Sex Differences in Stroke Risk Factors and Mechanisms in a Multi-Ethnic Asian Population

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Previous research indicates sex differences in stroke incidence and outcomes.
• Limited studies have explored these differences within Asian populations.
• This study addresses the need for more data on sex-based stroke variations in a multi-ethnic Asian context.

Purpose of the Study:

• To investigate sex differences in stroke risk factors and mechanisms.
• To analyze stroke subtypes (hemorrhagic and ischemic) and their underlying causes.
• To explore potential sex-ethnicity interactions in stroke presentation within an Asian cohort.

Main Methods:

• Retrospective analysis of 1165 stroke patients admitted to Raffles Hospital.
• Data collection included demographics, risk factors (hypertension, diabetes mellitus, hyperlipidaemia, smoking), and prior cerebrovascular events.
• Stroke classification utilized brain scans for hemorrhagic stroke (HS) vs. ischemic stroke (IS), with IS further categorized by TOAST and OCSP classifications.

Main Results:

• The study included 1165 patients, with 47.4% females, predominantly Chinese (83.0%).
• Common risk factors were hypertension (63.5%) and hyperlipidaemia (60.3%).
• Females were older and had higher rates of diabetes mellitus (DM), but lower rates of smoking, prior cerebrovascular events (pCeVD), and hemorrhagic stroke (HS) compared to males. No significant differences were found in HS or IS mechanisms. Significant sex-ethnicity interactions were observed (p < 0.001), with distinct ethnic distributions between sexes.

Conclusions:

• Findings align with prior studies showing older age, more DM, less smoking, and less HS in female stroke patients.
• No sex-based differences were identified in the mechanisms of hemorrhagic stroke (HS) or ischemic stroke (IS).
• A novel finding of sex-ethnicity differences in stroke presentation was observed, warranting further prospective investigation.