Sex differences in acute ischaemic stroke patients: clinical presentation, causes and outcomes

Abstract

Background To investigate sex differences in causes, clinical presentation, outcome and stroke recurrences in a large cohort of consecutive acute ischemic stroke (AIS) patients. Methods Patients from the Acute STroke Registry and Analysis of Lausanne were included from 03/2003‐04/2016. Multivariate analysis of clinical, pathophysiological and biological variables was conducted. We compared 12‐month functional outcome using modified‐Rankin‐score (mRS) shift analysis, 12‐month mortality and cerebrovascular recurrences after adjustment for potential confounders. Results From 3993 patients, 44% were female, were older and had more pre‐stroke handicap than male patients. In the multivariate analysis, we observed higher frequencies of several comorbidities in women (migraine, hypothyroidism, depression/psychotic disorders) and risk factors in men (more past cerebrovascular events, coronary artery disease, low cardiac ejection fraction, alcohol abuse and active cancer). We found women had a lower body mass index, more pretreatment with antihypertensive but less with antidiabetic/lipid‐lowering or antiplatelet drugs. Stroke severity was higher in women, but men had more cerebellar signs. Stroke due to atherosclerosis, small vessel disease or multiple origins was less frequent in women. In the adjusted 12‐month mRS shift analysis, female sex was associated with less favorable functional outcome (OR 1.19, 95%CI 1.04‐1.35), while 12‐month mortality (HR 1.01,CI 0.86‐1.19) and cerebrovascular recurrences (HR 1.14,CI 0.9‐1.45) were similar. Conclusions In this retrospective analysis of consecutive AIS patients, women had higher age, more pre‐stroke handicap and less atherosclerotic, lacunar or multiple stroke mechanisms. Female sex was associated with higher levels of long‐term disability than men, but mortality and cerebrovascular recurrences were not significantly different.