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

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http://hdl.handle.net/10138/340551

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Zuurbier , C C M , Molenberg , R , Mensing , L A , Wermer , M J H , Juvela , S , Lindgren , A E , Jääskeläinen , J E , Koivisto , T , Yamazaki , T , Uyttenboogaart , M , van Dijk , J M C , Aalbers , M W , Morita , A , Tominari , S , Arai , H , Nozaki , K , Murayama , Y , Ishibashi , T , Takao , H , Gondar , R , Bijlenga , P , Rinkel , G J E , Greving , J P & Ruigrok , Y M 2022 , ' Sex Difference and Rupture Rate of Intracranial Aneurysms : An Individual Patient Data Meta-Analysis ' , Stroke , vol. 53 , no. 2 , pp. 362-369 . https://doi.org/10.1161/STROKEAHA.121.035187

Title: Sex Difference and Rupture Rate of Intracranial Aneurysms : An Individual Patient Data Meta-Analysis
Author: Zuurbier, Charlotte C.M.; Molenberg, Rob; Mensing, Liselore A.; Wermer, Marieke J.H.; Juvela, Seppo; Lindgren, Antti E.; Jääskeläinen, Juha E.; Koivisto, Timo; Yamazaki, Tomosato; Uyttenboogaart, Maarten; van Dijk, J. Marc C.; Aalbers, Marlien W.; Morita, Akio; Tominari, Shinjiro; Arai, Hajime; Nozaki, Kazuhiko; Murayama, Yuichi; Ishibashi, Toshihiro; Takao, Hiroyuki; Gondar, Renato; Bijlenga, Philippe; Rinkel, Gabriel J.E.; Greving, Jacoba P.; Ruigrok, Ynte M.
Contributor organization: HUS Neurocenter
Neurokirurgian yksikkö
Department of Neurosciences
Clinicum
Date: 2022-02
Language: eng
Number of pages: 8
Belongs to series: Stroke
ISSN: 0039-2499
DOI: https://doi.org/10.1161/STROKEAHA.121.035187
URI: http://hdl.handle.net/10138/340551
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.
Subject: intracranial aneurysm
prevalence
risk factor
sex
subarachnoid hemorrhage
UNRUPTURED CEREBRAL ANEURYSMS
NATURAL-HISTORY
RISK-FACTORS
SUBARACHNOID HEMORRHAGE
ANGIOGRAPHY
PREDICTION
EMPHASIS
GROWTH
AGE
3112 Neurosciences
3124 Neurology and psychiatry
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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