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

Background and purpose: The aim was to investigate sex differences in the causes, clinical presentation, outcome and stroke recurrences in a large cohort of consecutive acute ischaemic stroke patients.

Methods: Patients from the Acute Stroke Registry and Analysis of Lausanne were included from March 2003 to April 2016. Multivariate analysis of clinical, pathophysiological and biological variables was conducted. The 12-month functional outcome using modified Rankin Scale shift analysis, 12-month mortality and cerebrovascular recurrences were compared 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, higher frequencies of several comorbidities were observed in women (migraine, hypothyroidism, depression/psychotic disorders) and of risk factors in men (more past cerebrovascular events, coronary artery disease, low cardiac ejection fraction, alcohol abuse and active cancer). Women had a lower body mass index and more pretreatment with antihypertensive drugs 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 modified Rankin Scale shift analysis, female sex was associated with less favourable functional outcome (odds ratio 1.19, 95% confidence interval 1.04-1.35), whilst 12-month mortality (hazard ratio 1.01, 95% confidence interval 0.86-1.19) and cerebrovascular recurrences (hazard ratio 1.14, 95% confidence interval 0.9-1.45) were similar.

Conclusions: In this retrospective analysis of consecutive acute ischaemic stroke 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.