Sex Differences in Onset and Progression of Cerebral Amyloid Angiopathy-Reference-Cited by-同舟云学术

Sex Differences in Onset and Progression of Cerebral Amyloid Angiopathy

Published:2023-02 Issue:2 Volume:54 Page:306-314
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Koemans Emma A.¹^ORCID,Castello Juan Pablo²³⁴,Rasing Ingeborg¹^ORCID,Abramson Jessica R.²³^ORCID,Voigt Sabine¹⁵^ORCID,Perosa Valentina³⁶^ORCID,van Harten Thijs W.⁵^ORCID,van Zwet Erik W.⁷,Terwindt Gisela M.¹^ORCID,Gurol M. Edip³^ORCID,Rosand Jonathan²³^ORCID,Greenberg Steven M.³^ORCID,van Walderveen Marianne A.A.⁵^ORCID,Biffi Alessandro²³^ORCID,Viswanathan Anand³^ORCID,Wermer Marieke J.H.¹^ORCID

Affiliation:

1. Department of Neurology, Leiden University Medical Center, the Netherlands (E.A.K., I.R., S.V., G.M.T., M.J.H.W.).

2. Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., J.R., A.B.).

3. Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.P.C., J.R.A., V.P., M.E.G., J.R., S.M.G., A.B., A.V.).

4. Department of Neurology, University of Miami Miller School of Medicine, FL (J.P.C.).

5. Department of Radiology, Leiden University Medical Center, the Netherlands (S.V., T.W.v.H., M.A.A.v.W.).

6. Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany (V.P.).

7. Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands (E.W.v.Z.).

Abstract

Background: Cerebral Amyloid Angiopathy (CAA) disease course is highly variable even in hereditary forms. Sex may be a possible modifying factor. We investigated biological sex differences in clinical disease course and magnetic resonance imaging-markers in sporadic (sCAA) and Dutch-type hereditary CAA (D-CAA). Methods: Patients with D-CAA and sCAA were included from hospital and research databases of the Leiden University Medical Center (2012–2020) and Massachusetts General Hospital (1994–2012). Key outcomes were: sex differences in symptomatic intracerebral hemorrhage (sICH) onset, recurrence and survival (analyzed using Kaplan Meier survival and regression analyses), and sex differences in magnetic resonance imaging-markers in D-CAA (explored using scatterplots), and in sCAA (investigated using regression analysis). Results: We included 136 patients with D-CAA (mean age 57 years, 56% women, 64% with previous sICH) and 370 patients with sCAA (mean age 76 years, 51% women, all with previous sICH). Men and women with D-CAA did not differ for sICH onset (median age 54 in men and 56 in women [ P =0.13]). Men with D-CAA had a slightly higher number of sICH compared with women (median 2 versus 1; adjusted RR, 1.5 [95% CI, 1.1–1.9]) and a shorter interval between the first and second sICH (median 1.8 years for men and 3.1 years for women, P =0.02). Men with sCAA had their first sICH at an earlier age (median 75 versus 78 years, respectively, P =0.003) and more lobar microbleeds (median 1 versus 0, P =0.022) compared with women with sCAA. No substantial differences were found in the other magnetic resonance imaging markers. Survival after first sICH was comparable between sexes for D-CAA ( P =0.12) and sCAA ( P =0.23). Conclusions: Men with CAA seem to have an earlier onset (sCAA) and more hemorrhagic disease course (sCAA and D-CAA) compared with women. Future studies are necessary to confirm these findings and determine the underlying role of sex-related factors.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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