Abstract
BackgroundSex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS).MethodsBetween January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients.ResultsThe E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003).ConclusionsThese findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.
Highlights
Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events
The levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, and TG were significantly higher, while the estimated glomerular filtration rate (eGFR) was significantly lower in the acute ischemic stroke (AIS) group than in the control group
There were no differences between the AIS and control groups in Body mass index (BMI), diabetes mellitus (DM), smoking, alcohol consumption, hyperlipidemia, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and hemoglobin A1c (HbA1c)
Summary
Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS). Previous preclinical evidence had shown that sex hormones play an important neuroprotective role following acute ischemic stroke (AIS) and other acute central nervous system conditions such as spinal cord and traumatic brain injuries [2]. Choi et al BMC Neurology (2021) 21:91 begin to decrease around 30 years of age in both sexes [5,6,7] Both clinical and experimental evidence suggest that androgen levels drop after ischemic stroke. This raises the question of whether ischemia-induced reduction in androgen levels may be as important as the steady levels of hormones prior to the insult. Some recent bench studies have revealed conflicting data and indicate that androgens can either prevent or exacerbate ischemic damage [8]
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