In the Journals

Stroke risk factors are sex-specific

Individualized stroke risk assessments that consider female- and male- specific characteristics can improve accuracy of risk scores, according to findings published in JAMA Neurology.

“The incidence of stroke is higher in men than in women,” Michiel H.F. Poorthuis, MD, from the department of neurology and neurosurgery at the University Medical Center Utrecht, the Netherlands, and colleagues wrote. “The influence of sex-specific risk factors on stroke incidence and mortality is largely unknown.”

Poorthuis and colleagues performed a systematic review and meta-analysis of observational studies published between Jan. 1, 1985, and Jan. 26, 2015, that evaluated sex-specific factors and their association with stroke. They used a generic variance-based, random-effects method to pool estimates. Seventy longitudinal studies and eight case-control studies involving 10,187,540 patients met inclusion criteria.

The researchers found an increased risk for ischemic stroke in women who had any hypertensive disorder in pregnancy, such as gestational hypertension, preeclampsia or eclampsia had (pooled RR = 1.8; 95% CI, 1.49-2.18). Women with late menopause occurring at the age of at least 55 years (pooled RR = 2.24; 95% CI, 1.19-4.21) and a history of gestational hypertension (pooled RR = 5.08; 95% CI, 1.8-14.34) had an increased risk for hemorrhagic stroke. There was an increased risk for any stroke in women with a history of oophorectomy (pooled RR = 1.42; 95%CI, 1.34-1.5), any hypertensive disorder in pregnancy (pooled RR = 1.63; 95%CI, 1.52-1.75), preeclampsia or eclampsia (pooled RR = 1.54; 95%CI, 1.39-1.7), gestational hypertension (pooled RR = 1.51; 95%CI, 1.27-1.8), preterm delivery (pooled RR = 1.62; 95%CI, 1.46-1.79) and stillbirth (pooled RR = 1.86; 95%CI, 1.15-3.02).

Conversely, there was a reduced risk for any stroke for women who had a hysterectomy (pooled RR = 0.88; 95%CI, 0.85-0.9). In women with a history of gestational hypertension the pooled RR of stroke mortality was 1.57 (95% CI, 1.04-2.39).

Men with a history of androgen deprivation therapy had an increased risk for ischemic stroke (pooled RR = 1.19; 95% CI, 1.05-1.34) and any stroke (pooled RR =1.21; 95%CI, 1.06-1.37). In addition, men who had an orchiectomy had an increased risk for ischemic stroke (pooled RR = 1.21; 95% CI, 1-1.46) and men with erectile dysfunction had an increased risk for any stroke (pooled RR = 1.35 [95%CI, 1.18-1.53]).

“These sex-specific variables could be helpful in identifying specific patient groups with an increased risk of stroke, and individual risk factors should be considered in recommendations on primary prevention of stroke and in secondary prevention of stroke in patients with manifest cardiovascular disease,” Poorthuis and colleagues wrote. – by Alaina Tedesco

Disclosure: Poorthuis reports no relevant financial disclosures. Please see full study for complete list of all other authors’ disclosures.