Abstract TMP96: Optimal Combination Drug Therapy and Clinical Outcomes After Stroke by Obesity Status
Background: Of various explanations for the ‘obesity paradox’ that lean people with cardiovascular diseases are more likely to have poorer outcomes vs. obese, one hypothesis is that obese patients display a readily identifiable high vascular risk phenotype that may lead to receiving or seeking earlier/more aggressive treatment.
Objective: To examine whether lean stroke patients are less likely to receive optimal combination treatment (OCT) and explore a differential impact of combination therapy on clinical outcomes in lean stroke patients.
Methods: We analyzed a clinical trial dataset comprising 3643 recent (<120 days) ischemic stroke patients followed up for 2 years. Subjects were categorized as having lean body mass index (BMI, <25 kg/m2, n=1006), overweight BMI (25 to 29.9 kg/m2, n=1493), and obese BMI 30 <kg/m2, n=1144). Subjects were categorized by level 0 to III depending on the number of the secondary prevention prescription divided by the number of drugs potentially indicated for each patient (0=none of the indicated medications and III=all indicated medications as OCT). Independent associations of each BMI category with all-cause death and major vascular events (stroke/myocardial infarction/vascular death) were assessed.
Results: All-cause death occurred in 7.3% in lean, 5.5% in overweight, and 5.1% in obese patients. Frequency of OCT (level III) was 45.8% in lean, 51.7% in overweight, and 55.3% in obese patients. Subjects with lower BMI status had lesser frequency of OCT (45.8% in lean, 51.7% in overweight, and 55.3% in obese; P<0.001). Obese (vs. lean) patients were less likely to experience death (HR 0.70; 95% CI: 0.50–0.99, P=0.034), although this decreased risk was slightly attenuated and not significant after multivariable adjustment and was not seen with major vascular events. In multivariable analyses, compared with levels 0 and I, level II and level III were linked to lower risk of major vascular events (0.55; 0.32-0.95 and 0.48; 0.28–0.83) and death (0.44; 0.21-0.96 and 0.23; 0.10–0.54) among lean patients.
Conclusions: OCT of secondary prevention medication after a recent ischemic stroke is less frequent in lean (vs. obese) patients, but when implemented is related to significantly better clinical outcomes among lean patients.
Author Disclosures: J. Park: None. B. Ovbiagele: None.
- © 2016 by American Heart Association, Inc.