Skip to main content
SpringerLink
Log in

Risk Factors for the Development of the Ischemic Stroke in the Carotid Arterial System in Males and Females

  • Published:
Human Physiology Aims and scope Submit manuscript

Abstract

Introduction: Biologically determined differences between males and females and different levels of sex hormones determine some specific features of their ischemic stroke (IS). Clinical studies aimed at identifying risk factors for the development of IS in persons of different sexes are considered to be necessary for elaborating strategies to increase life expectancy and to improve quality of life. Objective: to study risk factors for the development of IS in the arteries of the carotid system in males and females. Materials and methods: Risk factors for the development of IS in the arteries of the carotid system were analyzed in 268 patients for the period from 2010 to 2017. Among the patients, there were 148 (55%) men and 120 (45%) women aged from 47 to 79 years. MRI of the brain, duplex scanning of the cerebral arteries, and transthoracic and transesophageal echocardiography were used to establish the diagnosis of the stroke subtype. Results: In the age group 47–79 years, females had more often cardioembolic and lacunar stroke, while males had predominantly atherothrombotic stroke and stroke with competing causes. Atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease and excess body weight were also more common in females. In contrast, there were significantly more smokers and over-consumption of alcohol among males, and the same was true for small heart attacks and transient symptoms in the past history. Atherosclerosis of the extracranial part of the internal carotid artery (ICA) ofhigh degree was found more often in males, while females with atherothrombotic stroke had significantly higher blood cholesterol level. The study of arterial hypertension (AH) revealed the following differences between groups: AH III degree (180/110 mmHg or higher) was more often in females, and AH I degree (140–159/90–99 mmHg) in males, while the proportion of patients with grade II AH (160–179/100–109 mmHg) and patients without AH was approximately equal in the two groups. Conclusions: The risk factors for the development of IS in the arteries of the carotid system in men are atherosclerotic carotid stenosis, smoking and excessive alcohol consumption. Development of stroke in men is preceded by small infarcts with transient symptoms. The risk factors for the development of IS in the arteries of the carotid system in women are atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease, and excess body weight. As in men, despite significantly lower cholesterol levels, there are more pronounced atherosclerotic carotid stenosis and more frequent atherothombotic strokes, one may suggest the existence of an additional factor leading to stroke (alternatively, women may have some gender-specific protective factor).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

REFERENCES

  1. Reeves, M.J., Bushnell, C.D., Howard, G., et al., Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes, Lancet Neurol., 2008, vol. 7, pp. 915–926. https://doi.org/10.1016/S1474-4422(08)70193-5

    Article  PubMed  PubMed Central  Google Scholar 

  2. Appelros, P., Stegmayr, B., and Terént, A., Sex differences in stroke epidemiology: a systematic review, Stroke, 2009, vol. 40, pp. 1082–1090. https://doi.org/10.1161/STROKEAHA.108.540781

    Article  PubMed  Google Scholar 

  3. Suslina, Z.A., Gulevskaya, T.S., Maksimova, M.Yu., et al., Narusheniya mozgovogo krovoobrashcheniya: diagnostika, lechenie, profilaktika (Cerebral Discirculation: Diagnosis, Treatment, and Prevention), Moscow: MEDpress-Inform, 2016.

  4. Maksimova, M.Yu., Moskvicheva, A.S., and Chechetkin, A.O., The change in adrogenic status in men with atherothrombotic stroke, Ann. Klin. Eksp. Nevrol., 2017, no. 11 (3), pp. 29–35. https://doi.org/10.18454/ACEN.2017.3.4

  5. Wang, Y., Rudd, A.G., and Wolfe, C.D., Age and ethnic disparities in incidence of stroke over time: the South London stroke register, Stroke, 2013, vol. 44, no. 12, pp. 3298–3304. https://doi.org/10.1161/STROKEAHA.113.002604

    Article  PubMed  Google Scholar 

  6. The concept of development of the health care system in the Russian Federation until 2020. http://www.zdravo2020.ru.

  7. Shal’nova, S.A., Balanova, Yu.A., Konstantinov, V.V., et al., Arterial hypertension: prevalence, awareness, intake of antihypertensive drugs and the effectiveness of treatment among the population of the Russian Federation, Ross. Kardiol. Zh., 2006, no. 4, pp. 45–50.

  8. Krause, D.N., Duckles, S.P., and Pelligrino, D.A., Influence of sex steroid hormones on cerebrovascular function, J. Appl. Physiol., 2006, vol. 101, no. 4, pp. 1252–1261. https://doi.org/10.1152/japplphysiol.01095.2005

    Article  CAS  PubMed  Google Scholar 

  9. Pappa, T., Vemmos, K., Mantzou, E., et al., Estradiol levels predict short-term adverse health outcomes in postmenopausal acute stroke women, Eur. J. Neurol., 2012, vol. 19, no. 10, pp. 1300–1304. https://doi.org/10.1111/j.1468-1331.2012.03714.x

    Article  CAS  PubMed  Google Scholar 

  10. dos Santos, R.L., da Silva, F.B., Ribeiro, R.F., Jr., et al., Sex hormones in the cardiovascular system, Horm. Mol. Biol. Clin. Invest., 2014, vol. 18, no. 2, pp. 89–103. https://doi.org/10.1515/hmbci-2013-0048

    Article  CAS  Google Scholar 

  11. Ostchega, Y., Dillon, C.F., Hughes, J.P., et al., Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004, J. Am. Geriatr. Soc., 2007, vol. 55, no. 7, pp. 1056–1065.

    Article  Google Scholar 

  12. Holmegard, H.N., Nordestgaard, B.G., Jensen, G.B., et al., Sex hormones and ischemic stroke: a prospective cohort study and meta-analyses, J. Clin. Endocrinol. Metab., 2016, vol. 101, no. 1, pp. 69–78. https://doi.org/10.1210/jc.2015-2687

    Article  CAS  PubMed  Google Scholar 

  13. Svartberg, J., Jenssen, T., Sundsfjord, J., et al., The associations of endogenous testosterone and sex hormone-binding globulin with glycosylated hemoglobin levels, in community dwelling men. The Tromsø Study, Diabetes Metab., 2004, vol. 30, no. 1, pp. 29–34.

    Article  CAS  Google Scholar 

  14. Yeap, B.B., Hyde, Z., Almeida, O.P., et al., Lower testosterone levels predict incident stroke and transient ischemic attack in older men, J. Clin. Endocrinol. Metab., 2009, vol. 94, no. 7, pp. 2353–2359. https://doi.org/10.1210/jc.2008-2416

    Article  CAS  PubMed  Google Scholar 

  15. Kim, C., Cushman, M., Kleindorfer, D., et al., A review of the relationships between endogenous sex steroids and incident ischemic stroke and coronary heart disease events, Curr. Cardiol. Rev., 2015, vol. 11, no. 3, pp. 252–260.

    Article  CAS  Google Scholar 

  16. Kolovou, G.D., Kolovou, V., Kostakou, P.M., and Mavrogeni, S., Body mass index, lipid metabolism and estrogens: their impact on coronary heart disease, Curr. Med. Chem., 2014, vol. 21, no. 30, pp. 3455–3465.

    Article  CAS  Google Scholar 

  17. Petitti, D.B., Hormones and stroke prevention, in Stroke Prevention, Oxford, 2001, pp. 137–157.

  18. Angerer, P., Störk, S., Kothny, W., et al., Effect of oral postmenopausal hormone replacement on progression of atherosclerosis: a randomized, controlled trial, Arterioscler., Thromb., Vasc. Biol., 2001, vol. 21, no. 2, pp. 262–268.

    Article  CAS  Google Scholar 

  19. Dedov, I.I., Endokrinologiya: rukovodstvo dlya vrachei (Endocrinology: Guide for Physicians), Moscow: GEOTAR-Media, 2008.

  20. Sosudistye zabolevaniya i metabolicheskii sindrom: Rukovodstvo dlya vrachei (Cerebrovascular Diseases and Metabolic Syndrome: Guide for Physicians), Tan-ashyan, M.M., Ed., Moscow: AST 345, 2017.

  21. Kurth, T., Gaziano, J.M., Berger, K., et al., Body mass index and the risk of stroke in men, Arch. Int. Med., 2002, vol. 162, no. 22, pp. 2557–2562.

    Article  Google Scholar 

  22. Kurth, T., Gaziano, J.M., Rexrode, K.M., et al., Prospective study of body mass index and risk of stroke in apparently healthy women, Circulation, 2005, vol. 111, no. 15, pp. 1992–1998. https://doi.org/10.1161/01.CIR.0000161822.83163.B6

    Article  PubMed  Google Scholar 

  23. Hu, G., Tuomilehto, J., Silventoinen, K., et al., Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke, Arch. Int. Med., 2007, vol. 167, no. 13, pp. 1420–1427. https://doi.org/10.1001/archinte.167.13.1420

    Article  Google Scholar 

  24. Gambacciani, M., Ciaponi, M., Cappagli, B., et al., Prospective evaluation of body weight and body fat distribution in early postmenopausal women with and without hormonal replacement therapy, Maturitas, 2001, vol. 39, no. 2, pp. 125–132.

    Article  CAS  Google Scholar 

  25. Hjortland, M.C., McNamara, P.M., and Kannel, W.B., Some atherogenic concomitants of menopause: the Framingham study, Am. J. Epidemiol., 1976, vol. 103, no. 3, pp. 304–311.

    Article  CAS  Google Scholar 

  26. Stevenson, J., A woman’s journey through the reproductive, transitional and postmenopausal periods of life: impact on cardiovascular and musculo-skeletal risk and the role of estrogen replacement, Maturitas, 2011, vol. 70, no. 2, pp. 197–205. https://doi.org/10.1016/j.maturitas.2011.05.017

    Article  PubMed  Google Scholar 

  27. Bushnell, C.D., Stroke and the female brain, Nat. Clin. Pract. Neurol., 2008, vol. 4, no. 1, pp. 22–33. https://doi.org/10.1038/ncpneuro0686

    Article  Google Scholar 

  28. Lisabeth, L. and Bushnell, C., Stroke risk in women: the role of menopause and hormone therapy, Lancet Neurol., 2012, vol. 11, no. 1, pp. 82–91. https://doi.org/10.1016/S1474-4422(11)70269-1

    Article  PubMed  PubMed Central  Google Scholar 

  29. Haast, R.A., Gustafson, D.R., and Kiliaan, A.J., Sex differences in stroke, J. Cereb. Blood Flow Metab., 2012, vol. 32, no. 12, pp. 2100–2107. https://doi.org/10.1038/jcbfm.2012.141

    Article  PubMed  PubMed Central  Google Scholar 

  30. Aronov, D.M., Arabidze, G.G., Akhmedzhanov, N.M., et al., Russian recommendations, revision V, Ross. Kradiol. Zh., 2012, no. 5 (97), pp. 1–32.

  31. Shabalina, A.A., Hemostasis and biochemical markers of brain tissue damage in atherothrombotic and lacunar subtypes of ischemic stroke, Extended Abstract of Cand. Sci. (Med.) Dissertation, Moscow: Res. Center Neurol., 2009.

Download references

Author information

Authors and Affiliations

  1. Research Center of Neurology, 125367, Moscow, Russia

    M. Yu. Maksimova, A. S. Moskvicheva & A. O. Chechetkin

Authors
  1. M. Yu. Maksimova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. S. Moskvicheva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. O. Chechetkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Yu. Maksimova.

Ethics declarations

Conflict of interests. The authors declare there is no conflict of interest.

Statement of compliance with standards of research involving humans as subjects. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maksimova, M.Y., Moskvicheva, A.S. & Chechetkin, A.O. Risk Factors for the Development of the Ischemic Stroke in the Carotid Arterial System in Males and Females. Hum Physiol 45, 821–826 (2019). https://doi.org/10.1134/S0362119719080061

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1134/S0362119719080061

Keywords:

Search

Navigation