Evidence map›Paper›PMID 36725338›Full record

ArticleNeurology2023

Lifetime Cumulative Effect of Reproductive Factors on Stroke and Its Subtypes in Postmenopausal Chinese Women: A Prospective Cohort Study.

Leying Hou, Shuting Li, Siyu Zhu, Qian Yi, Wen Liu, You Wu, Feitong Wu, Yuelong Ji, Peige Song, Kazem Rahimi

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
4.2field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 19 citations in OpenAlex.

  1. Review
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  11. Reproductive hormones in relation to white matter hyperintensity volumes among midlife women.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 3 countries.

Leying HouFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
Shuting LiFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
Siyu ZhuFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
Qian YiFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
Wen LiuFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
You WuFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
Feitong WuFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
Yuelong JiFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
Peige SongFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom. peigesong@zju.edu.cn.ORCID 0000-0002-0196-9759
Kazem RahimiFrom the School of Public Health and Women's Hospital (L.H., S.L., S.Z., Q.Y., W.L., P.S.), Zhejiang University School of Medicine, Hangzhou, China; School of Medicine (Y.W.), Tsinghua University, Institute for Hospital Management, Tsinghua University, Beijing, China; Menzies Institute for Medical Research (F.W.), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (F.W.), Melbourne, Australia; Department of Maternal and Child Health (Y.J.), School of Public Health, Peking University, Beijing, China; Nuffield Department of Women's & Reproductive Health (K.R.), University of Oxford, United Kingdom; and Deep Medicine Programme (K.R.), Oxford Martin School, University of Oxford, United Kingdom.
University of Tasmania · AU

Funding

British Heart FoundationCancer Research UK 29186Medical Research Council MC_U137686851Medical Research Council MC_UU_00017/1Wellcome Trust 212946/Z/18/Z
6 · The paper itself

Abstract

BACKGROUND AND

objectivesMultiple reproductive factors are associated with stroke. Little is known about the cumulative effects of reproductive factors during a reproductive life course on stroke and its subtypes, especially among female Chinese individuals. The objective of this study was to assess the associations of lifetime cumulative estrogen exposure due to reproductive factors with stroke and its etiologic subtypes among postmenopausal Chinese women.

methodsPostmenopausal women without prior stroke at baseline (2004-2008) were selected from the China Kadoorie Biobank (CKB). Lifetime cumulative estrogen exposure due to reproductive factors was assessed using 3 composite indicators: reproductive lifespan (RLS), endogenous estrogen exposure (EEE), and total estrogen exposure (TEE). Stroke and its subtypes, ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), were identified through linkage to a disease registry system and health insurance data during follow-up (2004-2015). Multivariable-adjusted Cox proportional hazards regression models were applied to estimate the adjusted hazard ratio (aHR) and 95% CIs for the risk of stroke by quartiles of RLS, EEE, and TEE, respectively.

resultsA total of 122,939 postmenopausal participants aged 40-79 years without prior stroke at baseline were included. During a median follow-up period of 8.9 years, 15,139 cases with new-onset stroke were identified, including 12,853 cases with IS, 2,580 cases with ICH, and 269 cases with SAH. Compared with the lowest quartile (Q1) of RLS, the highest quartile (Q4) had a lower risk of total stroke (aHR: 0.95, 95% CI 0.92-0.98), IS (aHR: 0.95, 95% CI 0.92-0.98), and ICH (aHR: 0.87, 95% CI 0.81-0.94). Both EEE and TEE displayed a graded association with the subsequent descending risk of total stroke (aHR for Q4 vs Q1: EEE: 0.85, 95% CI 0.82-0.89; TEE: 0.87, 95% CI 0.84-0.90), IS (aHR for Q4 vs Q1: EEE: 0.86, 95% CI 0.83-0.90; TEE: 0.86, 95% CI 0.83-0.89), and ICH (EEE: 0.73, 95% CI 0.65-0.81; TEE: 0.83,95% CI 0.76-0.91), with a DISCUSSION: Individuals' cumulative estrogen exposure due to reproductive factors could potentially be a valuable indicator for risk stratification of stroke events after menopause.

Indexed as

StrokeSubarachnoid HemorrhageCerebral HemorrhageEast Asian PeopleEstrogensFemaleHumansPostmenopauseProspective StudiesRisk FactorsEstrogens

Identifiers

PMID36725338
PMCPMC10103112
OpenAlexW4318762898

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.