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Sex-specific association between body mass index and cerebral microbleed progression in adults aged 50-85 years
Cindy W Yoon1, Young Ju Suh2, Byeong C Kim3
1Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea.
Background And Purpose:
Previous studies have demonstrated sex differences in the association between body mass index (BMI) and hemorrhagic stroke. Cerebral microbleed (CMB) is a clinically important marker of bleeding-prone microangiopathy, which is associated with a risk of hemorrhagic stroke. No study has evaluated sex differences in the relationship between BMI and CMB. In this longitudinal study, we aimed to conduct sex-stratified analyses to assess whether sex modifies the effect of BMI on CMB progression.
Methods:
The database of the CHALLENGE study (Comparison Study of Cilostazol and Aspirin on Changes in Volume of Cerebral Small Vessel Disease White Matter Changes), which enrolled patients aged 50-85 years with cerebral small vessel disease, was analyzed. Of the 256 subjects, 189 who underwent a 2-year follow-up brain MRI scan were included in the analysis. We used a generalized linear mixed model with a negative binomial distribution to assess the association between BMI and the 2-year change in CMB count, and conducted sex-stratified analyses to account for potential sex-specific effects.
Results:
A total of 65 men and 124 women were analyzed. In the sex-stratified negative binomial model, a significant association was observed in women but not in men. In women, each 1 kg/m2 increase in BMI was significantly associated with a decrease in the 2-year change in the number of total CMBs after adjustment for age and baseline CMB count [β = -0.120, 95% confidence interval (CI): -0.202 to -0.037, p = 0.005]. When CMBs were categorized into lobar and deep/infratentorial regions, significant associations were observed for both lobar (β = -0.114, 95% CI: -0.213 to -0.015, p = 0.024) and deep/infratentorial CMBs (β = -0.123, 95% CI: -0.222 to -0.023, p = 0.015). By contrast, no significant associations were identified between BMI and the 2-year change in CMB counts in men (all p > 0.05).
Conclusion:
Higher BMI in later life was associated with less progression of CMBs in women, but not in men.
Insights
Higher body mass index (BMI) in women was linked to slower progression of cerebral microbleeds (CMBs), a marker of small vessel disease. This association was not observed in men, indicating a potential sex-specific effect on brain health.
Area of Science:
- Neurology
- Vascular Biology
- Epidemiology
Background:
- Sex differences exist in body mass index (BMI) and hemorrhagic stroke associations.
- Cerebral microbleeds (CMBs) are key indicators of microangiopathy and stroke risk.
- No prior studies have explored sex-specific relationships between BMI and CMB progression.
Purpose of the Study:
- To investigate sex differences in the association between BMI and CMB progression.
- To conduct sex-stratified analyses to determine if sex modifies the BMI-CMB relationship.
Main Methods:
- Analysis of longitudinal data from the CHALLENGE study (n=189) with 2-year follow-up.
- Utilized generalized linear mixed models with negative binomial distribution to assess BMI and CMB change.
- Performed sex-stratified analyses to identify potential sex-specific effects.
Main Results:
- A significant inverse association between BMI and CMB progression was found in women (p=0.005).
- Each unit increase in BMI correlated with decreased CMB progression in women for both lobar and deep/infratentorial regions.
- No significant association between BMI and CMB progression was observed in men (all p>0.05).
Conclusions:
- Higher BMI in later life is associated with reduced CMB progression in women.
- This relationship is sex-specific, with no significant association found in men.
- Findings highlight the importance of considering sex in BMI-related cerebrovascular research.
