Hacking stroke in women: towards aetiology-driven precision prevention

Os, H.J.A. van (2023)

Doctoral Thesis

Stroke is one of the leading causes of disability and death worldwide. Prevention of stroke is therefore essential. Effective prevention should be tailored to the clinical characteristics, lifestyle, and environment of the individual, among others. This is also known as precision prevention. An important example illustrating the need for precision prevention is the existence of sex differences in stroke occurrence. In practice, for predicting stroke risk, only traditional risk factors (such as smoking and hypertension) are included, and women-specific risk factors are not yet routinely included. As a result, women with an increased risk of stroke may be missed, which also prevents timely initiation of preventive treatments. In this thesis, I tried to lay the foundation for precision prevention of stroke in women.
Part I discussed the pathophysiology underlying women-specific risk factors for stroke, and gender differences in the clinical presentation of stroke. I found that the mechanisms underlying the relationship between women-specific risk factors and stroke, in particular the relationship between migraine and cerebral infarctions, seem to be particularly significant in the childbearing phase of life.
In Part II, I described how health data from the EHR can be used to develop prediction models for the risk of myocardial infarction or stroke specifically for women under 50 years of age, and found that women-specific risk factors can add value in the predictions. However, there is still a long way to go to actually implement these models in practice, such as testing them on new datasets, and complying with current laws and regulations for safe application.

• Stroke
• Sex differences
• Migraine
• Big data
• Pathophysiology
• Epidemiology
• Prediction research
• Machine learning

• All authors: Os, H.J.A. van
• Supervisor: Wermer, M.J.H.; Ferrari, M.D.
• Co-supervisor: Bonten, T.N.
• Committee: Chavannes, N.H.; Vos, H.M.M.; Herings, R.M.C.; Visser, M.C.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2023-03-07
• ISBN (print): 9789464730326
• Sponsorship: Dutch Heart Foundation; ZonMw