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Assessment of the interaction of age and sex on 90-day outcome after intracerebral hemorrhage

  1. Daniel Woo, MD, MS
  2. On behalf of the ERICH Investigators
  1. From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX.
    1. Correspondence to Dr. James: michael.james{at}duke.edu
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    Scientific Advisory Boards:

    1. (2) Oklahoma Medical Research Foundation, Wake Forest Nonhuman Primate Center

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    1. (2) NIH;

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    1. Rheumatic Disease Clinics

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    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. U01 NS069763-01 08/01/2010 - 07/31/2016 NINDS Minorities with Ischemic Stroke Study (ERICH) PI of Biostatistics and Bioinformatics Center P01 AR048929 09/01/2011 ? 08/30/2016 NIH Gene Expression in Pediatric Arthritis PI of Analysis Center Subcontract P30 CA12197 02/01/2012 ? 01/31/2017 NCI Comprehensive Cancer Center of Wake Forest University- Cancer Center Support Grant Co-Investigator HG007112 -01 05/01/2012 ? 03/31/2017 NIH Exome Sequencing to Identify CVD Risk Variants in Hispanic and African Americans Co-PI R01 DK090111-01 04/01/2011 - 03/31/2017 NIDDK Mapping Diabetes Susceptibility by expression traits in African Americans Co-Investigator R01 DK071891 07/01/2005 ? 06/30/2017 NIDDK Subclinical DVD in African American Type 2 Diabetes Co-Investigator R21 DK106554 08/01/2015 ? 07/31/2017 NIH Biomarkers for Molecular-Based-Decision-Making in Diagnosis and Treatment of Interstitial Cystitis Co-Investigator R01 HL 114587 06/01/2013 ? 05/31/2018 NIH Genetic Risk for Granulomatous Interstitial Lung Disease PI of Subcontract R01 HL119962 07/01/2013 ? 06/30/2018 NHLBI The Role of Hepatocyte ABCA1 in Lipid Metabolism and Transport Co-Investigator UG1 VA189824 08/01/2014 ? 07/31/2019 NCI Wake Forest NCORP Research Base Co-Investigator R01 NS093870 02/01/2016 ? 01/31/2021 NIH Recurrence of Stroke in Minority Populations Co-Investigator

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. RILITE Foundation 12/01/2015 ? 11/30/2017 Informing Drug Repositioning and Development Through Genomics PI

    Stock/Stock Options/Board of Directors Compensation:

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    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. salary from NIH grants. NINDS R01NS036695 U01NS069763

    Research Support, Academic Entities:

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    Employment, Commercial Entity:

    1. NONE

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    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

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    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) NINDS, R01NS030678, data manager, 2004-2017, (2) NINDS, R01NS036695, data manager, 2008-2013,2016-2017, (3) NINDS, R01NS039512, data manager, 2002-2012, (4) NINDS, K23NS049463, data manager, 2006-2011, (5) NINDS, U01NS069208, data manager, 2010?2014, (6) NINDS, U01NS069763, data manager, 2010-2016, (7) NINDS, U01NS086872, data analyst, 2014?2017, (8) NINDS, R01NS093878, data manager, 2016-2017

    Research Support, Academic Entities:

    1. NONE

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    1. NONE

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    Scientific Advisory Boards:

    1. (1) Boehringer-Ingelheim, Inc., anticoagulants and stroke (2014-2016); (2) BMS-Pfizer Partnership,anticoagulants and stroke (2014-2016); (3) Biotelemetry/Cardionet, monitoring for atrial fibrillation after stroke (2014- 2015); (6) Sanofi-Regeneron Partnership, alirocumab for atherosclerotic disease (2015- 2016)

    Gifts:

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    Editorial Boards:

    1. (1) Neurology, Resident and Fellow Section editor, published by American Academy of Neurology (2007-2015)

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    1. NONE

    Publishing Royalties:

    1. UpToDate, 2015, chapters on cryptogenic stroke and hemicraniectomy for acute stroke

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. (1) BMS-Pfizer Partnership, consultant regarding antithrombotics for stroke (2014); St. Jude's, consulting regarding cryptogenic stroke (2017)

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. (1) American Heart Association National Board of Directors (2014-2018); (2) American Heart Association Founders Affiliate Board of Directors(2008-2016); (2) American Heart Association NY City Board of Directors (2011-2017)

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) NIH/NINDS R01 29993, PI, 2007-2020 (2) NIH/NINDS P50 NS049060, Project 1, PI, NeuSTART, 2004- 2016

    Research Support, Academic Entities:

    1. NONE

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    Legal Proceedings:

    1. (1) Organon/Merck, NuvaRing and stroke litigation, 2009- 2016; (2) BMS-Sanofi Partnership, Plavix and stroke litigation (2015-2016); (3) Hi-Tech, DMAA and stroke litigation, 2015-2016

    Scientific Advisory Boards:

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    Editorial Boards:

    1. Neurology: Associate Editor 1 July 2009 - September 2015; Deputy Editor October 2015 - present Seminars in Neurology Editorial Board 2006-2014

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    Publishing Royalties:

    1. Chapter Author for Merritt's Neurology editions 10, 11, and 12.

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    Research Support, Government Entities:

    1. NINDS/NIH - R01 NS 069763 (co-investigator) 2010-2016 NINDS/NIH ? U-01 NS069208 (co-Prinicpal Investigator) 2010-2015 NHGRI/NIH ? U-01 HG005160 (co-Principal Investigator) 2009-2014

    Research Support, Academic Entities:

    1. University of Virginia - CENETERS OF EXCELLENCE CLINICAL RESEARCH GRANT SUPPORT - The UVA BRAIN AND AORTIC ANEURYSM SCREENING (BAAS) study - Principal Investigator 10/13-9/15

    Research Support, Foundations and Societies:

    1. NONE

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    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. (1) Neurotherapeutics, Section Edtior, Neuro-Critical Care Section, 2011 (2) Current Treatment Options in Neurology, Section Editor, 2009-present (3) Editorial Board, Neurology Today (4) Editorial Board, Neurosurgery (5) Editorial Board, Neurocritical Care (6) Editorial Board, Stroke (7) Edtorial Board, Neurology

    Patents:

    1. Provisional patent (1) Stroke detection technology

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Remedy Pharmaceuticals, Bard, Stryker

    Research Support, Government Entities:

    1. (1) NIH, (2) AHA

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. American Academy of Neurology Clinical Research Fellowship, American Heart Association Passano Foundation

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

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    1. NONE

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    1. NONE

    Research Support, Government Entities:

    1. NIH/ NINDS T32 NS047996 trainee, 2010-2012

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    1. NONE

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    1. NONE

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    Research Support, Government Entities:

    1. Ethnic/Racial Variations with Intracerebral Hemorrhage NIH-NS-069763 Genetic and Environmental Risk Factor for Hemorrhagic Stroke NIH-NS-036695

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    1. NONE

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    1. (1) Stroke Research and Treatment, Associate Editor, 2010-2014.

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    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NIH Funding: NS36695 (PI: 1998-Current); NS30678 (CoI: 1998-Current). NS69763 (PI: 2010-Current).

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

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    Abstract

    Objective: Because age affects hormonal production differently in women compared with men, we sought to define sex and age interactions across a multiracial/ethnic population after intracerebral hemorrhage (ICH) to uncover evidence that loss of gonadal hormone production would result in loss of the known neuroprotective effects of gonadal hormones.

    Methods: Clinical and radiographic data from participants in the Ethnic/Racial Variations of Intracerebral Hemorrhage study and the Genetic and Environmental Risk Factors for Hemorrhagic Stroke study prior to December 2013 were used. Relationships among sex, age, and outcome after ICH in 616 non-Hispanic black, 590 Hispanic, and 868 non-Hispanic white participants were evaluated using multivariable logistic regression analysis. Poor outcome was defined as modified Rankin Scale score ≥3 at 90 days after ICH.

    Results: Sex differences were found in multiple variables among the racial/ethnic groups, including age at onset, premorbid neurologic status, and neurologic outcome after ICH. Overall, no sex–age interaction effect was found for mortality (p = 0.183) or modified Rankin Scale score (p = 0.378) at 90 days after ICH. In racial/ethnic subgroups, only the non-Hispanic black cohort provided possible evidence of a sex–age interaction on 90-day modified Rankin Scale score (p = 0.003).

    Conclusion: Unlike in ischemic stroke, there was no evidence that patient sex modified the effect of age on 90-day outcomes after ICH in a large multiracial/ethnic population. Future studies should evaluate biological reasons for these differences between stroke subtypes.

    Clinicaltrials.gov identifier: NCT01202864.

    • Received March 8, 2016.
    • Accepted in final form January 25, 2017.

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

    OPEN ACCESS ARTICLE
    1. Published online before print July 14, 2017, doi: 10.1212/WNL.0000000000004255 Neurology 10.1212/WNL.0000000000004255
    1. Free via Open Access: OA
    2. » Abstract
    3. Full Text (PDF)
    4. Data Supplement
    5. Coinvestigators

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