Sex Differences in Intracranial Atherosclerosis in Patients With Hypertension With Acute Ischemic Stroke.
Jae W SongJiayu XiaoSteven Y CenXiao LiuFang WuKonrad SchlickDebiao LiQi YangShlee S SongZhaoyang FanPublished in: Journal of the American Heart Association (2022)
Background Studies suggest the presence of sex differences in hypertension prevalence and its associated outcomes in atherosclerosis and stroke. We hypothesized a higher intracranial atherosclerosis burden among men with hypertension and acute ischemic stroke compared with women. Methods and Results A multicenter retrospective study was performed from a prospective database identifying patients with hypertension presenting with intracranial atherosclerosis-related acute ischemic stroke and imaged with intracranial vessel wall magnetic resonance imaging. Proximal and distal plaques on vessel wall magnetic resonance imaging were scored. Negative binomial models assessed the associations between plaque-count and sex and the interaction between sex and treatment. Covariates were selected by a least absolute shrinkage and selection operator procedure. Sixty-one patients (n=42 men) were included. There were no significant differences in demographic or cardiovascular risk factors except for smoking history ( P =0.002). Adjusted total and proximal plaque counts for men were 1.6 (95% CI, 1.2-2.1; P <0.01) and 1.4 (95% CI, 1.0-1.9; P =0.03) times as high as women, respectively. Female sex was more protective for proximal plaque if treated for hypertension. The risk ratio of men versus women was 1.5 (95% CI, 1.0-2.1) for treated patients. The risk ratio of men versus women was 0.7 (95% CI, 0.4-1.3) for untreated patients. The relative difference between these 2 risk ratios was 2.0 (95% CI, 1.1-3.9), which was statistically significant from the interaction test, P =0.04. Conclusions Men with hypertension with acute ischemic stroke have significantly higher total and proximal plaque burdens than women. Women with hypertension on anti-hypertensive medication showed a greater reduction in proximal plaque burden than men. Further confirmation with a longitudinal cohort study is needed and may help evaluate whether different treatment guidelines for managing hypertension by sex can help reduce intracranial atherosclerosis burden and ultimately acute ischemic stroke risk.
Keyphrases
- acute ischemic stroke
- blood pressure
- magnetic resonance imaging
- end stage renal disease
- newly diagnosed
- polycystic ovary syndrome
- cardiovascular disease
- ejection fraction
- coronary artery disease
- chronic kidney disease
- middle aged
- prognostic factors
- peritoneal dialysis
- healthcare
- computed tomography
- pregnancy outcomes
- type diabetes
- risk factors
- emergency department
- clinical trial
- optic nerve
- breast cancer risk
- atrial fibrillation
- pregnant women
- adipose tissue
- patient reported
- skeletal muscle
- cervical cancer screening
- peripheral blood