Sex-specific risk factors for early-onset ischaemic stroke

The aim of this study is to investigate sex-specific risk factors for early-onset ischaemic stroke (men <55 and women <65 years old) in the Chinese population. We included 1,270 participants with their first early-onset ischaemic stroke after the baseline survey and 5,080 age-matched (±2 years) and sex-matched participants, which was an ongoing prospective cohort study conducted in the Kailuan community in Tanshan City, China. A conditional multivariate logistic regression model (backward) was used to analyse the sex-specific risk factors for early-onset ischaemic stroke. The effects of the risk factors were assessed by calculating standardized regression coefficients. The modifying effect of sex was explored using multiplicative interaction terms of sex with each of the risk factors, and sex-specific risk factors were identified by stratifying the main regression analysis by sex. There were 1,270 early-onset ischaemic strokes, 71% occurred in men and 29% in women. The control group included 5,080 participants. The top three risk factors for early-onset ischaemic stroke were hypertension (beta = .21), diabetes mellitus (beta = .21) and adverse pregnancy outcomes (beta = .14) in women and hypertension (beta = .26), increased hs-CRP (beta = .14) and diabetes mellitus (beta = .09) in men. There were significant interactions of sex with diabetes mellitus and systolic blood pressure (SBP). The effect of diabetes on early-onset ischaemic stroke was stronger in women (odds ratio [OR] = 2.69) than in men (OR = 1.61), but the effect weakened with each standard deviation increase in SBP (OR: 1.30 vs. 1.68). Our study found that the effects of risk factors for early-onset ischaemic stroke, especially diabetes mellitus and SBP, varied by sex.