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.
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.
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
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.
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.
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.
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
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
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.