Factors that pre-determine the main subtypes of ischemic stroke in middle-aged and senior women

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Abstract

Introduction. Brain health and active longevity are affected by a number of stroke risk factors. We should identify their relative impact on the main subtypes of ischemic stroke (IS) in middle-aged and senior women to consider prevention and management strategies.

Objective. To assess prevalence of isolated and combined factors that may contribute with a high probability to development of the various IS subtypes in women aged 45–74 years.

Materials and methods. The study included 348 female patients aged 45–74 years including 145 inpatients with carotid IS (main group) from Neurology Department 2, the Research Center of Neurology, and 203 women with cognitive disorders due to the chronic cerebral ischemia (controls). To assess the impact of various risk factors on the main IS subtypes, we generated multivariate predictive models using logistic regression and the Wald test.

Results. Predictive modeling of atherothrombotic IS demonstrated that type 2 diabetes mellitus increases IS risk by over 5 times (odds ratio [OR] = 5.961; 95% confidence interval [CI] 1.102–32.257; р = 0.038); internal carotid artery stenosis, by 7 times (OR = 7.187; 95% CI 1.827–28.273; р = 0.005); history of transient ischemic attacks (TIA), by 61 times (OR = 61.442; 95% CI 7.673–491.998; р < 0.001); excessive alcohol intake, by 49 times (OR = 49,382; 95% CI 4.557–535.121; р = 0.001); and HTN severity, by 4 times (OR = 4.445; 95% CI 2.331–8.476; р < 0.001). Predictive modeling of cardioembolic IS demonstrated that post-infarction cardiosclerosis increases IS risk by over 118 times (OR = 118.025; 95% CI 5.210–2673.796; р = 0.003), atrial fibrillation, by 108 times (OR = 108.493; 95% CI 24.312–484.159; р < 0.001), history of TIA, by over 71 times (OR = 71.558; 95% CI 7.945–644.535; р < 0.001); and HTN severity, by over 3 times (OR = 3.957; 95% CI 2.069–7.566; р < 0.001). Predictive modeling of lacunar IS demonstrated that type 2 diabetes mellitus increases IS risk by 8 times (OR = 8.324; 95% CI 1.923–36.041; р = 0.005), history of IS, by over 8 times (OR = 8.99; 95% CI 1.772–45.598; р = 0.008); and HTN severity, by 7 times (OR = 7.139; 95% CI 3.491–14.599; р < 0.001).

Conclusion. We identified a number of risk factors that may contribute to the development of the main IS subtypes in middle-aged and senior women.

 

About the authors

Marina Yu. Maximova

Research Center of Neurology

Author for correspondence.
Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-7682-6672

D. Sci (Med,), Professor, Head, 2nd Neurology department, Research Center of Neurology

Russian Federation, Moscow

Valeriya Yu. Sazonova

Research Center of Neurology

Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-8813-530X

Neurologist, Scientific Advisory Department, Research Center of Neurology

Russian Federation, Moscow

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2. Fig. 1. ROC curve for predicted probability of IS development in women aged 45–74 years.

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3. Fig. 2. ROC curve for predicted probability of large-artery atherothrombotic IS in women aged 45 to 74 years.

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4. Fig. 3. ROC curve for predicted probability of cardioembolic IS development in women aged 45–74 years.

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5. Fig. 4. ROC curve for predicted probability of lacunar embolic IS development in women aged 45–74 years.

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Copyright (c) 2023 Maximova M.Y., Sazonova V.Y.

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