Response to Letter by Doehner et al Regarding Article, “Association Between Obesity and Mortality After Acute First-Ever Stroke: The Obesity–Stroke Paradox”
We thank Doehner et al for the interest in our recent work1 and their thoughtful comments.
In their letter, they comment that we “seem hesitant to rely on our results for clinical application” pointing to a growing body of evidence that is in line with the results of our work. Indeed, we tried to be very careful and moderate when discussing the clinical implications of our study. We also agree with their comment that the use of the term paradox to describe our results actually denotes our expectations for the association between obesity and stroke mortality—mainly driven by the positive association in the general population—rather than the available evidence.
However, it should be kept in mind that our conclusions were drawn from a retrospective analysis of prospectively collected nonrandomized data of a hospital-based registry. As such, our study is subject to limitations such as selection bias and lack of data about potential confounders like body weight changes during the follow-up period, crossover treatment allocations, and patient adherence to treatment. Similar limitations are also recognized in the previous studies, which, as Doehner et al mention, yielded similar results. Although we agree with Doehner et al that there is increasing evidence of a reverse association between obesity and mortality in patients with established cardiovascular disease, we still remain cautious in the translation of our results to clinical implications; clinical recommendations need to be based on prospective randomized data when available. Judging from the concluding phrase of Doehner et al, we feel that despite the existing data, they share our cautious approach to recommendations about weight management in patients with stroke until prospective randomized data become available.
George Ntaios, MD
Kostas Vemmos, MD
Acute Stroke Unit
Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. Include a completed copyright transfer agreement form (available online at http://stroke.ahajournals.org and http://submit-stroke.ahajournals.org).
- © 2011 American Heart Association, Inc.