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Coronary Heart Disease and Diabetes Worsen Ischaemic Stroke Outcome in Women: Presented at ANA
By Maggie Schwarz
WASHINGTON, DC -- October 12, 2007 -- "Of a wide array of diseases, coronary heart disease [CHD] and diabetes demonstrate a greater association with a worsened functional outcome following ischaemic stroke in women," stated Cheryl D. Bushnell, MD, MHS, speaking here at the 132nd Annual Meeting of the American Neurological Association (ANA).
Dr. Bushnell, Associate Professor of Neurology, Wake Forest University Health Sciences, Winston-Salem, North Carolina and colleagues at Duke University, undertook this study of the association of various comorbidities with poorer functional outcome after ischaemic stroke because the specific predictors of poorer outcome have not been traditionally well understood. It is known that women with ischaemic stroke suffer poorer functional outcomes than do men.
Baseline comorbid conditions were prospectively assessed in 133 women with ischaemic stroke, and initial stroke severity was measured with the NIH Stroke Scale. Outcome was determined with the modified Rankin Score (mRS), which ranges from 0 (no disability) to 5 (bedridden) at 90 days follow-up. Comorbidity was assigned using the modified Charlson Index -- a comorbidity index for outcome prediction. Stroke and hemiplegia were excluded, but CHD and diabetes were included.
CHD, but not Charlson Index, was the only clinical factor associated with initial stroke severity (P =.036). In multivariable modeling adjusted for initial National Institutes of Health Stroke Scale (NIHSS) results, independent predictors of disability were CHD (P =.002) and diabetes (P <.001). Charlson Index was the sole independent predictor of mRS (P <.0001) when diabetes and CHD were excluded.
The impact of comorbidities on poor outcome in women with ischaemic stroke, thus, is explained primarily by the presence of CHD and diabetes. Women with these conditions may benefit from targeted post-stroke rehabilitation and support programs to improve their outcome after stroke, said Dr. Bushnell.
"Women with CHD or diabetes should be treated aggressively to prevent stroke, which carries worse functional outcome than in men," Dr. Bushnell explained. "Primary-care physicians may use this result as a platform to discuss stroke in their female patients with CHD or diabetes. If a stroke does occur, chances are it will result in a worse disability than it would in a man."
Dr. Bushnell hopes to validate the result in a different cohort of patients, and to study the effect of comorbidities on women and men concurrently. "Whether the presence of CHD or diabetes raises risk of worse disability in both men and women, or in one gender more than the other will be interesting to find out," she concluded.
[Presentation title: Comorbidities and Disability in Women With Ischemic Stroke. Abstract S5]
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