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