Gender-Specific Risk Profiles for Acute Ischemic Stroke

According to a population-based cross-sectional study, the risk factor profile for acute ischemic stroke may differ based on gender.

The risk factor profile for acute ischemic stroke (AIS) differed on the basis of gender, according to results of a population-based cross-sectional study, published in BMC Neurology.

Study researchers retrospectively assessed data collected at PRISMA Health in the United States between 2010 and 2016 for risk factors for AIS.

Patients (N=5469) were split between men (n=2662) and women (n=2807). Men with AIS were younger (P <.001), had lower BMI (P =.002), and had significantly different medical histories, including atrial fibrillation (AF), depression, heart failure, hypertension, and migraines.

Risk factors for AIS among women included AF (adjusted odds ratio [aOR], 1.308; P =.016), heart failure (aOR, 1.468; P =.005), anti-hypertension medications (aOR, 1.549; P =.016), increased total cholesterol (aOR, 1.005; P <.001), increased high-density lipoprotein-cholesterol (aOR, 1.037; P <.001), and increased National Institutes of Health Stroke Scale (aOR, 1.022; P <.001).

Among men, risk factors for AIS were coronary artery disease (aOR, 0.544; P <.001), history of smoking (aOR, 0.608; P <.001), increased serum creatinine (aOR, 0.788; P <.001), increased diastolic blood pressure (aOR, 0.979; P =.001), and ambulation improvement/change (aOR, 0.829; P =.017).

Stratified by AF status, the unique risk factors for AIS among women with AF included increased low-density lipoprotein cholesterol (aOR, 1.006; P =.003) and absence of ambulation (aOR, 2.258; P =.001). Among women without AF, unique factors were

BMI (aOR, 0.968; P <.001), hormone replacement therapy (aOR, 0.016; P =.001), increased heart rate (aOR, 0.980; P <.001), and antihypertensive medications (aOR, 0.810; P =.026).

For men with AF, unique AIS risk features were drug and alcohol abuse (aOR, 0.250; P =.016) and sleep apnea (aOR, 0.321; P =.012). Among men without AF, associated factors were coronary artery disease (aOR, 1.754; P <.0001), drug and alcohol use (aOR, 3.560; P <.0001), international normalization ratio (aOR, 1.749; P =.003), and increased diastolic blood pressure (aOR, 1.024; P <.0001).

The area under the receiver operating characteristic curve (AUC) for the whole cohort was 0.729 (95% CI, 0.7112-0.746; P <.001). The AUC for patients with AF was 0.757 (95% CI, 0.721-0.793; P <.001) and without AF was 0.757 (95% CI, 0.740-0.774; P <.001).

Limitations of this study including the sourcing of data from a single center and that results may not be generalizable to other populations.

Based on their findings, study researchers concluded “that migraines, elevated HDL, and elevated LDL were associated with female AIS patients with a baseline AF, while drugs and alcohol abuse history, sleep apnea, and higher serum creatinine level were associated with male AIS with baseline AF.” They added that “further studies are necessary to determine whether gender differences in risk factor profiles and commodities require consideration in clinical practice when it comes to AF as a risk factor management in AIS patients.”


Rathfoot C, Edrissi C, Sanders CB, Knisely K, Poupore N, Nathaniel T. Gender differences in comorbidities and risk factors in ischemic stroke patients with a history of atrial fibrillation. BMC Neurol. 2021;21:209. doi:10.1186/s12883-021-02214-8