Risk factors for the development of the ischemic stroke in the carotid arterial system in males and females

Introduction. Biologically determined differences between males and females and different levels of sex hormones determine some specific features of their ischemic stroke (IS). Clinical studies aimed at identifying risk factors for the development of IS in persons of different sexes are considered to be necessary for elaborating strategies to increase life expectancy and to improve quality of life.

Objective: to study risk factors for the development of IS in the arteries of the carotid system in males and females.

Materials and methods. Risk factors for the development of IS in the arteries of the carotid system were analyzed in 268 patients for the period from 2010 to 2017. Among the patients, there were 148 (55%) men and 120 (45%) women aged from 47 to 79 years. MRI of the brain, duplex scanning of the cerebral arteries, and transthoracic and transesophageal echocardiography were used to establish the diagnosis of the stroke subtype.

Results. In the age group 47-79 years, females had more often cardioembolic and lacunar stroke, while males had predominantly atherothrombotic  stroke  and stroke with competing causes. Atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease and excess body weight were also more common in females. In contrast, there were significantly more smokers and over-consumption of alcohol among males, and the same was true for small heart attacks and transient symptoms in the past history. Atherosclerosis of the extracranial part of the internal carotid artery (ICA) of high degree was found more often in males, while females with atherothrombotic stroke had significantly higher blood cholesterol level. The study of arterial hypertension (AH) revealed the following differences between groups: AH III degree (180/110 mm Hg or higher) was more often in females, and AH I degree (140-159 / 90-99 mm Hg) in males, while  the proportion of patients with grade II AH (160-179 / 100-109 mm Hg) and patients without AH  was approximately equal in the two groups.

Conclusions. The risk factors for the development of IS in the arteries of the carotid system in men are atherosclerotic carotid stenosis, smoking and excessive alcohol consumption. Development of stroke in men is preceded by small infarcts with transient symptoms. The risk factors for the development of IS in the arteries of the carotid system in women are atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease, and excess body weight. As in men, despite of significantly higher cholesterol levels, there are more pronounced atherosclerotic carotid stenosis and more frequent ISs, one may suggest the existence of an additional factor leading to stroke (alternatively, women may have some gender-specific protective factor).