SUN-610 - Sex Differences in Ischemic Stroke for Type 2 Diabetic Patients: A Retrospective Analysis Lipid Levels and Diabetes Disease Control on Stroke Recurrence and Survival

Background: Recent meta-analyses indicate that women with Type 2 diabetes have increased risk of ischemic stroke compared to men. However, our understanding of sex-specific differences in lipid levels and diabetes disease control on stroke recurrence and survival is limited.

Methods: A retrospective observational analysis at a tertiary-care hospital system was conducted between December 2013 – December 2023 to identify sex-specific associations between laboratory parameters of lipid levels and diabetic disease control and recurrent ischemic stroke risk and survival in Type 2 diabetic patients. Multivariate logistic regression and Kaplan-Meier analysis were performed to predict recurrence risk and survival outcomes.

Results: When comparing laboratory values at time of presentation, there were no significant differences in hemoglobin A1C (HbA1C) levels between first and recurrent ischemic stroke patients, irrespective of patient sex. High-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TCHOL) were significantly lower in male versus female patients with first ischemic stroke-only (pHDL < 0.001, pLDL = 0.03, and pTCHOL < 0.001 respectively). For female patients, LDL was the only lipid marker that was significantly different with recurrent ischemic stroke versus first ischemic stroke alone (p < 0.001).

When comparing lipid laboratory values and HbA1C at first ischemic stroke event, male and female patients with a recurrent ischemic stroke event throughout the study period had significantly higher HbA1C than same-sex counterparts with first stroke only (pFemale = 0.02 and pMale < 0.001). With increasing age, there was a significant downward trend in HbA1C at time of presentation using a linear regression model for both sexes, however there were no significant differences in HbA1C at presentation among any age cohorts for first stroke-only or recurrent stroke subgroups.

When evaluating sex-specific cohorts, HbA1C at time of first ischemic stroke was a significant estimator of time to recurrent stroke and time to death for both male-only and female-only subgroups, with more intensive glycemic control associated with significantly higher post-stroke mortality (p < 0.01). However when identical HbA1C categories were compared in a sex-wise manner, there were no sex differences in mortality or recurrence risk based on level of glycemic control ( p< 0.01).

Conclusion: Our findings provide evidence of sex-specific differences in lipid levels that may be relevant for sex-associated variation in ischemic stroke outcomes and suggest that more intensive glycemic control may be associated with higher post-stroke mortality.

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