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Sex Differences in Frequency, Severity, and Distribution of Cerebral Microbleeds
Simon Fandler-Höfler1,2, Sebastian Eppinger1,3, Gareth Ambler4
1Department of Neurology, Medical University of Graz, Graz, Austria.
JAMA Network Open
|October 15, 2024
Summary
Sex differences exist in cerebral small vessel disease (SVD) markers like cerebral microbleeds (CMB) and lacunes. These variations suggest potential underlying pathophysiological differences between males and females in SVD manifestation and outcomes.
Area of Science:
- Neurology
- Radiology
- Epidemiology
Background:
- Cerebral small vessel disease (SVD) is a significant contributor to cerebrovascular outcomes.
- Limited data exists regarding sex-based differences in the prevalence, severity, and impact of SVD.
Purpose of the Study:
- To investigate sex-specific differences in the frequency, severity, and distribution of cerebral microbleeds (CMB) and other SVD markers.
- To explore sex differences in outcomes such as mortality and recurrent cerebrovascular events following SVD.
Main Methods:
- Pooled individual patient data from 38 prospective cohort studies (Microbleeds International Collaborative Network) were analyzed.
- Magnetic resonance imaging (MRI) was used to identify SVD markers including CMB, lacunes, and white matter hyperintensities.
- Multivariable regression models were employed to assess sex differences in SVD markers and clinical outcomes.
Main Results:
- Cerebral microbleeds (CMB) were more frequent in male patients (adjusted odds ratio [aOR], 0.86; P < .001).
- Female patients exhibited fewer lacunes (aOR, 0.82; P < .001) but more severe white matter hyperintensities (aOR, 1.10; P = .04) compared to males.
- CMB presence was linked to increased mortality risk in females (hazard ratio, 1.15; P = .01), but not in males.
Conclusions:
- Significant sex differences were observed in the prevalence of SVD markers, suggesting distinct pathophysiological pathways.
- Further research is warranted to elucidate the specific pathomechanisms and clinical implications of SVD in relation to sex.
