Stroke Risk Factors Differ Between Younger Men and Women

Daniel M. Keller, PhD

November 23, 2015

SANTIAGO, Chile — Among younger individuals with ischemic strokes, men and women differ in the cause of stroke, arterial territories, outcomes, and risk factors, a study shows.

"The modifiable risk factors have a high occurrence in both genders," Ielyzaveta Zinchenko, MD, from the stroke unit at Strasbourg University Hospital in France, said. "If we looked at the differences between genders, we can see that men had statistically more risk factors [such] as cannabis use and drinking."

Men also had a higher prevalence of the modifiable risk factors dyslipidemia, hypertension, and diabetes.

Dr Zinchenko reported her findings here at the XXII World Congress of Neurology (WCN).

The incidence, causes, and risk factors for stroke differ between younger and older patients. Although sex differences exist for cerebrovascular disease between the sexes over the lifetime, few studies have addressed sex differences in stroke among younger patients.

Dr Zinchenko and colleagues therefore performed a prospective study of patients younger than 45 years with an acute ischemic stroke confirmed by MRI between 2005 and 2014. They assessed risk factors, clinical characteristics of the patients, vascular health, cardiac structure and function, and clinical presentation of the stroke, and they also performed toxicologic screening. The mean age of both men and women was about 36 years.

The prevalence of atrial fibrillation did not differ between men and women (2.2% vs 3.7%, respectively; P = .52), but men had more modifiable and potentially modifiable risk factors than women.

Table. Risk Factors Among Younger Ischemic Stroke Patients by Sex

Endpoint Men (n = 175) (%) Women (n = 159) (%) P Value
Modifiable risk factors      
  Cigarette smoking 54.8 44.0 .062
  Regular cannabis use 23.4 10.6 .003
  Heavy drinking 22.8 6.2 <.001
Potentially modifiable risk factors      
  Dyslipidemia 49.7 32.0 .004
  History of migraine 12.5 37.1 <.001
     Without aura 8.0 26.4 <.001
     With aura 4.5 10.6 .09
  Hypertension 30.2 16.3 .004
  Diabetes type 1 or 2 7.4 1.8 .03


The only stroke cause that differed between the sexes was dissection in the cervical arteries. It affected 8% of men and 15% of women in the study (P = .006).

Women had more anterior territory strokes (70%) than men (52.6%; P = .001), so conversely, men had more posterior territory strokes (P = .002). Only 3% to 4% of each sex had strokes in both areas.

Presenting symptoms at admission were generally similar, but because of the affected arterial territories men had more cerebellar symptoms than women (5.7% vs 0.6%, respectively; P < .001).

Also at discharge, men had more cerebellar symptoms (7% vs 1.2%, respectively; P = .02), as well as more dysarthria (13.5% vs 4.5%; P < .001).

Generally Good Outcomes

"As to functional outcome, we found no differences between genders, and functional outcome was favorable in 90% of cases," Dr Zinchenko reported.

At 3 to 6 months, approximately 80% of each sex had a modified Rankin Scale (mRS) score of 0 to 1. Another 10% had an mRS score of 2. Very few patients died in either group.

She concluded that "gender influences many aspects of ischemic stroke, including stroke risk, incidence, diagnosis, symptoms, and outcomes," and pointed out that although both sexes had a high prevalence of modifiable risk factors, men in particular had a high occurrence of lifestyle risk factors of heavy drinking and cannabis use as well as hypertension, diabetes, and dyslipidemia.

Men therefore may be targets for more intensive risk factor control, but both sexes could probably benefit as they have potentially many years of life to gain, she said.

Dr Zinchenko also suggested that clinicians be aware of intracranial arterial stenosis, which was the second most common stroke cause (20.5% of men, 18.2% of women) after cardioembolism (26.2% vs 27%, respectively).

Session chairman Didier Leys, MD, PhD, professor of neurology at the University of Lille in France, told Medscape Medical News that this study presents an important message.

"Most of these young people who have an ischemic stroke have risk factors…the advice we can give is not to smoke, not to drink, not to use cannabis, and so on. But this is a message for all the population, not specifically for these patients," he advised.

Younger people are often less accessible than older ones for prevention messages; thus, risk factors may first be detected at the time of a stroke. So secondary prevention is important, Dr Leys said, "because we know that recurrent strokes are more severe and with cognitive impairment, and epilepsy, and so on."

Although he works 400 km from Strasbourg, Dr Leys said he was surprised that cannabis consumption was so high there. It is estimated to be much lower in Lille and in Heidelberg, Germany, which are only 200 km from Strasbourg. He said perhaps authorities or the medical communities are not doing a good job of detecting it in their areas. And the approximately 50% occurrence of cigarette smoking in both men and women was also higher than what he sees in his practice.

The study did not receive any commercial funding. Dr Zinchenko and Dr Leys have disclosed no relevant financial relationships.

XXII World Congress of Neurology (WCN). Abstract 317. Presented November 2, 2015.


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