Female patients who experienced strokes may have a lower prevalence of cerebral microbleeds but a higher risk of mortality when they occur, according to a new study.
In the cohort study, published in JAMA Network Open, investigators examined sex-based differences in cerebral small vessel disease markers, including cerebral microbleeds (CMB), lacunes, and white matter hyperintensities. The analysis included 20,314 patients (mean age = 70.1 years, 57.7% male) with ischemic stroke or transient ischemic attack, pooling data from 38 cohort studies across 18 countries. The objective of the study was to determine variations in the frequency, severity, and outcomes of small vessel disease (SVD) markers between male and female patients.
Key results showed that CMBs were more prevalent in male patients compared with female patients (28.5% vs 26.9%). After adjusting for confounding variables, female patients had a lower prevalence of CMBs (adjusted odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.80–0.92) and lacunes (adjusted OR = 0.82, 95% CI = 0.74–0.90) compared with male patients. Further, female patients had a higher prevalence of severe white matter hyperintensities (adjusted OR = 1.10, 95% CI = 1.01–1.20).
During a median follow-up of 1.4 years, 11.9% of the patients died. The presence of CMBs was linked to a higher risk of mortality in female patients (hazard ratio [HR] = 1.15, 95% CI = 1.02–1.31) but not in male patients (HR = 0.95, 95% CI = 0.84–1.07). Recurrent ischemic stroke occurred in 5.5% of the patients, and 0.9% of them experienced recurrent intracranial hemorrhage, with no statistically significant differences in these outcomes between the male and female patients.
These findings indicated potential pathophysiological differences in the manifestation and severity of SVD between male and female patients.
Full disclosures can be found in the published study.