Elderly women have lower rates of stroke, cardiovascular events, and mortality after hospitalization for transient ischemic attack.
Elderly women have lower rates of stroke, cardiovascular events, and mortality after hospitalization for transient ischemic attack.
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DOI：
10.1161/strokeaha.108.543009
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发表时间：
2009-06
期刊：
影响因子：
8.3
通讯作者：
Goldstein LB
中科院分区：
文献类型：
--
作者：
Lichtman JH;Jones SB;Watanabe E;Allen NB;Wang Y;Howard VJ;Goldstein LB
TIA患者中风、心血管事件和死亡的风险增加，但对男性和女性的这些风险是否不同知之甚少。我们确定是否有性别为基础的差异，这些结果30天和一年后，TIA使用全国样本的老年患者。对2002年因TIA（ICD-9 435）、卒中（ICD-9 433、434、436）、冠状动脉疾病（CAD; ICD-9 410-414）、全因再入院和死亡而出院的65岁或以上的付费医疗保险患者确定30天和1年住院率。考克斯比例风险模型和随机效应逻辑模型比较了人口统计学、病史、合并症和既往住院的风险调整后的结局。该研究包括122，063例TIA住院患者（平均年龄79.0±7.6岁; 62%为女性; 86%为白色）。男性更年轻，但心脏合并症的发生率高于女性。TIA入院后30天和1年，女性的中风、CAD和死亡率（未经调整）较低。这些关系在30天的卒中风险调整分析中持续存在（HR=0.70，95% CI 0.64-0.77），CAD（0.86，0.74-1.00）和死亡率（OR=0.74，0.68-0.82），以及1年时卒中（HR=0.85，0.81-0.89）、CAD（0.81，0.77-0.86）和死亡（OR=0.78，0.75-0.81）。这些数据表明，在TIA出院后的第一年内，女性的预后比男性好。需要进一步的研究来确定可能解释这些与性别有关的结果差异的因素。
TIA patients are at increased risk for stroke, cardiovascular events, and death, yet little is known about whether these risks differ for men and women. We determined whether there are sex-based differences in these outcomes 30-days and one year following TIA using a national sample of elderly patients. Rates of 30-day and one year hospitalization for TIA (ICD-9 435), stroke (ICD-9 433, 434, 436), coronary artery disease (CAD; ICD-9 410–414), all-cause readmission, and mortality were determined for fee-for-service Medicare patients 65 years of age or older discharged with a TIA in 2002. Cox proportional hazards models and random effects logistic models compared outcomes with risk-adjustment for demographics, medical history, comorbidities, and prior hospitalizations. The study included 122,063 TIA hospitalizations (mean age 79.0±7.6 years; 62% women; 86% White). Men were younger, but had higher rates of cardiac comorbidities than women. Women had lower unadjusted rates of stroke, CAD, and mortality at 30-days and one year following TIA admission. These relationships persisted in risk-adjusted analyses at 30-days for stroke (HR=0.70, 95% CI 0.64–0.77), CAD (0.86, 0.74–1.00), and mortality (OR=0.74, 0.68–0.82), as well as at one year for stroke (HR=0.85, 0.81–0.89), CAD (0.81, 0.77–0.86), and mortality (OR=0.78, 0.75–0.81). These data suggest that women have a better prognosis than men within the first year following hospital discharge for a TIA. Additional research is needed to identify factors that may explain these sex-related differences in outcomes.