The Stroke–obesity Paradox Becomes Evident in yet Another Study

Pavankumar Kamat

Disclosures

October 07, 2021

Takeaway

  • Overweight or obesity may be linked to a more favourable prognosis for subsequent major adverse cardiovascular events (MACE), peripheral vascular disease (PVD) and mortality in stroke survivors, regardless of confounding variables at the time of stroke.

  • The authors warn that the stroke–obesity paradox is strictly an association and should not be considered causal.

Why this matters

  • There is contrasting evidence of the protective effects of higher body mass index (BMI) in stroke survivors.

Study design

  • The population-based cohort study included 30,702 patients with incident stroke (age, ≥18 years) with baseline BMI record and without prior history of MACE, identified from the UK Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics databases (1998-2017).

  • BMI was categorised as:

    • underweight (<18.5 kg/m2);

    • normal weight (18.5-24.9 kg/m2);

    • overweight (25.0-29.9 kg/m2);

    • obesity class I (30.0-34.9 kg/m2);

    • obesity class II (35.0-39.9 kg/m2); and

    • obesity class III (≥40 kg/m2).

  • The cohort was followed for a median of 12.9 years.

  • Primary outcome: first subsequent MACE after incident stroke.

  • Secondary outcome: all-cause mortality.

  • Funding: None.

Key results

  • Overall, 1217 (4.0%) were underweight, 10,783 (35.1%) had a normal BMI, 10,979 (35.8%) were overweight, 5206 (17.0%) had obesity class I, 1749 (5.7%) had obesity class II and 768 (2.5%) had obesity class III.

  • Patients with higher BMI vs those with normal BMI were at a lower risk of subsequent (adjusted HR [aHR]; 95% CI):

    • MACE (overweight: 0.96; 0.93-0.99);

    • PVD:

      • overweight (0.65; 0.49-0.85); and

      • obesity class III (0.19; 0.50-0.77).

    • cardiovascular-related death:

      • overweight (0.80; 0.74-0.86);

      • obesity class I (0.79; 0.71-0.88); and

      • obesity class II (0.80; 0.67-0.96).

    • all-cause mortality:

      • overweight (0.75; 0.71-0.79);

      • obesity class I (0.75; 0.70-0.81); and

      • obesity class II (0.77; 0.68-0.86).

  • Results were similar irrespective of sex, diabetes mellitus, smoking and cancer status at the time of incident stroke.

Limitations

  • The study only used BMI as a marker of obesity.

 

Akyea RK, Doehner W, Iyen B, Weng SF, Qureshi N, Ntaios G. Obesity and long-term outcomes after incident stroke: a prospective population-based cohort study. J Cachexia Sarcopenia Muscle. 2021 Sep 27 [Epub ahead of print]. doi: 10.1002/jcsm.12818. PMID: 34581015  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....