Sex differences in lipid-lowering therapy after atherothrombotic ischemic stroke: The multicenter MaLIC study

Women have poorer outcomes after ischaemic stroke. The primary objective was to assess sex-based differences in the management and intensity of lipid-lowering therapy following non-cardioembolic ischaemic stroke or transient ischaemic attack (TIA). Secondary objectives were to analyse sex-based differences in vascular risk profile, pre-event functional status, and stroke severity.

Subanalysis of the second phase of the MaLIC study (Management of Stroke in Catalonia and the Balearic Islands), a prospective, multicentre study conducted in 20 hospitals. Adults with non-cardioembolic ischaemic stroke or TIA were included. Vascular risk factors, stroke severity, lipid profile, and intensity of lipid-lowering therapy at hospital discharge were compared according to sex.

A total of 591 patients were included, of whom 223 (37.7%) were women. Women were older (76 vs. 70 years; P<.0001), had greater pre-event functional dependence (mRS>2: 16.1% vs. 7.9%; P=.003), and a lower prevalence of ischaemic heart disease (4.9% vs. 14.4%; P<0001) and peripheral arterial disease (6.3% vs. 13.0%; P=.01). Although women had higher LDL cholesterol levels at admission (103.5 vs. 92mg/dl; P=.004), they were less frequently prescribed high-intensity lipid-lowering therapy at discharge (64.1% vs. 72.3%; P=.04). No differences were observed in stroke code activation or reperfusion therapies.

Women were less frequently prescribed high-intensity lipid-lowering therapy at discharge than men, despite having higher LDL cholesterol levels. These findings highlight an opportunity to optimise lipid-lowering therapy after the cerebrovascular event.