Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis-Reference-Cited by-同舟云学术

Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis

Published:2022-02 Issue:2 Volume:53 Page:362-369
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Zuurbier Charlotte C.M.¹^ORCID,Molenberg Rob²^ORCID,Mensing Liselore A.¹,Wermer Marieke J.H.³^ORCID,Juvela Seppo⁴^ORCID,Lindgren Antti E.⁵⁶⁷^ORCID,Jääskeläinen Juha E.⁵⁶⁷,Koivisto Timo⁵⁶⁷,Yamazaki Tomosato⁸,Uyttenboogaart Maarten⁹^ORCID,van Dijk J. Marc C.²^ORCID,Aalbers Marlien W.²,Morita Akio¹⁰^ORCID,Tominari Shinjiro¹¹,Arai Hajime¹²,Nozaki Kazuhiko¹³^ORCID,Murayama Yuichi¹⁴^ORCID,Ishibashi Toshihiro¹⁴^ORCID,Takao Hiroyuki¹⁴^ORCID,Gondar Renato¹⁵^ORCID,Bijlenga Philippe¹⁵,Rinkel Gabriel J.E.¹,Greving Jacoba P.¹⁶^ORCID,Ruigrok Ynte M.¹^ORCID

Affiliation:

1. UMC Utrecht Brain Center, Department of Neurology and Neurosurgery (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.), University Medical Center Utrecht, the Netherlands.

2. Departments of Neurosurgery (R.M., J.M.C.v.D., M.W.A.), University Medical Center Groningen, the Netherlands.

3. Department of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.).

4. Department of Clinical Neurosciences, University of Helsinki, Finland (S.J.).

5. Department of Clinical Radiology (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland.

6. Neurosurgery of NeuroCenter (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland.

7. Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.).

8. Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Japan (T.Y.).

9. Neurology and Medical Imaging Center (M.U.), University Medical Center Groningen, the Netherlands.

10. Medical Center UCAS Japan Coordinating Office- University of Tokyo- Nippon Medical School, Neurological Surgery (A.M.).

11. Department of Health Informatics, School of Public Health, Kyoto University, Japan (S.T.).

12. Department of Neurosurgery, Juntendo University- Medical School, Tokyo, Japan (H.A.).

13. Department of Neurosurgery, Shiga University of Medical Science, Japan (K.N.).

14. Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.).

15. Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.).

16. Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, the Netherlands.

Abstract

Background and Purpose: In previous studies, women had a higher risk of rupture of intracranial aneurysms than men, but female sex was not an independent risk factor. This may be explained by a higher prevalence of patient- or aneurysm-related risk factors for rupture in women than in men or by insufficient power of previous studies. We assessed sex differences in rupture rate taking into account other patient- and aneurysm-related risk factors for aneurysmal rupture. Methods: We searched Embase and Pubmed for articles published until December 1, 2020. Cohorts with available individual patient data were included in our meta-analysis. We compared rupture rates of women versus men using a Cox proportional hazard regression model adjusted for the PHASES score (Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm, Site of Aneurysm), smoking, and a positive family history of aneurysmal subarachnoid hemorrhage. Results: We pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12 193 unruptured intracranial aneurysms, and 24 357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%/person-years [95% CI, 0.89–1.21]) and 63 men (rupture rate 0.74%/person-years [95% CI, 0.58–0.94]). Women were older (61.9 versus 59.5 years), were less often smokers (20% versus 44%), more often had internal carotid artery aneurysms (24% versus 17%), and larger sized aneurysms (≥7 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07–1.93) and the adjusted women/men ratio was 1.39 (95% CI, 1.02–1.90). Conclusions: Women have a higher risk of aneurysmal rupture than men and this sex difference is not explained by differences in patient- and aneurysm-related risk factors for aneurysmal rupture. Future studies should focus on the factors explaining the higher risk of aneurysmal rupture in women.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

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

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