Gender heterogeneity in the influencing factors for cerebral microbleeds in acute ischemic stroke patients

Abstract

Background

Cerebral microbleeds (CMBs) are common in acute ischemic stroke (AIS) patients. The presence of CMBs increases the risk of hemorrhagic transformation in AIS patients, and it is also closely associated with cognitive decline and even dementia. At present, there exist different opinions on the independent risk factors for CMBs, and there is no consensus on whether there are gender differences in -post-stroke CMB. Therefore, this study sought to investigate gender heterogeneity in the influencing factors for CMBs by studying male and female AIS patients.

Methods

This was a China-based, Single-center, retrospective review of data from 482 AIS inpatients at the Neurology Department of Hebei General Hospital (NCT05882123). Both demographic and clinical data were collected from the study subjects. Different head magnetic resonance imaging sequences were used to assess the subjects’ CMBs, white matter lesions, and old lacunar infarcts (LI). Various statistical methods, including the t-test, χ² test, and logistic regression, were used to analyze the gender heterogeneity of the influencing factors for CMBs in AIS patients.

Results

When compared with the male AIS patients, the female AIS patients were older and had higher total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, ApoA, ApoB, and fibrinogen levels. The female AIS patients also had higher National Institute of Health Stroke Scale scores and hypertension disease composition ratios. By contrast, the proportions of female AIS patients with a history of smoking and a history of alcohol consumption were both lower than the corresponding proportions of male AIS patients. These differences were all statistically significant (p < .05). There were no statistically significant differences in the incidence and severity of CMBs between the male and female AIS patients (χ² ＝ 0.851, 3.092, p > .05). The univariate and multivariate stepwise logistic regression analyses confirmed that age (OR = 1.074, 95% CI: 1.013–1.139, p = .016) and old LI (OR = 4.295, 95% CI: 1.062–17.375, p = .041) were independent risk factors for comorbid CMBs in the female AIS patients, while blood glucose (OR = 0.692, 95% CI: 0.494–0.968, p = .031) was an independent protective factor for comorbid CMBs in the female AIS patients. However, these factors were not found to be independent risk or protective factors for comorbid CMBs in male AIS patients.

Conclusion

There are gender differences in the influencing factors for CMBs in AIS patients. Age, old LIs, and blood glucose are independent risk or protective factors for comorbid CMBs in female AIS patients, although they are not associated with the risk of developing CMBs in male AIS patients.

Keywords:

• Acute ischemic stroke
• cerebral microbleeds
• influencing factors
• gender heterogeneity

Transparency

Declaration of funding

This work was supported by the Nature Science Fundation of Hebei Province (Grant No. H2020206632), Scientific and Technological Innovation 2030-Major Project Subject of Brain Science and Brain-inspired Research (Grant No.2021ZD0201807), Hebei Province Government-funded Excellent Talents Project in Clinical Medicine (Grant No. 2022-180-5), the “Spark” scientific research project of the First Hospital of Hebei Medical University (Grant No. XH202314), the medical science research project of Hebei Province (Grant No. 20230984), and the Project of Traditional Chinese Medicine of Hebei Province (Grant No. 2023064 and 2023065).

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

PYL and SJT conceived and designed the project. XG and YX were responsible for the collection of clinical data. The demographic data and detailed clinical data collected by ZJT, with help from Professor PYL. ZYS and XSG conducted the statistical analysis on the data. XG and YX wrote the manuscript with help from SJT. All authors read and approved the final manuscript.

Acknowledgements

Not applicable.

Data availability statement 

The raw data supporting the conclusions of this article are available from the corresponding author on reasonable request.

Ethics statement

The study was approved by the Biomedical Research Ethics Committee of the First hospital of Hebei Medical University (approval number: 20220642) as per the World Medical Association outlined in the Declaration of Helsinki. The need for written informed consent to participate was waived by the ethics committee due to retrospective nature of the study. We promised that the data of the participants were anonymized or maintained with confidentiality, and the rights or interests of participants were not invaded.