From the Departments of Radiology (F.F., K.K., G.M.P., C.R.J., P.V.), Health Sciences Research (S.D.W., S.A.P., R.O.R., M.M. Mielke), Neurology (J.G.-R., D.S.K., R.O.R., M.M. Mielke, R.C.P.), and Psychology (M.M. Machulda), Mayo Clinic Rochester; and School of Medicine (F.F.), University of Minnesota, Minneapolis.
Neurology. 2018 Feb 6;90(6):e466-e473. doi: 10.1212/WNL.0000000000004913. Epub 2018 Jan 17.
To examine sex differences in cerebrovascular pathologies (CVPs) as seen on fluid-attenuated inversion recovery (FLAIR) MRI and in cardiovascular and metabolic risk factors in a population-based cognitively unimpaired cohort and to examine whether sex is independently associated with FLAIR findings after accounting for differences in important midlife risk factors.
We identified 1,301 cognitively normal participants (663 men and 638 women) enrolled in the Mayo Clinic Study of Aging (age ≥70 years) who had FLAIR MRI and ascertained total burden of white matter (WM) hyperintensities (WMH), subcortical infarctions, and cortical infarctions. We compared CVPs and midlife and late-life vascular risk factors between men and women. We fit regression models with each CVP as an outcome, treating age, sex, and midlife risk factors as predictors.
Women had significantly greater WMH volume relative to their WM volume compared to men (2.8% vs 2.4% of WM, < 0.001), while men had a greater frequency of cortical infarctions compared to women (9% vs 4%, < 0.001). Subcortical infarctions were equally common in men and women (20%). In regression modeling after adjustment for WM volume, the mean WMH volume difference between men and women was of the same magnitude as a 7-year difference in age. In contrast, men had 2.2-greater relative odds of having a cortical infarction compared to women. These sex differences persisted even after adjustment for midlife vascular risk factors.
There were important sex differences in CVP findings on FLAIR in cognitively unimpaired elderly. Understanding these sex differences could aid in the development of sex-specific preventive strategies.
在一个基于人群的认知正常队列中，检查脑血 管病变 (CVPs) 在磁共振液体衰减反转恢复 (FLAIR) 成像上的性别差异，以及心血管和代谢风险因素，并检查在考虑到重要中年风险因素差异后，性别是否与 FLAIR 结果独立相关。
我们确定了 1301 名认知正常的参与者（663 名男性和 638 名女性），他们参加了梅奥诊所老龄化研究（年龄≥70 岁），并进行了 FLAIR MRI 检查，确定了白质（WM）高信号（WMH）、皮质下梗死和皮质梗死的总负担。我们比较了男性和女性的 CVPs 以及中年和晚年的血管危险因素。我们使用每个 CVP 作为结果的回归模型，将年龄、性别和中年风险因素作为预测因素。
与男性相比，女性的 WM 体积中 WMH 体积明显更大（WM 的 2.8%对 2.4%， < 0.001），而男性的皮质梗死频率高于女性（9%对 4%， < 0.001）。皮质下梗死在男性和女性中同样常见（20%）。在调整 WM 体积后进行回归建模，男性和女性之间的平均 WMH 体积差异与年龄相差 7 年的差异相当。相比之下，男性发生皮质梗死的相对优势比女性高 2.2 倍。即使在调整中年血管风险因素后，这些性别差异仍然存在。
在认知正常的老年人群中，FLAIR 上的 CVP 发现存在重要的性别差异。了解这些性别差异可能有助于制定针对特定性别的预防策略。
