Underreporting of Sex-Specific Findings in Risk Factors for Unruptured Intracranial Aneurysms

Abstract

Introduction: Women are overrepresented in the unruptured intracranial aneurysm (UIA) population, with an overall two-thirds of patients being female. The reasons behind this female preponderance are still unclear. Therefore, we performed a systematic review of clinical risk factors for UIA, with a specific aim of assessing whether these risk factor associations are sex-dependent. Methods: We systematically searched 5 electronic medical databases for all relevant literature up to March 2024. Cohort and case-control studies reporting on the lifestyle factors smoking, alcohol use, hypertension, hypercholesterolemia, physical activity, diabetes, and BMI were included. Results: We found a total of 21 studies, reporting on 347,907 participants and 8,698 UIA cases, that met our inclusion criteria. However, only one study provided its results stratified by sex, making it impossible to perform sex-stratified analyses. Conclusion: Our findings illustrate the scarcity of sex-stratified results in studies on risk factors for UIAs. Since knowledge on potential sex differences in UIA could help understand the female predominance, we highlight a need for more sex-stratified research in this field.