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(Stroke. 2008;39:3145.)
© 2008 American Heart Association, Inc.

Original Contributions

Contribution of Obesity and Abdominal Fat Mass to Risk of Stroke and Transient Ischemic Attacks

Yaroslav Winter, MD; Sabine Rohrmann, PhD; Jakob Linseisen, PhD; Oliver Lanczik, MD; Peter A. Ringleb, MD; Johannes Hebebrand, MD Tobias Back, MD

From the Department of Neurology (Y.W., O.L., T.B.), Klinikum Mannheim, University of Heidelberg, Germany; the Division of Cancer Epidemiology (S.R., J.L.), German Cancer Research Center, Heidelberg, Germany; the Department of Child and Adolescent Psychiatry (J.H.), Rheinische Kliniken, University of Duisburg-Essen, Germany; the Department of Neurology (P.A.R.), Klinikum Heidelberg, University of Heidelberg, Germany; the Department of Neurology (T.B.), Saxon Hospital Arnsdorf, Arnsdorf/Dresden, Germany; and the Center for Mental Health (Y.W.), Klinikum Stuttgart, Germany.

Correspondence to Prof Tobias Back, MD, Department of Neurology, Saxon Hospital Arnsdorf, Hufelandstr. 15, D-01477 Arnsdorf/Dresden, Germany. E-mail tobias.back{at}skhar.sms.sachsen.de

Background and Purpose— Waist circumference has been shown to be a better predictor of cardiovascular risk than body mass index (BMI). Our case-control study aimed to evaluate the contribution of obesity and abdominal fat mass to the risk of stroke and transient ischemic attacks (TIA).

Methods— We recruited 1137 participants: 379 cases with stroke/TIA and 758 regional controls matched for age and sex. Associations between different markers of obesity (BMI, waist-to-hip ratio, waist circumference and waist-to-stature ratio) and risk of stroke/TIA were assessed by using conditional logistic regression adjusted for other risk factors.

Results— BMI showed a positive association with cerebrovascular risk which became nonsignificant after adjustment for physical inactivity, smoking, hypertension, and diabetes (odds ratio 1.18; 95% CI, 0.77 to 1.79, top tertile versus bottom tertile). Markers of abdominal adiposity were strongly associated with the risk of stroke/TIA. For the waist-to-hip ratio, adjusted odds ratios for every successive tertile were greater than that of the previous one (2nd tertile: 2.78, 1.57 to 4.91; 3rd tertile: 7.69, 4.53 to 13.03). Significant associations with the risk of stroke/TIA were also found for waist circumference and waist-to-stature ratio (odds ratio 4.25, 2.65 to 6.84 and odds ratio 4.67, 2.82 to 7.73, top versus bottom tertile after risk adjustment, respectively).

Conclusions— Markers of abdominal adiposity showed a graded and significant association with risk of stroke/TIA, independent of other vascular risk factors. Waist circumference and related ratios can better predict cerebrovascular events than BMI.

Key Words: stroke • transient ischemic attack • obesity • body mass index • waist circumference • risk factors