Title : Endogenous sex hormone levels and risk of ischemic stroke: A systematic review and meta-analysis
Background and aims: Ischemic stroke (IS) causes significant mortality worldwide and has higher incidence among men than women. In this study, we investigated the risk-association of endogenous sex hormones in males and females with ischemic stroke.
Methods: Comprehensive literature search was performed in various electronic databases, including PubMed, EMbase, Cochrane Library, Worldwide Science, and Google Scholar up to 10th April 2022. Pooled Standard Mean Deviations (SMDs) with 95% Confidence Intervals (CIs) for males and females were calculated, along with subgroup analysis based on ethnicity (Caucasian vs. Asian). Sensitivity analysis was performed to detect the heterogeneity between studies and Begg’s funnel plot assessed any publication biases.
Results: We included 10 case-control studies with 2026 IS cases and 7688 control subjects, including 6 from Caucasian and 4 from Asian population. Our findings revealed a significant protective association of total testosterone (SMD=-1.23, 95% CI=-2.02 to - 0.44) and free testosterone (SMD=-2.53, 95% CI=-4.77 to -0.30) levels with the risk of IS in the overall male population. Additionally, significant protective association was also observed in the Caucasian population regarding total testosterone (SMD=-1.34, 95% CI=-2.46 to -0.22) and free testosterone (SMD=-3.39, 95% CI=-6.18 to -0.59) levels with IS risk. However, no significant relationship was observed in estradiol, progesterone, and luteinizing hormone levels for both the sexes with IS risk.
Conclusion: Our meta-analysis is the first one to highlight the necessity to conduct clinical investigations on endogenous sex hormones to determine IS risk in patients. Sex hormones could be significant biomarkers to determine IS risk based on gender.
Keywords: Sex hormones, Ischemic stroke, Testosterone, Meta-analysis.