{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:13:55Z","timestamp":1790867635833,"version":"4.1.0"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi241141-4\"><jats:title>Importance<\/jats:title><jats:p>Cerebral small vessel disease (SVD) is associated with various cerebrovascular outcomes, but data on sex differences in SVD are scarce.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241141-5\"><jats:title>Objective<\/jats:title><jats:p>To investigate whether the frequency, severity, and distribution of cerebral microbleeds (CMB), other SVD markers on magnetic resonance imaging (MRI), and outcomes differ by sex.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241141-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study used pooled individual patient data from the Microbleeds International Collaborative Network, including patients from 38 prospective cohort studies in 18 countries between 2000 and 2018, with clinical follow-up of at least 3 months (up to 5 years). Participants included patients with acute ischemic stroke or transient ischemic attack with available brain MRI. Data were analyzed from April to December 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241141-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Outcomes of interest were presence of CMB, lacunes, and severe white matter hyperintensities determined on MRI. Additionally, mortality, recurrent ischemic stroke, and intracranial hemorrhage during follow-up were assessed. Multivariable random-effects logistic regression models, Cox regression, and competing risk regression models were used to investigate sex differences in individual SVD markers, risk of recurrent cerebrovascular events, and death.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241141-8\"><jats:title>Results<\/jats:title><jats:p>A total of 20\u202f314 patients (mean [SD] age, 70.1 [12.7] years; 11\u202f721 [57.7%] male) were included, of whom 5649 (27.8%) had CMB. CMB were more frequent in male patients, and this was consistent throughout different age groups, locations, and in multivariable models (female vs male adjusted odds ratio [aOR], 0.86; 95% CI, 0.80-0.92; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Female patients had fewer lacunes (aOR, 0.82; 95% CI, 0.74-0.90; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) but a higher prevalence of severe white matter hyperintensities (aOR, 1.10; 95% CI, 1.01-1.20; <jats:italic>P<\/jats:italic>\u2009=\u2009.04) compared with male patients. A total of 2419 patients (11.9%) died during a median (IQR) follow-up of 1.4 (0.7-2.5) years. CMB presence was associated with a higher risk of mortality in female patients (hazard ratio, 1.15; 95% CI, 1.02-1.31), but not male patients (hazard ratio, 0.95; 95% CI, 0.84-1.07) (<jats:italic>P<\/jats:italic> for interaction\u2009=\u2009.01). A total of 1113 patients (5.5%) had recurrent ischemic stroke, and 189 patients (0.9%) had recurrent intracranial hemorrhage, with no sex differences.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241141-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cohort study using pooled individual patient data found varying frequencies of individual SVD markers between female and male patients, indicating potential pathophysiological differences in manifestation and severity of SVD. Further research addressing differences in pathomechanisms and outcomes of SVD between female and male patients is required.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.39571","type":"journal-article","created":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T15:13:22Z","timestamp":1729005202000},"page":"e2439571","source":"Crossref","is-referenced-by-count":15,"title":["Sex Differences in Frequency, Severity, and Distribution of Cerebral Microbleeds"],"prefix":"10.1001","volume":"7","author":[{"given":"Simon","family":"Fandler-H\u00f6fler","sequence":"first","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria"},{"name":"Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Eppinger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria"},{"name":"Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Ambler","sequence":"additional","affiliation":[{"name":"Department of Statistical Science, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Nash","sequence":"additional","affiliation":[{"name":"Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kneihsl","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria"},{"name":"Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keon-Joo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Korea University Guro Hospital, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Sung","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Shiozawa","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatoshi","family":"Koga","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linxin","family":"Li","sequence":"additional","affiliation":[{"name":"Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Lovelock","sequence":"additional","affiliation":[{"name":"Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Chabriat","sequence":"additional","affiliation":[{"name":"Assistance Publique \u2013 H\u00f4pitaux de Paris, Lariboisi\u00e8re Hospital, Translational Neurovascular Centre, Paris, France"},{"name":"Federation Hospitalo\u2013Universitaire NeuroVasc, Universit\u00e9 de Paris, Paris, France"},{"name":"INSERM U1141, Paris, 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