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Background  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.    Methods  Five 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.    Results  A 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).    Conclusions  Metabolic 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.

Sex-specific association of metabolic risk factors with brain ischemic lesions by severity and location