İskemik İnme ve Cinsiyet

Öz

Amaç: İnme bir beyin bölgesinin beslenmesinin bozulmasına bağlı olarak fonksiyon kaybına uğramasıdır. İnme ve buna bağlı gelişen komplikasyonları önlemenin yolu değiştirilebilir risk faktörlerini kontrol altına almaktan geçmektedir. Cinsiyet değiştirilemeyen risk faktörlerinden olup cinsiyetler arası farklılıklar önleme konusunda bize yol gösterici olacaktır. Bu sebeple çalışmamızda iskemik inme etiyolojisinin cinsiyetler arasındaki farklılıklarını ortaya koymaya çalıştık.Gereç ve Yöntemler: 2011-2016 yılları arasında akut iskemik inme tanısıyla yatırılarak takip edilen hastaların dosyaları retrospektif olarak incelendi. Cinsiyet, Hipertansiyon, Diyabet, Koroner kalp hastalığı, geçirilmiş inme öyküsü, sigara ve alkol kullanımı, Atriyal fibrilasyon varlığı, boy kilo değerleri, hiperkolesterolemi varlığı, ekokardiyografi, karotis-vertebral USG Doppler, vasküler inceleme, hemorajik transformasyon gelişimi ve ölüm durumları kayıt edilmiştir. Toplam 560 hasta çalışmaya dahil edildi. Bulgular: Çalışmaya katılan hastaların Kadın/erkek 249/311 yaş ortalaması 74,05±10,9’dur. Erkek hastalarda 80 yaşına kadar inme daha sık olurken bu yaştan sonra kadınlarda daha fazla olduğu ve yaşla bu farkın giderek arttığı görüldü. En sık görülen risk faktörü %68,5 ile hipertansiyondu. İkinci en sık görülen risk faktörü Hiperkolesterolemi olarak saptandı %50,2 . Hipertansiyon kadınlarda daha sık görülürken alkol ve sigara kullanımı erkek hastalarda daha sık izlendi. Sonuç: Yaş kadın bireylere inme riskini artıran büyük bir etken olarak göze çarpmaktadır. Hipertansiyonun ve hiperkolesterolemi başta olmak üzere diğer risk faktörlerinin kontrol altına alınması yaşlı kadın hastalarda daha da önem arz etmektedir

Anahtar Kelimeler

• İnme, Cinsiyet, Yaş, İskemik inme, Hipertansiyon

Ischaemic Stroke and Gender

Abstract

Objective: Stroke is dysfunction of a brain region due to loss of blood supply. The effective method to prevent stroke and its comorbidities is the adequate control of the risk factors. Sex is one of the nonmodifiable risk factors for stroke. We therefore aimed to evaluate differences in the aetiology of ischemic stroke between genders. Material and Methods: Patients with a diagnosis of acute ischemic stroke treated in our service between 2011 and 2016 were selected from the hospital system. The parameters evaluated included age, sex, hypertension, diabetes mellitus, coronary heart disease, history of prior stroke, smoking, alcohol use, atrial fibrillation, Body mass index, hypercholesterolaemia, echocardiography, carotid and vertebral Doppler ultrasound, angiography reports, haemorrhagic transformations and death. A total of 560 patients was included in the study. Results: The mean age of the patients was 74.05±10.9 years; 249 44.5% were female and 311 55.5% were male. Men had more stroke episodes than women until the age of 80 years but women had more stroke after 80 years and this difference increased over the years. Hypertension was the most common risk factor at 68.5%. The second most common risk factor was hypercholesterolemia 50.2% . Hypertension was more common in women, while alcohol and smoking were more common in male patients.Conclusion: Age is an important factor that increases the risk of stroke in women more than men. Control of risk factors, especially hypertension and hypercholesterolemia, is more important in elderly female patients

Keywords

• Stroke, Gender, Age, Ischaemic stroke, Hypertension

References

1. World Health Organization. The top 10 causes of death. 2012 http:// www. who. int/ mediacentre/ factsheets/ fs310/ en/ index1. html2016.
2. Mazzaglia G, Ambrosioni E, Alacqua M, Alacqua M, Filippi A, Sessa E, Immordino V, Borghi C, Brignoli O, Caputi AP, Cricelli C, Mantovani LG. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation 2009; 120:1598-605.
3. Kettani FZ, Dragomir A, Côté R, Roy L, Bérard A, Blais L, Lalonde L, Moreau P, Perreault S. Impact of a better adherence to antihypertensive agents on cerebrovascular disease for primary prevention. Stroke 2009; 40:213-20.
4. Türk Börü Ü, Kulualp AŞ, Tarhan ÖF, Bölük C, Duman A, Zeytin Demiral G, Güçlü Altun İ, Taşdemir M. Stroke prevalence among the Turkish population in a rural area of Istanbul: A community-based study. SAGE Open Med 2018; 6:2050312118797565.
5. Oncel C, Tokgöz F, Bozkurt AI, Erdoğan C. Prevalence of cerebrovascular disease: A door-to-door survey in West Anatolia. Neurol Sci 2014; 35:373-7.
6. Rexode KM. Emerging risk factors in women. Stroke 2010; 41:9-11.
7. Gorelick PB. Stroke prevention. Arch Neurol 1995; 52: 347-55.
8. Broderick J, Brott T, Kothari R. The Greater Cincinnati/ Northern Kentucky Stroke Study: Preliminary first-ever and total incidence rates of stroke among blacks. Stroke 1998; 29(2):415-21.

9. Kumral E, Özkaya B, Sağduyu A, Şirin H, Vardarlı E, Pehlivan M. The Ege Stroke Registry. A hospital based study in the Aegian Region, İzmir, Turkey. Analysis of 2000 patients. Cerebrovascular Dis 1998; 8:278-88.
10. Sacco RL, Boden-Albala B, Gan R, Chen X, Kargman DE, Shea S, Paik MC, Hauser WA. Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study. Am J Epidemiol 1998; 147:259-68.
11. Bousser MG. Stroke in women: The 1997 Paul Dudley White International Lecture. Circulation 1999; 99:463-7.
12. Wolf PA. Cerebrovascular risk. In: Izzo JLJ, Black HR, editors. Hypertension Primer: The Essentials of High Blood Pressure. Baltimore, Md: Lippincott, Williams & Wilkins, 1999;239.
13. Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: A risingtide. Hypertension 2004; 44:398-404.
14. Wolf PA, Kannel WB, Mc Gee DL. Prevention of ischemic stroke, Risk Factors, Barnet et al, Stroke, Edinburgh, London: Churchill Livingstone, 1988; 967-88.
15. Li S, Zhao X, Wang C, Liu L, Liu G, Wang Y, Wang C, Jing J, Wang Y. Risk factors for poor outcome and mortality at 3 months after the ischemic stroke in patients with atriyal fibrillation.Journal of Stroke an Cerebrovascular Diseases 2013; 22(8):e419-25.
16. Sakamoto Y, Sato S, Kuronuma Y, Nagatsuka K, Minematsu K, Kazunori T. Factors associated with proximal carotid axis occlusion in patients with acute stroke and atrial fibrillation. Journal of Stroke and Cerebrovascular Diseases 2014; 23(5):799-804.
17. Sacco RL. Risk factors. Outcomes and stroke subtypes for ischemic stroke. Neurology 1997; 49 Suppl 4:39-44.
18. Scott E, Kasner SE, Lynn MJ, Jackson BP, Pullicino PM, Chimowitz MI. Warfarin versus aspirin for symptomatic intracranial disease (WASID) trial investigators. Echocardiography in patients with symptomatic intracranial stenosis. Journal of Stroke and Cerebrovascular Diseases 2007; 16(5):216-9.
19. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358:1033-41.
20. Kannel WB, Wolf PA, Verter J. Manifestions of coronary disease predisposing to stroke. The Framingham Study. JAMA 1983; 250:2942-6.
21. Davis PH, Dambrosia JM, Schoenberg BS, Schoenberg DG, Pritchard DA, Lilienfeld AM, Whisnant JP. Risk factors for ischemic stroke. A prospective study in Rochester, Minnesota. Annals of Neurology 1987; 22:319-27.
22. Colditz GA, Bonita R, Stampfer MJ, Willett WC, Rosner B, Speizer FE, Hennekens CH. Cigarette smoking and risk of stroke in middle-aged women. New England Journal of Medicine 1988; 318:937-41.
23. Wolf PA, D’Agostino RB, Kannel WB, Bonita R, Belanger AJ. Cigarette smoking as a risk factor for stroke. The framingham study. JAMA 1988; 259:1025-9.
24. Balkan S: Serebrovasküler Hastalıklar. Ankara: Güneş Kitabevi Yayınları, 2002; 5:56.
25. Oğul, E. Klinik Nöroloji. Ankara: Nobel ve Güneş Kitabevi, 2002.
26. Keheya S, Tekatas A, Aynacı Ö, Utku U, Solmaz V. A comparison of risk factors and prognosis between intra and extracranial acute atherosclerotic stroke in the Turkish population: A prospective study. Neurol Res 2016; 38:864- 70.