Association of Body Mass Index and Risk of Stroke After Acute Minor Stroke or TIA: a Post Hoc Analysis of a Randomized Controlled Trial
- 76 Downloads
The “obesity paradox” was reported in patients with stroke. We aimed to evaluate the pattern and magnitude of association between body mass index (BMI) and prognosis of stroke in patients with minor ischemic stroke or transient ischemic attack (TIA). A total of 5163 patients with available BMI data from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial were included. Patients were classified into three groups according to their BMI values: normal weight (< 23.9 kg/m2), overweight (24–27.9 kg/m2), and obese (≥ 28.0 kg/m2). The efficacy outcomes included a new stroke (ischemic or hemorrhagic), poor functional outcome defined as modified Rankin scale ≥ 2 points and death from any cause within 90 days. The interaction effects were determined using multivariable Cox or logistic regression models. After 90 days of follow up, there were 513 new strokes. Overweight (BMI 24–27.9 kg/m2) patients had a higher risk of recurrent strokes than those with normal weight (10.8% vs 8.8%; HR = 1.24, 95% CI 1.02–1.50) after adjusting for the baseline covariates, but no significant association was observed for those who were obese (P = 0.37). No significant association was found between being overweight or obese and poor functional outcome or death. For patients with a minor ischemic stroke or TIA, being overweight was associated with an increased risk of recurrent stroke compared to being of normal weight in our study.
Trial registration: URL:http://www.clinicaltrials.gov. Unique identifier: NCT00979589.
KeywordsBody mass index Ischemic stroke Obesity Prognosis Transient ischemic attack
Body mass index
Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events
Modified Rankin Scale
Transient ischemic attack
National Institutes of Health stroke scale
We appreciated all the patients, relevant clinicians, imaging, and laboratory technicians who participated in the study and many individuals not specifically mentioned in the paper who have supported the study.
This study was supported by the National Natural Science Foundation of China(81870929), grants from National Key Technology Research and Development Program of the Ministry of Science and Technology of the People’s Republic of China (2015BAI12B04 and 2015BAI12B02), a grant from Beijing Municipal Science and Technology Commission (D151100002015001), a grant from Beijing Institute for Brain Disorders (1152130306), Joint Funds of Science and Technology Innovation of Fujian Province (2017Y9086), a grant from Medical Innovation Project for Research Talents of Fujian Province (2018-CX-25), and a grant from Science and Technology Major Project of Fujian Province (2017YZ0001-1).
Compliance with Ethical Standards
The protocol and data collection of the CHANCE trial were approved by ethics committee of Beijing Tiantan Hospital and all other participating hospitals, in compliance with the Declaration of Helsinki. Written informed consent was obtained from all participants or their legal proxies.
Conflict of Interest
The authors declare that there are no conflicts of interest.
- Coull AJ, Lovett JK, Rothwell PM, Oxford Vascular S (2004) Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ 328(7435):326. https://doi.org/10.1136/bmj.37991.635266.44 CrossRefPubMedPubMedCentralGoogle Scholar
- Doehner W, Schenkel J, Anker SD, Springer J, Audebert HJ (2013) Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial. Eur Heart J 34(4):268–277. https://doi.org/10.1093/eurheartj/ehs340 CrossRefPubMedGoogle Scholar
- Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease (2014) Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45(7):2160–2236. https://doi.org/10.1161/STR.0000000000000024 CrossRefPubMedGoogle Scholar
- Ois A, Gomis M, Rodriguez-Campello A, Cuadrado-Godia E, Jimenez-Conde J, Pont-Sunyer C et al (2008) Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke. Stroke 39(6):1717–1721. https://doi.org/10.1161/STROKEAHA.107.505438 CrossRefPubMedGoogle Scholar
- Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN et al (2007) Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 370(9596):1432–1442. https://doi.org/10.1016/S0140-6736(07)61448-2 CrossRefPubMedGoogle Scholar
- Ruland S, Hung E, Richardson D, Misra S, Gorelick PB (2005) African American antiplatelet stroke prevention study I. impact of obesity and the metabolic syndrome on risk factors in African American stroke survivors: a report from the AAASPS. Arch Neurol 62(3):386–390. https://doi.org/10.1001/archneur.62.3.386 CrossRefPubMedGoogle Scholar
- Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K et al (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 37(2):577–617. https://doi.org/10.1161/01.STR.0000199147.30016.74 CrossRefPubMedGoogle Scholar
- Suk SH, Sacco RL, Boden-Albala B, Cheun JF, Pittman JG, Elkind MS, Paik MC, Northern Manhattan Stroke Study (2003) Abdominal obesity and risk of ischemic stroke: the northern Manhattan stroke study. Stroke 34(7):1586–1592. https://doi.org/10.1161/01.STR.0000075294.98582.2F CrossRefPubMedGoogle Scholar
- Vemmos K, Ntaios G, Spengos K, Savvari P, Vemmou A, Pappa T, Manios E, Georgiopoulos G, Alevizaki M (2011) Association between obesity and mortality after acute first-ever stroke: the obesity-stroke paradox. Stroke 42(1):30–36. https://doi.org/10.1161/STROKEAHA.110.593434 CrossRefPubMedGoogle Scholar
- von Weitzel-Mudersbach P, Andersen G, Hundborg HH, Johnsen SP (2013) Transient ischemic attack and minor stroke are the most common manifestations of acute cerebrovascular disease: a prospective, population-based study--the Aarhus TIA study. Neuroepidemiology 40(1):50–55. https://doi.org/10.1159/000341696 CrossRefGoogle Scholar
- Wang Y, Johnston SC, Investigators C (2010) Rationale and design of a randomized, double-blind trial comparing the effects of a 3-month clopidogrel-aspirin regimen versus aspirin alone for the treatment of high-risk patients with acute nondisabling cerebrovascular event. Am Heart J 160(3):380–6 e1. https://doi.org/10.1016/j.ahj.2010.05.017 CrossRefPubMedGoogle Scholar
- Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC, CHANCE Investigators (2013) Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 369(1):11–19. https://doi.org/10.1056/NEJMoa1215340 CrossRefPubMedGoogle Scholar
- Wang Y, Pan Y, Zhao X, Li H, Wang D, Johnston SC, Liu L, Meng X, Wang A, Wang C, Wang Y, CHANCE Investigators (2015) Clopidogrel with aspirin in acute minor stroke or transient ischemic attack (CHANCE) trial: one-year outcomes. Circulation 132(1):40–46. https://doi.org/10.1161/CIRCULATIONAHA.114.014791 CrossRefPubMedGoogle Scholar
- Wohlfahrt P, Lopez-Jimenez F, Krajcoviechova A, Jozifova M, Mayer O, Vanek J, Filipovsky J, Llano EM, Cifkova R (2015) The obesity paradox and survivors of ischemic stroke. J Stroke Cerebrovasc Dis 24(6):1443–1450. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.008 CrossRefPubMedGoogle Scholar
- Zhou BF (2002) Cooperative Meta-Analysis Group of the Working Group on Obesity in C. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci 15(1):83–96PubMedGoogle Scholar