ABSTRACT NUMBER: ESOC2026A872 HORMONAL PREDICTORS OF STROKE: THE ROLE OF TESTOSTERONE AND CORTISOL/TESTOSTERONE RATIO IN A CLINICAL COHORT

Abstract Background and aims Hormonal imbalances, particularly in cortisol and testosterone, have been implicated in cardiovascular and cerebrovascular diseases. The cortisol/testosterone (C/T) ratio may reflect stress-related endocrine dysregulation and could influence stroke risk, yet evidence in clinical populations remains limited.This study aimed to evaluate the associations of serum cortisol, testosterone, and the cortisol/testosterone (C/T) ratio with stroke risk. Methods A total of 233 participants were enrolled from Al-Azhar University Hospitals between March 2024 and March 2025. Serum cortisol and testosterone levels were measured using liquid chromatography-tandem mass spectrometry. Logistic regression calculated odds ratios (ORs) for stroke, and restricted cubic splines assessed dose-response relationships between hormone levels and stroke risk. Results After adjusting for confounders, higher testosterone levels were inversely associated with stroke in males (per 1 unit increase, OR = 0.84, 95% CI: 0.71–0.98). In contrast, the serum C/T ratio was positively associated with stroke in both sexes (males: OR = 1.15, 95% CI: 1.03–1.32; females: OR = 1.14, 95% CI: 1.01–1.30). Dose-response analysis indicated a significant linear relationship between testosterone, C/T ratio, and stroke risk in males (P < 0.05 for overall association; P > 0.05 for nonlinearity). Conclusions In this cohort, serum testosterone was inversely associated with stroke in males, while a higher C/T ratio increased stroke risk in both males and females, highlighting potential hormonal markers for stroke risk stratification and early clinical assessment. Conflict of interest Nothing to disclose