Obesity and Abdominal Fat Markers in Patients with a History of Stroke and Transient Ischemic Attacks

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Background

Abdominal obesity is a well-recognized cardiovascular risk factor. Conflicting data concerning its significance with respect to stroke have been discussed in recent years. The objective of this study was to analyze the association between anthropometric parameters and the risk of stroke and transient ischemic attacks (TIAs) in German primary care.

Methods

Patient recruitment in this large-scale epidemiological study was performed in 3188 representative primary care offices in Germany. Among 6980 study participants, 1745 patients with a history of stroke or TIA were identified and matched for age and gender with 5235 regional controls. Associations between standard anthropometric measures such as body mass index (BMI), waist-to-hip ratio, waist circumference, waist-to-height ratio, and cerebrovascular risk were investigated using logistic regression analysis with adjustment for age, gender, and vascular risk factors.

Results

BMI showed no significant associations with the risk of stroke or TIA in any of the applied mathematical models. Markers of abdominal obesity were associated with an increased risk of stroke or TIA in the unadjusted model (waist circumference: odds ratio [OR] 1.15; 95% confidence interval [CI], 1.00-1.32; waist-to-hip ratio: OR 1.21; 95% CI, 1.05-1.38; waist-to-height ratio: OR 1.25; 95% CI, 1.09-1.44, comparisons between top and bottom tertiles). After adjustment for vascular risk factors, all associations were insignificant.

Conclusions

Abdominal obesity is a stronger predictor of risk of stroke or TIA than BMI. However, the association between abdominal obesity and the risk of stroke or TIA is not independent of other vascular risk factors. Stroke-related weight changes should be considered in longitudinal studies examining the role of obesity in cerebrovascular disease.

Introduction

The prevalence of obesity is increasing. In industrial countries, more than 50% of the population is overweight (e.g., 65.7% in the United States), and 15%-30% meets the diagnostic criteria for obesity.1 The role of obesity as a cardiovascular risk factor has consistently been documented in large-scale prospective studies.2, 3 However, the relationship between obesity, increased visceral fat measures, and stroke is not well defined in the medical literature. Some studies found a positive association between increased body mass index (BMI) and the risk of stroke.4, 5, 6 In contrast, there is evidence from other studies indicating no association after adjustment for vascular risk factors such as physical inactivity, smoking, arterial hypertension, diabetes mellitus, and dyslipidemia.7, 8 The latest data indicate that it is not BMI but markers of abdominal obesity that are significantly associated with the risk of stroke or transient ischemic attacks (TIAs).6 These associations persisted after adjustment for other vascular risk factors and tended to be higher in women.

With data from the large-scale epidemiological DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) study, we tried to replicate and expand Winter et al.6 The aim was to analyze the association between anthropometric parameters and the risk of stroke or TIA in patients recruited in the German primary care setting.

Section snippets

Patients and Methods

DETECT is a large nationally representative epidemiological cross-sectional study of 55,518 unselected consecutive patients recruited in 3188 representative primary care offices in Germany.9, 10, 11 For more information about the study, see Wittchen et al,11 Schneider et al,10 Bohler et al,9 and the website http://www.detect-studie.de. In total, 1745 patients in this study had a history of stroke or TIA and were included in this analysis (806 patients having suffered a stroke and 939 patients

Statistical Analysis

Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for WC, WHtR, WHR, and BMI. Adjustment was performed for the following vascular risk factors: arterial hypertension, diabetes mellitus, dyslipidemia, smoking during the previous 5 years, and physical inactivity (physical activity of less than 2 hours/week). Statistical analysis was performed with STATA version 10.1 (StataCorp, Stata Statistical Software, Release 10.1; College

Results

Among the 55,518 patients, 1745 had a history of stroke or TIA. These 1745 patients were matched for age and gender with 5235 regional controls. Table 1 describes the demographic data, anthropometric values, and the distribution of vascular risk factors in the study population stratified by gender. Cases had significantly higher values of markers of abdominal obesity (WHtR, WC) and a higher prevalence of vascular risk factors (arterial hypertension, diabetes mellitus, and dyslipidemia).

The

Discussion

We performed a large cross-sectional study (DETECT) investigating the role of obesity markers in cerebrovascular disease. According to the results of our study, markers of abdominal obesity had a stronger predictive value in relation to cerebrovascular disease than BMI.

The association between abdominal fat markers and an increased cardiovascular risk was recently documented.3, 18 The case–control Northern Manhattan Stroke Study described an increased risk of ischemic stroke in individuals with

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Grant support: The DETECT study was supported by an unrestricted educational grant from Pfizer GmbH, Karlsruhe, Germany.

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