。结论:在这项基于人群的大型研究中,缺血性中风与男女发生MACE的风险增加独立相关。首次缺血性卒中与男女发生MACE的风险增加有关。风险是随时间变化的,在30天内最高(女性:调整后的危险比,25.1 [95%CI,19.3-32.6];男性:aHR,23.4 [95%CI,17.2-31.9]),但在降低之间保持显着性31和90天(女性:aHR,4.8 [95%CI,3.8-5.4];男性:aHR,4.2 [95%CI,3.3-5.4])和91至365天(aHR,2.1 [95%CI, 1.8-2.3];男性:aHR,2.0 [95%CI,1.7-2.3]。结论:在这项基于人群的大型研究中,缺血性中风与男女发生MACE的风险增加独立相关。首次缺血性卒中与男女发生MACE的风险增加有关。风险是随时间变化的,在30天内最高(女性:调整后的危险比,25.1 [95%CI,19.3-32.6];男性:aHR,23.4 [95%CI,17.2-31.9]),但在降低之间保持显着性31和90天(女性:aHR,4.8 [95%CI,3.8-5.4];男性:aHR,4.2 [95%CI,3.3-5.4])和91至365天(aHR,2.1 [95%CI, 1.8-2.3];男性:aHR,2.0 [95%CI,1.7-2.3]。结论:在这项基于人群的大型研究中,缺血性中风与男女发生MACE的风险增加独立相关。3.8-6.0];男性:aHR,4.2 [95%CI,3.3-5.4])和91至365天(aHR,2.1 [95%CI,1.8-2.3];男性:aHR,2.0 [95%CI,1.7-2.3]) 。结论:在这项基于人群的大型研究中,缺血性中风与男女发生MACE的风险增加独立相关。3.8-6.0];男性:aHR,4.2 [95%CI,3.3-5.4])和91至365天(aHR,2.1 [95%CI,1.8-2.3];男性:aHR,2.0 [95%CI,1.7-2.3]) 。结论:在这项基于人群的大型研究中,缺血性中风与男女发生MACE的风险增加独立相关。
更新日期:2020-01-29
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