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Etiology, risk factors and sex differences in ischemic stroke in the Ludwigshafen stroke study, a population-based stroke registry

Palm, Frederik ; Urbanek, Christian ; Wolf, Johanna ; Buggle, Florian ; Kleemann, Thomas ; Hennerici, Michael G. ; Inselmann, Gerhard ; Hagar, M. ; Safer, Anton ; Becher, Heiko ; Grau, Armin J.

In: Cerebrovascular diseases, 33 (2012), Nr. 1. pp. 69-75. ISSN 1015-9770

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Background: Stroke etiology in ischemic stroke guides preventive measures and etiological stroke subgroups may show considerable differences between both sexes. In a population-based stroke registry we analyzed etiological subgroups of ischemic stroke and calculated sex-specific incidence and mortality rates. Methods: The Ludwigshafen Stroke Study is a prospective ongoing population-based stroke registry. Multiple overlapping methods of case ascertainment were used to identify all patients with incident stroke or transient ischemic attack. Modified TOAST ( Trial of Org 10172 in Acute Stroke Treatment) criteria were applied for subgroup analysis in ischemic stroke. Results: Out of 626 patients with first-ever ischemic stroke in 2006 and 2007, women (n = 327) were older (73.5 8 12.6 years) than men (n = 299; 69.7 8 11.5 years; p < 0.001). The age-adjusted incidence rate of ischemic stroke was significantly higher in men (1.37; 95% CI 1.20–1.56) than in women (1.12; 95% CI 0.97–1.29; p = 0.04). Cardioembolism (n = 219; 35.0%), smallartery occlusion (n = 164; 26.2%), large-artery atherosclerosis (n = 98; 15.7%) and ‘probable atherothrombotic stroke’ (n = 84; 13.4%) were common subgroups of ischemic stroke. Stroke due to large-artery atherosclerosis (p = 0.025), current smoking (p = 0.008), history of smoking (p < 0.001), coronary artery disease (p = 0.0015) and peripheral artery disease (p = 0.024) was significantly more common in men than in women. Overall, 1-year survival was not different between both sexes; however, a significant age-sex interaction with higher mortality in elderly women (>85 years) was detected. Conclusions: Cardioembolism is the main source for ischemic stroke in our population. Etiology of ischemic stroke differs between sexes, with large-artery atherosclerotic stroke and associated diseases (coronary artery disease and peripheral artery disease) being more common in men.

Item Type: Article
Journal or Publication Title: Cerebrovascular diseases
Volume: 33
Number: 1
Publisher: S. Karger AG
Date Deposited: 08 Jan 2015 08:39
Date: 2012
ISSN: 1015-9770
Page Range: pp. 69-75
Faculties / Institutes: Medizinische Fakultät Mannheim > Neurologische Klinik
Medizinische Fakultät Heidelberg > Institut für Public Health (IPH)
Subjects: 610 Medical sciences Medicine
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