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The female stroke survival advantage: relation to age.

https://arctichealth.org/en/permalink/ahliterature91306
Source
Neuroepidemiology. 2009;32(1):47-52
Publication Type
Article
Date
2009
Author
Olsen Tom Skyhøj
Dehlendorff Christian
Andersen Klaus Kaae
Author Affiliation
Stroke Unit, Hvidovre University Hospital, Hvidovre, Denmark. Tom.Skyhoej.Olsen@hvh.regionh.dk
Source
Neuroepidemiology. 2009;32(1):47-52
Date
2009
Language
English
Publication Type
Article
Abstract
BACKGROUND: Age-related hormonal factors are thought to be related to the gender gap in longevity. Testing the hypothesis that survival is best in young premenopausal women we studied the effect of age on 1-week mortality in stroke patients. METHODS: A registry was started in 2001 with the aim of registering all hospitalized patients in Denmark. The patients' risk factors, stroke severity and CT scan were evaluated. A total of 25,607 patients (63%) gave complete information on all risk factors and were used in the analysis. Independent predictors of survival were identified by means of multiple logistic regression. RESULTS: The probability of death within 1 week adjusted for stroke severity, stroke type and risk factors was highly age-dependent in both men and women. Up to the age of 50 years, the 1-week female/male mortality rates paralleled being slightly (15%) but insignificantly better in women. While mortality increased almost linearly in women over the entire age range, it increased steeply in men from the age of 50 and at the age of 80 years survival was 80% better in women. CONCLUSION: The female stroke survival advantage applies to all ages. It increases with age due to a steeply increase of mortality in middle-aged and elderly men.
PubMed ID
19001796 View in PubMed
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Female survival advantage relates to male inferiority rather than female superiority: A hypothesis based on the impact of age and stroke severity on 1-week to 1-year case fatality in 40,155 men and women.

https://arctichealth.org/en/permalink/ahliterature99528
Source
Gend Med. 2010 Aug;7(4):284-95
Publication Type
Article
Date
Aug-2010
Author
Olsen Tom Skyhøj
Andersen Klaus Kaae
Author Affiliation
The Stroke Unit, Frederiksberg Hospital, Frederiksberg, Denmark.
Source
Gend Med. 2010 Aug;7(4):284-95
Date
Aug-2010
Language
English
Publication Type
Article
Abstract
Background: It is generally believed that differences in age, stroke characteristics, and cardiovascular risk factors account for observed sex-specific differences in stroke survival. Objectives: We aimed to study female stroke survival advantage before and after the average age of menopause, and whether female survival advantage applies only to patients for whom stroke is the most likely cause of death. Methods: The Danish National Indicator Project, a registry designed to list all hospitalized stroke patients in Denmark beginning in March 2001, had 40,155 registered patients as of February 2007. All registered patients had undergone evaluation including stroke severity (as measured by the Scandinavian Stroke Scale [SSS], using a total score of 0-58, in which lower scores indicate more severe strokes), computed tomography, and cardiovascular risk factors. Patients were followed from admission until death or censoring. Case fatality (stratified by 1 week, 1 month, 3 months, and 1 year) in men and women was correlated with age and stroke severity. Adjustment for cardiovascular risk factors was performed by means of multivariate regression analysis. Results: A total of 20,854 (51.9%) men and 19,301 (48.1%) women were registered. Women were significantly older than men at the time of stroke (74.5 vs 69.7 years, respectively; P
PubMed ID
20869629 View in PubMed
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Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors.

https://arctichealth.org/en/permalink/ahliterature89360
Source
Stroke. 2009 Jun;40(6):2068-72
Publication Type
Article
Date
Jun-2009
Author
Andersen Klaus Kaae
Olsen Tom Skyhøj
Dehlendorff Christian
Kammersgaard Lars Peter
Author Affiliation
Informatics and Mathematical Modelling, Section for Statistics, Technical University of Denmark, Lyngby, Denmark.
Source
Stroke. 2009 Jun;40(6):2068-72
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Aged
Brain Ischemia - complications - mortality - pathology
Cerebral Hemorrhage - complications - mortality - pathology
Denmark - epidemiology
Female
Humans
Male
Regression Analysis
Risk factors
Sex Factors
Smoking - epidemiology
Stroke - etiology - mortality - pathology
Survival
Abstract
BACKGROUND AND PURPOSE: Stroke patients with hemorrhagic (HS) and ischemic strokes were compared with regard to stroke severity, mortality, and cardiovascular risk factors. METHODS: A registry started in 2001, with the aim of registering all hospitalized stroke patients in Denmark, now holds information for 39,484 patients. The patients underwent an evaluation including stroke severity (Scandinavian Stroke Scale), CT, and cardiovascular risk factors. They were followed-up from admission until death or censoring in 2007. Independent predictors of death were identified by means of a survival model based on 25,123 individuals with a complete data set. RESULTS: Of the patients 3993 (10.1%) had HS. Stroke severity was almost linearly related to the probability of having HS (2% in patients with the mildest stroke and 30% in those with the most severe strokes). Factors favoring ischemic strokes vs HS were diabetes, atrial fibrillation, previous myocardial infarction, previous stroke, and intermittent arterial claudication. Smoking and alcohol consumption favored HS, whereas age, sex, and hypertension did not herald stroke type. Compared with ischemic strokes, HS was associated with an overall higher mortality risk (HR, 1.564; 95% CI, 1.441-1.696). The increased risk was, however, time-dependent; initially, risk was 4-fold, after 1 week it was 2.5-fold, and after 3 weeks it was 1.5-fold. After 3 months stroke type did not correlate to mortality. CONCLUSIONS: Strokes are generally more severe in patients with HS. Within the first 3 months after stroke, HS is associated with a considerable increase of mortality, which is specifically associated with the hemorrhagic nature of the lesion.
PubMed ID
19359645 View in PubMed
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Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study.

https://arctichealth.org/en/permalink/ahliterature83544
Source
Stroke. 2007 Oct;38(10):2646-51
Publication Type
Article
Date
Oct-2007
Author
Olsen Tom Skyhøj
Christensen Rune Haubo Bojesen
Kammersgaard Lars Peter
Andersen Klaus Kaae
Author Affiliation
Stroke Unit, Department of Neurorehabilitation, Hvidovre University Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark. Tom.Skyhoej.Olsen@hvh.regionh.dk
Source
Stroke. 2007 Oct;38(10):2646-51
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Biological Markers - blood
Brain Ischemia - blood - mortality
Cause of Death
Cerebrovascular Accident - blood - mortality
Cholesterol - blood
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Hypercholesterolemia - blood - mortality
Linear Models
Male
Prognosis
Retrospective Studies
Severity of Illness Index
Abstract
BACKGROUND AND PURPOSE: Evidence of a causal relation between serum cholesterol and stroke is inconsistent. We investigated the relation between total serum cholesterol and both stroke severity and poststroke mortality to test the hypothesis that hypercholesterolemia is primarily associated with minor stroke. METHODS: In the study, 652 unselected patients with ischemic stroke arrived at the hospital within 24 hours of stroke onset. A measure of total serum cholesterol was obtained in 513 (79%) within the 24-hour time window. Stroke severity was measured with the Scandinavian Stroke Scale (0=worst, 58=best); a full cardiovascular risk profile was established for all. Death within 10 years after stroke onset was obtained from the Danish Registry of Persons. RESULTS: Mean+/-SD age of the 513 patients was 75+/-10 years, 54% were women, and the mean+/-SD Scandinavian Stroke Scale score was 39+/-17. Serum cholesterol was inversely and almost linearly related to stroke severity: an increase of 1 mmol/L in total serum cholesterol resulted in an increase in the Scandinavian Stroke Scale score of 1.32 (95% CI, 0.28 to 2.36, P=0.013), meaning that higher cholesterol levels are associated with less severe strokes. A survival analysis revealed an inverse linear relation between serum cholesterol and mortality, meaning that an increase of 1 mmol/L in cholesterol results in a hazard ratio of 0.89 (95% CI, 0.82 to 0.97, P=0.01). CONCLUSIONS: The results of our study support the hypothesis that a higher cholesterol level favors development of minor strokes. Because of selection, therefore, major strokes are more often seen in patients with lower cholesterol levels. Poststroke mortality, therefore, is inversely related to cholesterol.
PubMed ID
17761907 View in PubMed
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[Lower mortality in patients with stroke and atrial fibrillation who received anticoagulation treatment]

https://arctichealth.org/en/permalink/ahliterature84022
Source
Ugeskr Laeger. 2007 Oct 8;169(41):3493-5
Publication Type
Article
Date
Oct-8-2007
Author
Andersen Klaus Kaae
Olsen Tom Skyhøj
Author Affiliation
Danmarks Tekniske Universitet, Informatik og Matematisk Modellering.
Source
Ugeskr Laeger. 2007 Oct 8;169(41):3493-5
Date
Oct-8-2007
Language
Danish
Publication Type
Article
Abstract
A registry of hospitalized stroke patients in Denmark included 1,909 patients with stroke and atrial fibrillation (AF) without contraindications to anticoagulation (AC) treatment. AC instituted in 60.2% was significantly associated to age and stroke severity. In a Cox Proportional Hazard regression model the risk of death was doubled in patients who had no AC treatment (HR =1.91, 95% CI=1.44 to 2.52). The study indicates under-use of AC in elderly stroke patients with AF, leading to increased mortality.
PubMed ID
17967281 View in PubMed
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Reduced poststroke mortality in patients with stroke and atrial fibrillation treated with anticoagulants: results from a Danish quality-control registry of 22,179 patients with ischemic stroke.

https://arctichealth.org/en/permalink/ahliterature79288
Source
Stroke. 2007 Feb;38(2):259-63
Publication Type
Article
Date
Feb-2007
Author
Andersen Klaus Kaae
Olsen Tom Skyhøj
Author Affiliation
Department of Informatics and Mathematical Modelling, Section for Statistics, Technical University of Denmark, Lyngby, Denmark.
Source
Stroke. 2007 Feb;38(2):259-63
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Brain Ischemia - drug therapy - mortality
Cerebrovascular Accident - drug therapy - mortality
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Quality Control
Registries
Survival Rate - trends
Time Factors
Abstract
BACKGROUND AND PURPOSE: The preventive effect of anticoagulation in patients with stroke and atrial fibrillation (AF) is documented only in trials of minor stroke. Although anticoagulation reduced stroke recurrence, those trials did not demonstrate an influence of anticoagulation on survival. METHODS: A nationwide registry that was started in 2001 with the aim of registering all hospitalized stroke patients in Denmark now includes 24 791 patients. We studied the survival of patients with ischemic stroke and AF with respect to anticoagulation treatment. All underwent an evaluation for stroke severity (according to the Scandinavian Stroke Scale), computed tomography scan, and an evaluation for cardiovascular risk factors. Follow-up duration was 4 years (mean, 1.2 years). RESULTS: Of all patients, 22 179 (89.4%) experienced an ischemic stroke. In total, 3670 (16.5%) had AF, and 1909 had no contraindication to anticoagulation treatment. Anticoagulation treatment was initiated in 1149 of these patients (60.2%) but omitted in 760 (39.8%) despite no contraindication to such treatment. Of the patients so treated, 18.9% died during follow-up versus 45.2% without treatment. Patients who received treatment were younger (76.7+/-9.5 versus 80.7+/-9.0 years, P
Notes
Comment In: Stroke. 2007 Jul;38(7):e61; author reply e6217510452
PubMed ID
17194876 View in PubMed
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Sex Differences in Stroke Survival: 10-Year Follow-up of the Copenhagen Stroke Study Cohort.

https://arctichealth.org/en/permalink/ahliterature84253
Source
J Stroke Cerebrovasc Dis. 2005 Sep-Oct;14(5):215-20
Publication Type
Article
Author
Andersen Morten Nonboe
Andersen Klaus Kaae
Kammersgaard Lars Peter
Olsen Tom Skyhøj
Author Affiliation
Informatics and Mathematical Modeling, Section for Intelligent Signal Processing, Technical University of Denmark, Denmark.
Source
J Stroke Cerebrovasc Dis. 2005 Sep-Oct;14(5):215-20
Language
English
Publication Type
Article
Abstract
Background: Although diverging, most studies show that sex has no significant influence on stroke survival. Methods: In a Copenhagen, Denmark, community all patients with stroke during March 1992 to November 1993 were registered on hospital admission. Stroke severity was measured using the Scandinavian Stroke Scale (0-58); computed tomography determined stroke type. A risk factor profile was obtained for all including ischemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, previous stroke, smoking, and alcohol consumption. Date of death was obtained within a 10-year follow-up period. Predictors of death were identified using a Cox proportional hazards model. Results: Of 999 patients, 559 (56%) were women and 440 (44%) were men. Women were older (77.0 v 70.9 years; P
PubMed ID
17904029 View in PubMed
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Sex-related time-dependent variations in post-stroke survival--evidence of a female stroke survival advantage.

https://arctichealth.org/en/permalink/ahliterature87261
Source
Neuroepidemiology. 2007;29(3-4):218-25
Publication Type
Article
Date
2007
Author
Olsen Tom Skyhøj
Dehlendorff Christian
Andersen Klaus Kaae
Author Affiliation
Stroke Unit, Hvidovre University Hospital, Hvidovre, Denmark. Tom.Skyhoej.Olsen@hvh.regionh.dk
Source
Neuroepidemiology. 2007;29(3-4):218-25
Date
2007
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Cause of Death
Cerebral Hemorrhage - mortality
Denmark
Female
Follow-Up Studies
Humans
Male
Mathematical Computing
Middle Aged
Patient Admission - statistics & numerical data
Proportional Hazards Models
Recurrence
Registries
Risk factors
Sex ratio
Stroke - mortality
Survival Analysis
Abstract
BACKGROUND: Women live longer than men, yet most studies show that gender has no influence on survival after stroke. METHODS: A registry was started in 2001, with the aim of registering all hospitalized stroke patients in Denmark, and it now holds 39,484 patients of which 48% are female. We studied the influence of gender on post-stroke mortality, from the time of admission through the subsequent years until death or censoring (mean follow-up time: 538 days). All patients underwent an evaluation including stroke severity, computed tomography and cardiovascular risk factors. Independent predictors of death were identified by means of a survival model based on 22,222 individuals with a complete data set. RESULTS: Females were older and had severer stroke. Interestingly, the risk of death between genders was time dependent. The female/male stroke mortality rate favoured women from the first day of stroke and remained so during the first month suggesting a female survival advantage. Throughout the second month the rate reversed in favour of men suggesting that women in that period are paying a 'toll' for their initial survival advantage. Hereafter, the rate steadily decreased, and after 4 months women continued to have the same low risk as in the first week. CONCLUSIONS: Our study suggests a female superiority in stroke survival competence.
PubMed ID
18075278 View in PubMed
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8 records – page 1 of 1.