Sex-specific association between body mass index and cerebral microbleed progression in adults aged 50-85 years.

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/m Conclusion: Higher BMI in later life was associated with less progression of CMBs in women, but not in men.