Abstract
BackgroundMales and females exhibit significant differences in metabolism and in brain ischemic stroke and different features of brain ischemic lesions are related to different health outcomes. It is critical to understand sex differences in their associations to optimize prevention and intervention for both sexes. We aimed to investigate the sex-specific association of metabolic risk factors with brain ischemic lesions by severity and location.MethodsFive thousand seven hundred ninety-one participants who underwent comprehensive health examinations between Jan. 1, 2017, and Dec. 31, 2017, were enrolled. Clinical and laboratory data about metabolic risk factors were obtained. Brain ischemic lesions were further categorized by severity (mild ischemic lesions or severe infarct lesions) and location (strictly lobar or deep brain/infratentorial areas) based on brain magnetic resonance imaging reports. Sex- and age-specific detected rates were calculated, and generalized linear models and multinomial logistic regression were used to analyze the associations between metabolic risk factors and the presence, severity, and location of ischemic lesions stratified by sex.ResultsA total of 2712 (46.8%) participants had at least one brain ischemic lesions. Age (adjusted OR, 1.10 [1.10–1.11], p < 0.001) and hypertension (adjusted OR, 1.42 [1.22–1.64], p < 0.001) were generally associated with higher risks of brain ischemia in both sexes. Metabolic syndrome was associated with greater adjusted ORs for brain ischemia with different severity and location in men (adjusted ORs between 1.23 and 1.49) but not in women. Overweight and obesity were related to lesions located strictly in lobar in men (adjusted OR, 1.23 and 1.33, respectively) and lesions located in deep brain/infratentorial areas in women (adjusted OR, 1.57 and 2.26, respectively).ConclusionsMetabolic syndrome was associated with brain ischemic lesions in men but not in women. Higher body mass index was related to ischemic lesions located in lobar in men and in deep brain/infratentorial areas in women. Its mechanisms remain to be further investigated.
Highlights
Males and females exhibit significant differences in metabolism and in brain ischemic stroke and different features of brain ischemic lesions are related to different health outcomes
Overweight and obesity were related to lesions located strictly in lobar in men and lesions located in deep brain or infratentorial areas in women
There are two possible reasons for these inconsistent findings: one is that unlike healthy participants receiving health checkups paid by their employers in some other studies, the majority of the participants who visited our examination center and asked for a brain magnetic resonance imaging (MRI) scan were concerned about their worse health status such as diabetes, obesity, and other comorbidities; the other is that we reported all kinds of brain ischemic lesions seen on MRI images regardless of their size, whether they were symptomatic or silent, old or new, while others focusing on silent brain infarcts (SBI) included only lesions with the size of 3–15 mm and were silent ones and subjects with stroke, transient ischemic attack, or other cardiovascular diseases were excluded
Summary
Males and females exhibit significant differences in metabolism and in brain ischemic stroke and different features of brain ischemic lesions are related to different health outcomes. It is critical to understand sex differences in their associations to optimize prevention and intervention for both sexes. We aimed to investigate the sex-specific association of metabolic risk factors with brain ischemic lesions by severity and location. Brain ischemic lesions are frequently seen on brain magnetic resonance imaging (MRI) especially in the elderly population and have been reported to be associated with cognitive impairment [1], depression [2], stroke [3], mortality [4], and other adverse health outcomes [5]. The incidence of total stroke was greater among
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