Relationship Between Gender Differences and Clinical Outcome in Patients With the Antiphospholipid Syndrome

Abstract

Antiphospholipid syndrome (APS), characterized by artherial and/or venous thrombosis, pregnancy morbidity and “antiphospholipid” antibodies (aPLs), is more common in women than in men, with a female to male ratio of about 3.5:1. Only few studies have investigated the clinical differences between male and female patients with APS. Therefore, this study was aimed to analyze the differences of clinical manifestations and laboratory tests, at diagnosis, between female and male APS patients and the clinical outcome. We enrolled 191 consecutive APS patients (125 with primary APS, PAPS, and 66 with secondary APS, SAPS) with a female predominant ratio of approximately 3:1 (142 vs 49). The prevalence of PAPS was higher in males than females (p<0.001). The analysis of aPL profile revealed that high IgM anti-cardiolipin (aCL) and high-medium IgG aCL titers were more frequent in males. In thrombotic APS peripheral arterial thrombosis was more common in male than female patients (p=0.049), as well as myocardial infarction (p=0.031). Multivariate analysis to correct for cardiovascular risk factors, high titer of aPLs and triple positivity for aPLs, revealed that the odds ratio for myocardial infarction in male was 3.77. Thus, APS may be considered as a disease in which serological (IgM titer) and clinical profiles are influenced by gender.

Risk Factors for Antiphospholipid Antibodies and Antiphospholipid Syndrome

“…However, when describing only PAPS, the female-to-male ratio decreases or is even inverted. 3,26 Since thrombotic events are easier to assess and register than aPL positivity in the healthy population, more accurate data are available on APS.…”

“…In spite of females making up the majority of APS patients (mostly due to its association with SLE and obstetric events), male patients have an increased risk of thrombosis and thrombosis recurrence compared to females in most studies. 26,54,55 Age Some studies, including a systematic review of 43 studies with stroke related to APS, showed that aPL may have a big role in strokes in younger patients. Individuals younger than 50 years and positive aPL have an increased risk for thrombotic cerebrovascular events by almost sixfold compared to those younger than 50 years and negative aPL.…”

“…In spite of females making up the majority of APS patients (mostly due to its association with SLE and obstetric events), male patients have an increased risk of thrombosis and thrombosis recurrence compared to females in most studies. 26 54 55…”

Antiphospholipid syndrome, thrombosis and multidisciplinary management

“…When conditions such as SLE and obstetric APS are removed, the ratio of APS in women and men has been reported to be between 2–5:1 6 . APS in men is more commonly primary (6:1), whereas in women secondary APS is more common (1.4:1) 7 …”

“…6 APS in men is more commonly primary (6:1), whereas in women secondary APS is more common (1.4:1). 7 Although peripheral thrombosis and pulmonary embolus are the most common APS manifestations in both sexes, the distribution of thrombosis varies. Male PAPS patients present more frequently with myocardial infarction, mesenteric and hepatic vein thrombosis whereas more female PAPS patients have strokes, 6 livedo and headaches.…”