Abstract Number: Esoc2026a606 Sex Differences in Vascular Risk Factors and Stroke Severity in Acute Ischemic Stroke

Abstract Background and aims Sex differences influence stroke epidemiology, risk profiles, and clinical presentation. However, data remain limited. This study aimed to examine sex disparities in vascular risk factors and initial stroke severity in patients with acute ischemic stroke. Methods We conducted a retrospective observational study of consecutive adults admitted with acute ischemic stroke to a tertiary stroke unit over three years. Demographic characteristics, vascular risk factors, and baseline stroke severity assessed by the National Institutes of Health Stroke Scale (NIHSS) were collected from the SITS registry. Sex-based comparisons were performed using univariate analyses followed by multivariable linear regression to identify independent predictors of stroke severity. Results A total of 721 patients were included (366 males, 355 females), with a median age of 65 years and no significant sex difference at presentation. Hypertension was the most prevalent risk factor in both sexes. Atrial fibrillation was more frequent among females, whereas smoking was almost exclusively reported among males. Congestive heart failure was more frequent in males. Females exhibited higher baseline NIHSS scores; however, after adjustment for age and vascular risk factors, sex was no longer independently associated with stroke severity. Age at onset emerged as the only independent predictor of higher NIHSS scores. Conclusions Patients with ischemic stroke have distinct sex-specific vascular risk profiles. While females present with more severe strokes in unadjusted analyses, age rather than sex independently predicts initial stroke severity. These findings support sex-sensitive prevention strategies, including improved detection of atrial fibrillation in women and targeted smoking cessation interventions for men. Conflict of interest Ahmed Abdalla: nothing to disclose, Nermin Hamdy: nothing to disclose, Ahmed Elhussieny: nothing to disclose