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Sex Differences in Onset and Progression of Cerebral Amyloid Angiopathy

Authors :
Emma A. Koemans
Juan Pablo Castello
Ingeborg Rasing
Jessica R. Abramson
Sabine Voigt
Valentina Perosa
Thijs W. van Harten
Erik W. van Zwet
Gisela M. Terwindt
M. Edip Gurol
Jonathan Rosand
Steven M. Greenberg
Marianne A.A. van Walderveen
Alessandro Biffi
Anand Viswanathan
Marieke J.H. Wermer
Source :
Stroke. 54:306-314
Publication Year :
2023
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2023.

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.

Details

ISSN :
15244628 and 00392499
Volume :
54
Database :
OpenAIRE
Journal :
Stroke
Accession number :
edsair.doi...........78a0c0ace70a8cf794e7671b66b5980f
Full Text :
https://doi.org/10.1161/strokeaha.122.040823