Sex differences in the association between major risk factors and the risk of stroke in the UK Biobank cohort study

Sanne A E Peters; Cheryl Carcel; Elizabeth R C Millett; Mark Woodward

doi:10.1212/WNL.0000000000010982

Sex differences in the association between major risk factors and the risk of stroke in the UK Biobank cohort study

Neurology. 2020 Nov 17;95(20):e2715-e2726. doi: 10.1212/WNL.0000000000010982. Epub 2020 Oct 16.

Authors

Sanne A E Peters¹, Cheryl Carcel², Elizabeth R C Millett¹, Mark Woodward²

Affiliations

¹ From The George Institute for Global Health (S.A.E.P., E.R.C.M., M.W.), University of Oxford, UK; Julius Center for Health Sciences and Primary Care (S.A.E.P.), University Medical Center Utrecht, Utrecht University, the Netherlands; The George Institute for Global Health (C.C., M.W.), University of New South Wales; The University of Sydney (C.C.), Sydney School of Public Health, Sydney Medical School, New South Wales, Australia; and Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD. [email protected].
² From The George Institute for Global Health (S.A.E.P., E.R.C.M., M.W.), University of Oxford, UK; Julius Center for Health Sciences and Primary Care (S.A.E.P.), University Medical Center Utrecht, Utrecht University, the Netherlands; The George Institute for Global Health (C.C., M.W.), University of New South Wales; The University of Sydney (C.C.), Sydney School of Public Health, Sydney Medical School, New South Wales, Australia; and Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD.

Abstract

Objective: To determine whether there are sex differences in the association between risk factors and incident stroke, including stroke subtypes.

Methods: A total of 471,971 (56% women) UK Biobank participants without a history of cardiovascular disease were included. During 9 years of follow-up, 4,662 (44% women) cases of stroke were recorded. Cox models yielded adjusted hazard ratios (HRs) and women-to-men ratios of HRs (RHRs) for stroke associated with 7 risk factors.

Results: The incidence rate per 10,000 person-years was 8.66 (8.29-9.04) in women and 13.96 (13.44-14.50) in men for any stroke, 6.06 (5.75-6.38) in women and 11.35 (10.88; 11.84) in men for ischemic stroke, and 1.56 (1.41-1.73) in women and 2.23 (2.02-2.45) in men for hemorrhagic stroke. The association between increases in blood pressure, body anthropometry, and lipids, diabetes, and atrial fibrillation and any stroke was similar between men and women. Hypertension, smoking, and a low socioeconomic status were associated with a greater HR of any stroke in women than men; the RHRs were 1.36 (1.26-1.47), 1.18 (1.02-1.36), and 1.17 (1.03-1.33), respectively. Diabetes was associated with a higher HR of ischemic stroke in women than men (RHR 1.25 [1.00-1.56]). Atrial fibrillation was associated with a higher HR of hemorrhagic stroke in women than men (RHR 2.80 [1.07-7.36]).

Conclusion: Several risk factors are more strongly associated with the risk of any stroke or stroke subtypes in women compared with men. Despite this, the incidence of stroke remains higher among men than women.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Atrial Fibrillation / complications
Atrial Fibrillation / epidemiology
Biological Specimen Banks
Brain Ischemia / complications
Brain Ischemia / epidemiology*
Cerebral Hemorrhage / complications
Cerebral Hemorrhage / epidemiology*
Cohort Studies
Diabetes Mellitus / epidemiology
Female
Humans
Hypertension / complications
Hypertension / epidemiology
Incidence
Male
Middle Aged
Risk Factors
Sex Factors*
Smoking / adverse effects
Smoking / epidemiology
Socioeconomic Factors
Stroke / epidemiology*
Stroke / etiology
United Kingdom / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding