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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Generally, women demonstrate smaller autonomic and cardiovascular reactions to stress, compared with men. The mechanism of this sex-dependent difference is unknown, although reduced baroreflex sensitivity may be involved. Recently, we identified a cortical network associated with autonomic cardiovascular responses to baroreceptor unloading in men. The current investigation examined whether differences in the neural activity patterns within this network were related to sex-related physiological responses to lower body negative pressure (LBNP, 5, 15, and 35 mmHg). Forebrain activity in healthy men and women (n = 8 each) was measured using functional magnetic resonance imaging with blood oxygen level-dependent (BOLD) contrast. Stroke volume (SV), heart rate (HR), and muscle sympathetic nerve activity (MSNA) were collected on a separate day. Men had larger decreases in SV than women (P < 0.01) during 35 mmHg LBNP only. At 35 mmHg LBNP, HR increased more in males then females (9 +/- 1 beats/min vs. 4 +/- 1 beats/min, P < 0.05). Compared with women, increases in total MSNA were similar at 15 mmHg LBNP but greater during 35 mmHg LBNP in men [1,067 +/- 123 vs. 658 +/- 103 arbitrary units (au), P < 0.05]. BOLD signal changes (P < 0.005, uncorrected) were identified within discrete forebrain regions associated with these sex-specific HR and MSNA responses. Men had larger increases in BOLD signal within the right insula and dorsal anterior cingulate cortex than women. Furthermore, men demonstrated greater BOLD signal reductions in the right amygdala, left insula, ventral anterior cingulate, and ventral medial prefrontal cortex vs. women. The greater changes in forebrain activity in men vs. women may have contributed to the elevated HR and sympathetic responses observed in men during 35 mmHg LBNP.
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PMID:Forebrain neural patterns associated with sex differences in autonomic and cardiovascular function during baroreceptor unloading. 1727 71

The purpose of this study was to investigate the association of atrial fibrillation (AFIB) with multiple measures of cognitive performance in a large community-based sample extensively characterized for vascular risk factors. Our primary analysis included 1011 Framingham Offspring Study (Framingham, Mass) men, mean age = 61.0 (37-89) years, free of clinical stroke and dementia. Using multivariable linear regression models, we related the presence (n = 59) versus absence (n = 952) of AFIB in men to a global measure of performance and multiple measures of specific cognitive abilities assessed an average of 8 months after the AFIB surveillance period. Adjusting for age, education, multiple cardiovascular risk factors, and cardiovascular disease, men with AFIB exhibited significantly lower mean levels of cognitive performance compared with men in normal sinus rhythm. Men with AFIB exhibited lower performance on global cognitive ability and cognitive abilities including Similarities (abstract reasoning), Visual Reproductions-Immediate Recall, Visual Reproductions-Delayed Recall, Visual Organization, Logical Memory-Delayed Recall, and Trail Making A (scanning and tracking) and Trail Making B (scanning, tracking, and executive functioning). Further studies leading to a better understanding of the mechanisms underlying the relation between AFIB and cognitive performance are important.
J Stroke Cerebrovasc Dis
PMID:Atrial fibrillation is associated with lower cognitive performance in the Framingham offspring men. 1790 78

Epidemiological studies report that quercetin, an antioxidant flavonol found in apples, berries, and onions, is associated with reduced risk of coronary heart disease and stroke. Quercetin supplementation also reduces blood pressure in hypertensive rodents. The efficacy of quercetin supplementation to lower blood pressure in hypertensive humans has never been evaluated. We tested the hypothesis that quercetin supplementation reduces blood pressure in hypertensive patients. We then determined whether the antihypertensive effect of quercetin is associated with reductions in systemic oxidant stress. Men and women with prehypertension (n = 19) and stage 1 hypertension (n = 22) were enrolled in a randomized, double-blind, placebo-controlled, crossover study to test the efficacy of 730 mg quercetin/d for 28 d vs. placebo. Blood pressure (mm Hg, systolic/diastolic) at enrollment was 137 +/- 2/86 +/- 1 in prehypertensives and 148 +/- 2/96 +/- 1 in stage 1 hypertensive subjects. Blood pressure was not altered in prehypertensive patients after quercetin supplementation. In contrast, reductions in (P < 0.01) systolic (-7 +/- 2 mm Hg), diastolic (-5 +/- 2 mm Hg), and mean arterial pressures (-5 +/- 2 mm Hg) were observed in stage 1 hypertensive patients after quercetin treatment. However, indices of oxidant stress measured in the plasma and urine were not affected by quercetin. These data are the first to our knowledge to show that quercetin supplementation reduces blood pressure in hypertensive subjects. Contrary to animal-based studies, there was no quercetin-evoked reduction in systemic markers of oxidative stress.
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PMID:Quercetin reduces blood pressure in hypertensive subjects. 1795 77

The distribution of allele and genotype frequencies of the Alu-insertion polymorphism of the angiotensin-converting enzyme (ACE) gene and missence mutations leading to the substitution of arginine to cysteine in positions 112 and 158 of apolipoprotein E (APOE) has been studied in 166 patients with brain intracranial aneurysms and in 192 controls of Russian origin from Ural region. Brain vascular aneurysms with hypertension were associated with the D*D* ACE genotype in men and with the e2 allele and the e2/e3 APOE genotype in women. The association was also observed between the e2 allele and the e2/e3 APOE genotype and family history of stroke, hemorrhages and aneurysms in patients. Men with the I*D* ACE genotype and the e4 APOE allele were at lower risk.
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PMID:[The role of angiotensin-converting enzyme and apolipoprotein E in the development of intracranial aneurysms.]. 1847 80

Prior studies have suggested gender-based differences in the care of elderly patients with acute medical conditions such as myocardial infarction and stroke, but it is unknown whether these differences are seen in the care of abdominal pain. The objective of this study was to examine differences in evaluation, management, and diagnoses between elderly men and women presenting to the Emergency Department (ED) with abdominal pain. For this observational cohort study, a chart review was conducted of consecutive patients aged 70 years or older presenting with a chief complaint of abdominal pain. Primary outcomes were care processes (e.g., receipt of pain medications, imaging) and clinical outcomes (e.g., hospitalization, etiology of pain, and mortality). Of 131 patients evaluated, 60% were women. Groups were similar in age, ethnicity, insurance status, and predicted mortality. Men and women did not differ in the frequency of medical (56% vs. 57%, respectively), surgical (25% vs. 18%, respectively), or non-specific abdominal pain (19% vs. 25%, respectively, p = 0.52) diagnoses. Similar proportions underwent abdominal imaging (62% vs. 68%, respectively, p = 0.42), received antibiotics (29% vs. 30%, respectively, p = 0.85), and opiates for pain (35% vs. 41%, respectively, p = 0.50). Men had a higher rate of death within 3 months of the visit (19% vs. 1%, respectively, p < 0.001). Unlike prior research in younger patients with abdominal pain and among elders with other acute conditions, we noted no difference in management and diagnoses between older men and women who presented with abdominal pain. Despite a similar predicted mortality and ED evaluation, men had a higher rate of death within 3 months.
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PMID:Does gender influence emergency department management and outcomes in geriatric abdominal pain? 1899 17

Post-stroke levels of total cholesterol (TC) appear to be negatively associated with stroke mortality. Statin pretreatment might affect this association. Sex differences in the prognostic value of the lipid profile have not yet been studied. We have evaluated the impact of TC, high- and low-density lipoprotein (HDL and LDL, respectively), and triglyceride (TG) levels on the 3-month outcome after a first ischemic stroke (IS) according to sex and previous statin use. The study group consisted of a hospital-based cohort of consecutive patients with a diagnosis of first IS. Poor outcome was defined as a modified Rankin Scale (mRS) score >or=3 at 90 days. The odds ration (OR) for poor prognosis was analyzed for each sex using logistic regression models adjusted for vascular risk factors and statin pretreatment. A total of 591 patients were included in the analysis (318 men). The predictors of a 90-day poor outcome were age and initial NIH Stroke Scale (NIHSS) score in women, and age, initial NIHSS, smoking, atrial fibrillation, and thrombolytic treatment in men. In women, none of the lipids studied affected the 90-day prognosis. Men falling in the last quintile of TC [OR: 0.68 95% confidence interval (95% CI) 0.52-0.88; p = 0.004] and LDL (OR 0.74, 95% CI 0.56-0.98; p = 0.04) have better outcome than men in the first quintile. Adjusting for statin pretreatment did not change the results. The results indicated that an association between poststroke lipids and prognosis may vary by sex. In women, lipids were not associated with the outcome; in men, lower TC and LDL were associated with worse prognosis. These differences can not be explained by statin use and require further research.
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PMID:Sex differences in the prognostic value of the lipid profile after the first ischemic stroke. 1925 78

Better assessment of the association between cardiovascular disease and osteoporosis in older men may help identify shared etiologies for bone and heart health in this population. We assessed the association of BMD and bone turnover markers (BTMs) with risk of cardiovascular events (myocardial infarction or stroke) in 744 men >or=50 yr of age. During the 7.5-yr prospective follow-up, 43 strokes and 40 myocardial infarctions occurred in 79 men. After adjustment for confounders (age, weight, height, smoking, education, physical activity, self-reported history of diabetes, hypertension, and prevalent ischemic heart disease), men in the lowest quartile of BMD at the spine, whole body, and forearm had a 2-fold increased risk of cardiovascular events. Men in the highest quartile of bone resorption markers (deoxypyridinoline [DPD], C-telopeptide of type I collagen) had a 2-fold increased risk of cardiovascular events (e.g., multivariable-adjusted hazard ratio [including additional adjustment for BMD] was 2.11 [95% CI: 1.26-3.56], for the highest quartile of free DPD relative to the lowest three quartiles). The results were similar for men without prevalent ischemic heart disease and for myocardial infarction and stroke analyzed separately. Our data suggest that men with low BMD or high bone resorption may be at increased risk of myocardial infarction and stroke in addition to fracture. Thus, men with osteoporosis may benefit from screening for cardiovascular disease. Further study to elucidate the biological mechanism shared by bone and vascular disease may help efforts to identify men at risk or develop treatment.
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PMID:Increased bone resorption is associated with increased risk of cardiovascular events in men: the MINOS study. 1945 64

The role of triglycerides in the risk of ischemic stroke remains controversial. We tested the hypothesis that increased levels of nonfasting triglycerides are associated with ischemic stroke in the general population. Men with a nonfasting triglyceride level 5 mmol/l had a multivariable, adjusted hazard ratio for ischemic stroke of 2.5 (95% confidence interval: 1.3-4.8) compared with men with a nonfasting triglyceride level < 1 mmol/l. The corresponding value in women was 3.8 (1.3-11). We conclude that the level of nonfasting triglycerides is associated with risk of ischemic stroke.
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PMID:[Nonfasting triglycerides and risk of ischemic stroke--secondary publication]. 1967 35

BACKGROUND: Studies of the lifestyle predictors of cardiovascular diseases (CVD) have been predominantly conducted in Caucasian populations. There are few data from other populations, such as Chinese men, who have different lifestyles and a different spectrum of CVD as compared with Caucasian populations. METHODS: Based on the baseline data of the Shanghai Men's Health Study during March 2002-June 2006, a matched case-control analysis including 518 myocardial infarction, 333 hemorrhagic stroke, and 1927 ischemic stroke cases was conducted. Five controls were selected for each case. The lifestyle factors under study included alcohol, tea and ginseng consumption, physical activity during adolescence, and weight change from age 20 to 40. The associations of these lifestyle factors with myocardial infarction and stroke were evaluated. To account for the misclassification of exposures and disease diagnosis, a sensitivity analysis was conducted. RESULTS: Alcohol consumption was inversely associated with myocardial infarction (OR=0.63, 95% CI: 0.50, 0.80). Tea consumption was inversely associated with hemorrhagic (OR=0.63, 95% CI: 0.49, 0.81) and ischemic stroke (OR=0.77, 95% CI: 0.69, 0.85). Weight increase from age 20 to 40 was positively associated with myocardial infarction and stroke in a dose-response manner (trend p<0.001). CONCLUSIONS: Alcohol and tea consumption may decrease the prevalence of myocardial infarction and stroke, respectively. Weight increase from age 20 to 40 may increase the prevalence of myocardial infarction and stroke in Chinese men.
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PMID:The association of alcohol, tea, and other modifiable lifestyle factors with myocardial infarction and stroke in Chinese men. 1973 Jul 1

Urinary incontinence (UI) in community-dwelling men affects quality of life and increases the risk of institutionalization. Observational studies and randomized, controlled trials published in English from 1990 to November 2007 on the epidemiology and prevention of UI were identified in several databases to abstract rates and adjusted odds ratios (OR) of incontinence, calculate absolute risk difference (ARD) after clinical interventions, and synthesize evidence with random-effects models. Of 1083 articles identified, 126 were eligible for analysis. Pooled prevalence of UI increased with age to 21% to 32% in elderly men. Poor general health, comorbidities, severe physical limitations, cognitive impairment, stroke (pooled OR 1.54; 95% confidence interval [CI], 1.14-2.1), urinary tract infections (pooled OR 3.49; 95% CI, 2.33-5.23), prostate diseases, and diabetes (pooled OR 1.36; 95% CI, 1.14-1.61) were associated with UI. Treatment with tolterodine alone (ARD 0.17; 95% CI, 0.02-0.32) or combined with tamsulosin (ARD 0.17; 95% CI, 0.08-0.25) resulted in greater self-reported benefit compared with placebo. Radical prostatectomy or radiotherapy for prostate cancer compared with watchful waiting increased UI. Short-term prevention of UI with pelvic floor muscle rehabilitation after prostatectomy was not consistently seen across randomized, controlled trials. The prevalence of incontinence increased with age and functional dependency. Stroke, diabetes, poor general health, radiation, and surgery for prostate cancer were associated with UI in community-dwelling men. Men reported overall benefit from drug treatments. Limited evidence of preventive effects of pelvic floor rehabilitation requires future investigation.
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PMID:Male urinary incontinence: prevalence, risk factors, and preventive interventions. 1991 40


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