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Gender and thrombolysis therapy in acute ischemic stroke patients with incidence of obesity

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Abstract

Objective

To investigate clinical risk factors that were associated with gender differences in thrombolysis therapy in stroke patients with incidence of obesity.

Method

Retrospective data of obese acute ischemic stroke patients were extracted from a stroke registry between January 2010 and June 2016. Gender differences in exclusion from rtPA or thrombolysis therapy were determined following an adjustment for differences in demographics, clinical risk factors using multiple regression analysis. Significant interactions between variables in the regression models were determined using variance inflation factors.

Results

A total of 1105 obese stroke patients were admitted, 549 were excluded from rtPA of which 51.7% were males and 48.3% were females. Among obese male stroke patients, age > 80 years (OR = 1.029, 95% CI, 1.005–1.054, P = 0.016), a history of peripheral vascular disease (OR = 3.008, 95% CI, 0.989–9.153, P = 0.052), and an elevated diastolic blood pressure (OR = 1.018, 95% CI, 1.001–1.035, P = 0.038) were associated with exclusion from rtPA therapy. In obese female stroke patients, coronary artery disease was associated with exclusion from rtPA (OR = 2.478, 95% CI, 1.270–4.836, P = 0.008) while antihypertensive therapy was associated with inclusion for rtPA (OR = 0.326, 95% CI, 0.139–0.764).

Conclusion

Elderly obese male stroke patients with elevated diastolic blood pressure, history of peripheral vascular disease, and obese female stroke patients with a history of coronary artery disease were more likely to be excluded from rtPA.

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References

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 307:491–497

    Article  PubMed  Google Scholar 

  2. Flegal KM, Graubard BI, Williamson DF, Gail MH (2007) Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 298:2028–2037

    Article  CAS  PubMed  Google Scholar 

  3. Dorner TE, Rieder A (2012) Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol 155:56–65

    Article  PubMed  Google Scholar 

  4. Fredwall M, Sternberg S, Blackhurst D, Lee A, Leacock R, Nathaniel TI (2016) Gender differences in exclusion criteria for recombinant tissue-type plasminogen activator. J Stroke Cerebrovasc Dis 25:2569–2574

    Article  PubMed  Google Scholar 

  5. Gargano JW, Wehner S, Reeves M (2008) Sex differences in acute stroke care in a statewide stroke registry. Stroke 39:24–29

    Article  PubMed  Google Scholar 

  6. Li B, Wang T, Lou YZ, Guo XF, Gu HF, Zhu YX et al (2015) Sex differences in outcomes and associated risk factors after acute ischemic stroke in elderly patients: a prospective follow-up study. J Stroke Cerebrovasc Dis 24:2277–2284

    Article  PubMed  Google Scholar 

  7. Michel P, Odier C, Rutgers M, Reichhart M, Maeder P, Meuli R et al (2010) The acute stroke registry and analysis of Lausanne (ASTRAL) design and baseline analysis of an ischemic stroke registry including acute multimodal imaging. Stroke 41:2491–2498

    Article  PubMed  Google Scholar 

  8. Di Carlo A, Lamassa M, Consoli D, Valentia V, Inzitari D (2010) Sex differences in presentation, severity, and management of stroke in a population-based study. Neurology 75:670–671

    Article  PubMed  Google Scholar 

  9. Gainey J, Brechtel L, Konklin S, Madeline L, Lowther E, Blum B et al (2018) In a stroke cohort with incident hypertension; are more women than men likely to be excluded from recombinant tissue-type plasminogen activator (rtPA)? J Neurol Sci 387:139–146

    Article  PubMed  Google Scholar 

  10. Gibson CL (2013) Cerebral ischemic stroke: is gender important? J Cereb Blood Flow Metab 33:1355–1361

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rao ZZ, Gu HQ, Li ZX, Wang YL, Wang YJ (2018) Disparities in outcomes among inpatient stroke in women associated with rural-urban insurance status in China. Stroke 49

  12. Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G et al (2008) Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 7:915–926

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mitchell AB, Cole JW, McArdle PF, Cheng YC, Ryan KA, Sparks MJ et al (2015) Obesity increases risk of ischemic stroke in young adults. Stroke 46:1690–1692

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wang HJ, Si QJ, Shan ZL, Guo YT, Lin K, Zhao XN et al (2015) Effects of body mass index on risks for ischemic stroke, thromboembolism, and mortality in Chinese atrial fibrillation patients: a single-center experience. PLoS One 10

  15. Kernan (2014) Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association (vol 45, pg 2160, 2014). Stroke 45:E172-E

    Article  Google Scholar 

  16. O'Donnell MJ, Xavier D, Liu LS, Zhang HY, Chin SL, Rao-Melacini P et al (2010) Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 376:112–123

    Article  PubMed  Google Scholar 

  17. Toss F, Wiklund P, Franks PW, Eriksson M, Gustafson Y, Hallmans G et al (2011) Abdominal and gynoid adiposity and the risk of stroke. Int J Obes 35:1427–1432

    Article  CAS  Google Scholar 

  18. Reeves M, Bhatt A, Jajou P, Brown M, Lisabeth L (2009) Sex differences in the use of intravenous rt-PA thrombolysis treatment for acute ischemic stroke a meta-analysis. Stroke 40:1743–1749

    Article  CAS  PubMed  Google Scholar 

  19. Blum B, Wormack L, Holtel M, Penwell A, Lari S, Walker B et al (2019) Gender and thrombolysis therapy in stroke patients with incidence of dyslipidemia. BMC Womens Health 19

  20. Meseguer E, Mazighi M, Labreuche J, Arnaiz C, Cabrejo L, Slaoui T et al (2009) Outcomes of intravenous recombinant tissue plasminogen activator therapy according to gender a clinical registry study and systematic review. Stroke 40:2104–2110

    Article  CAS  PubMed  Google Scholar 

  21. Gainey J, Blum B, Bowie B, Cooley K, Madeline L, Ervin EL et al (2018) Stroke and dyslipidemia: clinical risk factors in the telestroke versus non-telestroke. Lipids Health Dis 17

  22. Wapshott T, Blum B, Williams K, Nathaniel TI (2017) Investigation of gender differences and exclusive criteria in a diabetic acute ischemic stroke population treated with recombinant tissue-type plasminogen activator (rtPA). J Vasc Interv Neurol 9:26–32

    PubMed  PubMed Central  Google Scholar 

  23. Nathaniel TI, Cochran T, Chaves J, Fulmer E, Sosa C, Yi S et al (2016) Co-morbid conditions in use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute ischaemic stroke. Brain Inj 30:1261–1265

    Article  PubMed  Google Scholar 

  24. Colello MJ, Ivey LE, Gainey J, Faulkner RV, Johnson A, Brechtel L et al (2018) Pharmacological thrombolysis for acute ischemic stroke treatment: gender differences in clinical risk factors. Adv Med Sci 63:100–106

    Article  PubMed  Google Scholar 

  25. Gainey J, Brecthtel J, Blum B, Keels A, Madeline L, Lowther E et al (2018) Functional outcome measures of recombinant tissue plasminogen activator–treated stroke patients in the Telestroke technology. J Exp Neurosci 12:1–11

    Article  Google Scholar 

  26. Brecthel L, Gainey J, Penwell A, Nathaniel TI (2018) Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients. BMC Neurol 18

  27. Brian Fazzone GM, Black L-A, Williams J-A, Leacock R, Sternberg S, Blackhurst D, Nelson A, Nathaniel TI (2016) Exclusion and inclusion criteria for thrombolytic therapy in an ischemic stroke population. J Neurol Disord Stroke 4:1112

    Google Scholar 

  28. Cochran T, Chaves J, Fulmer E, Blackhurst D, Sternberg S, Leacock R et al (2014) Analysis of comorbidities in ischemic stroke patients. Neurology 82(Supplement):278

    Google Scholar 

  29. Lawson TR, Brown IE, Westerkam DL, Blackhurst DW, Sternberg S, Leacock R et al (2015) Tissue plasminogen activator (rt-PA) in acute ischemic stroke: outcomes associated with ambulation. Restor Neurol Neurosci 33:301–308

    CAS  PubMed  Google Scholar 

  30. Lawson T, Brown I, Westerkam D, Blackhurst D, Sternberg S, Leacock R, et al (2015) A new diagnostic tool for measuring the effectiveness of intravenous tissue plasminogen activator (r-pa) In The Treatment Of Acute Ischemic Stroke Internnational stroke conference. 4:P346

  31. Whisnant JP, Basford JR, Bernstein EF (1990) Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke 4:637–676

    Google Scholar 

  32. Asdaghi N, Romano JG, Wang KF, Ciliberti-Vargas MA, Koch S, Gardener H et al (2016) Sex disparities in ischemic stroke care FL-PR CReSD study (Florida-Puerto Rico collaboration to reduce stroke disparities). Stroke 47:2618–2626

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sposato LA, Zamora R, Zurru C, Esnaola MM, Fustinoni O, Saposnik G (2008) Sex disparities in ischemic stroke care and outcome in an emerging country. The argentinian national stroke registry (ReNACer). Neurology 70:A202-A

    Google Scholar 

  34. Reed SD, Cramer SC, Blough DK, Meyer K, Jarvik JG (2001) Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke 32:1832–1839

    Article  CAS  PubMed  Google Scholar 

  35. Katzan IL, Hammer MD, Hixson ED, Furlan AJ, Abou-Chebl A, Nadzam DM et al (2004) Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 61:346–350

    Article  PubMed  Google Scholar 

  36. Hills NK, Johnston SC (2006) Why are eligible thrombolysis candidates left untreated? Am J Prev Med 31:S210–S2S6

    Article  PubMed  Google Scholar 

  37. Gargano JW, Wehner S, Reeves MJ (2007) Sex differences in clinical presentation among confirmed acute stroke admissions from a statewide stroke registry. Stroke 38:508

    Article  Google Scholar 

  38. Labiche LA, Chan WY, Saldin KR, Morgenstern LB (2002) Sex and acute stroke presentation. Ann Emerg Med 40:453–460

    Article  PubMed  Google Scholar 

  39. Tolibova N, Vakhabova N (2017) Gender differences in stroke subtypes, severity, risk factors, and outcomes among elderly patients with acute ischemic stroke in Uzbekistan. J Neurol Sci 381:377

    Google Scholar 

  40. Zrelak PA (2018) Gender differences in symptom perception and care-seeking behavior in acute stroke. Stroke 49

  41. Simpson CR, Wilson C, Hannaford PC, Williams D (2005) Evidence for age and sex differences in the secondary prevention of stroke in Scottish primary care. Stroke 36:1771–1775

    Article  CAS  PubMed  Google Scholar 

  42. Syamlal G, Mazurek JM, Dube SR (2014) Gender differences in smoking among US working adults. Am J Prev Med 47:467–475

    Article  PubMed  PubMed Central  Google Scholar 

  43. Gonzalez-Rivas JP, Nieto-Martinez R, Brajkovich I, Ugel E, Risquez A (2018) Prevalence of dyslipidemias in three regions in Venezuela: the VEMSOLS study results. Arq Bras Cardiol 110:30–35

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Kapral MK, Fang JM, Hill MD, Silver F, Richards J, Jaigobin C et al (2005) Sex differences in stroke care and outcomes - results from the registry of the Canadian stroke network. Stroke 36:809–814

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA

    Brice Blum, Alexandria Penwell, Leah Wormack, Brittany Walker, Shyyon Lari & Thomas I. Nathaniel

Authors
  1. Brice Blum
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  2. Alexandria Penwell
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  3. Leah Wormack
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  4. Brittany Walker
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  5. Shyyon Lari
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  6. Thomas I. Nathaniel
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Corresponding author

Correspondence to Thomas I. Nathaniel.

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Approval for this study was obtained from the ethics committee of the Greenville Health system in 2017. Since this is a retrospective data analysis, all data were de-identified, and the study did not involve patients and no consent was required.

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Blum, B., Penwell, A., Wormack, L. et al. Gender and thrombolysis therapy in acute ischemic stroke patients with incidence of obesity. Neurol Sci 40, 1829–1839 (2019). https://doi.org/10.1007/s10072-019-03902-7

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  • DOI: https://doi.org/10.1007/s10072-019-03902-7

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