Sex differences in risk factors for aneurysmal subarachnoid haemorrhage: Systematic review and meta-analysis

Sabah Rehman; Berhe W Sahle; Ronil V Chandra; Mitchell Dwyer; Amanda G Thrift; Michele Callisaya; Monique Breslin; Hoang T Phan; Petr Otahal; Seana Gall

doi:10.1016/j.jns.2019.116446

Sex differences in risk factors for aneurysmal subarachnoid haemorrhage: Systematic review and meta-analysis

J Neurol Sci. 2019 Nov 15:406:116446. doi: 10.1016/j.jns.2019.116446. Epub 2019 Aug 31.

Authors

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. Electronic address: sabah.rehman@utas.edu.au.
² Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
³ Monash University, Melbourne, Australia. Electronic address: ronil.chandra@monash.edu.
⁴ School of Health Sciences, College of Health and Medicine, University of Tasmania, Australia. Electronic address: mitchell.dwyer@utas.edu.au.
⁵ Monash University, Melbourne, Australia. Electronic address: amanda.thrift@monash.edu.
⁶ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Monash University, Melbourne, Australia. Electronic address: michele.callisaya@utas.edu.au.
⁷ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. Electronic address: monique.breslin@utas.edu.au.
⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. Electronic address: thi.phan@utas.edu.au.
⁹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. Electronic address: petr.otahal@utas.edu.au.
¹⁰ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Monash University, Melbourne, Australia; National Heart Foundation, Australia. Electronic address: Seana.Gall@utas.edu.au.

PMID: 31521957
DOI: 10.1016/j.jns.2019.116446

Abstract

Background: Aneurysmal subarachnoid haemorrhage (aSAH) disproportionally affects women. We conducted a systematic review and meta-analysis to explore sex differences in aSAH risk factors.

Methods: Case-control/cohort studies were searched to November 2017 with sex-specific risk factors for aSAH. Meta-analysis was performed when a risk factor was reported in ≥2 studies.

Results: Of 31 studies, 22 were eligible for meta-analysis. Female sex was associated with greater odds of aSAH (HR_adjusted 1.90 [1.47-2.46]. There was no detectable difference between the sexes for hypertension (OR_adjusted: men 3.13 [2.26-4.34]; women 3.65 [2.87-4.63], p = .18), smoking (OR_adjusted: men 2.96 [1.68-5.21]; women 3.11 [1.21-7.97], p = .95), aSAH family history, systolic blood pressure, age and some genetic variations. Alcohol (OR_adjusted: men 1.50 [1.04-2.17]; women 0.83 [0.48-1.45], p = .003), high alanine aminotransferase levels, and some gene variants increased the risk of aSAH in men. Reproductive factors, divorce and some genetic variations increased the risk in women. High aspartate aminotransferase levels in men and, diabetes (OR_adjusted: men 0.57 [0.32-1.01]; women 0.24 [0.13-0.43], p = .01) and parity in women reduced aSAH risk.

Conclusion: We recommend sex-specific re-analysis of existing studies of aSAH risk factors. Known aSAH risk factors (hypertension, smoking and alcohol consumption) should be targeted to prevent aSAH in men and women. Registration PROSPERO (ID: CRD42018091521).

Keywords: Risk factors; Sex characteristics; Subarachnoid haemorrhage.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Alcohol Drinking / adverse effects
Alcohol Drinking / blood
Alcohol Drinking / epidemiology
Blood Pressure / physiology
Case-Control Studies
Cohort Studies
Gonadal Steroid Hormones / blood*
Humans
Risk Factors
Sex Characteristics*
Smoking / adverse effects
Smoking / blood
Smoking / epidemiology
Subarachnoid Hemorrhage / blood*
Subarachnoid Hemorrhage / diagnosis
Subarachnoid Hemorrhage / epidemiology*

Substances

Gonadal Steroid Hormones