on August 14, 2008
Published online before print August 14, 2008, doi: 10.1161/STROKEAHA.108.523001
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Submitted on April 15, 2008
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. * To whom correspondence should be addressed. 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.
Revised on May 6, 2008
Accepted on May 20, 2008
Contribution of Obesity and Abdominal Fat Mass to Risk of Stroke and Transient Ischemic Attacks
Yaroslav Winter MD;
Key words: stroke • transient ischemic attack • obesity • body mass index • waist circumference • risk factors