Sex- and Age-Related Variations in Intracranial Aneurysms among Patients with ADPKD: Significance of Middle Cerebral Artery Aneurysms in Elderly Women

Background: The effects of sex differences on intracranial aneurysms (IAs) in patients with autosomal dominant polycystic kidney disease (ADPKD) are not fully elucidated. Methods: We enrolled 519 patients with ADPKD. Logistic regression analyses using sex, age ≥50 years, hypertension, family history of IA or subarachnoid hemorrhage (IA/SAH), and chronic kidney disease (CKD) stages 4–5 or height-adjusted total kidney volume (htTKV) were conducted to identify factors related to IAs. Results: Sex disparities in intracranial aneurysms (IAs) were evident among ADPKD patients. Women showed a higher prevalence of anterior circulation IAs compared to men (62.7% vs. 44.8%; P=0.0403), with women also experiencing SAH at an older age than men (46 years vs. 37.5 years; P=0.0490). In the entire cohort, female sex was significantly linked with IA (OR=1.78). Stratified by sex, CKD stages 4–5 (OR=4.21), family history of IA/SAH (OR=3.11), and hypertension (OR=2.22) were significantly associated with IA in females, while in males, only family history of IA/SAH (OR=2.35) and CKD stages 4–5 (OR=2.21) were risk factors for IA. Interestingly, when classified by sex and age (≥50 years), gender disparities in IAs were pronounced among patients aged ≥50 years. Anterior circulation IAs (OR=4.58: 71.4% in women vs. 35.3% in men; P=0.0173), particularly middle cerebral artery IAs (OR=10.88: 40.5% in women vs. 5.9% in men; P=0.0113), were more prevalent in women aged ≥50 years compared to men. Moreover, women aged ≥50 years had a significantly higher prevalence of hypertension (OR=4.11), CKD4–5 (OR=10.60), IAs (OR=3.06), and middle cerebral artery IAs (OR=5.93) compared to those <50 years. Additionally, women over 50 years exhibited an increased incidence of middle cerebral artery aneurysms, with multivariate logistic analysis associating these aneurysms with female gender and hypertension. Conclusion: IAs in patients with ADPKD were affected by attributes (age and sex). Sex and age-specific medical treatment might be desirable, especially, women should pay attention to the incidence of middle aortic aneurysm and its risk factors, which increase with age.