Abstract
BackgroundThe association of body mass index (BMI) with risks of ischemic stroke subtypes have not been established.MethodsCumulative average BMI was calculated using self-reported body weight and height obtained from baseline (Cohort I in 1990, and Cohort II from 1993–1994) and 5- and 10-year questionnaire surveys of Japan Public Health Center-based prospective (JPHC) study. A total of 42,343 men and 46,413 women aged 40–69 years were followed-up for the incidence of lacunar, large-artery occlusive, and cardioembolic strokes. A sub-distribution hazard model was used to estimate sub-distribution hazard ratios (SHRs) and the 95% confidence intervals (CIs).ResultsDuring a median of 20.0 years of follow-up, we documented 809 and 481 lacunar, 395 and 218 large-artery occlusive, and 568 and 298 cardioembolic strokes in men and women, respectively. After adjustment for baseline age, updated smoking, alcohol consumption, leisure-time physical activity, and histories of hypertension, dyslipidemia, and diabetes mellitus, cumulative average BMI was positively linearly associated with lacunar (trend P = 0.007), large-artery occlusive (trend P = 0.002), and cardioembolic (trend P < 0.001) strokes in men, and with lacunar (trend P < 0.001) and large-artery occlusive (trend P = 0.003) strokes in women. There were approximately two-fold excess risk of cardioembolic stroke in both sexes and of lacunar and large-artery occlusive strokes in women for cumulative average BMI ≥30 kg/m2 compared to BMI 23–<25 kg/m2.ConclusionCumulative average BMI showed a positive linear effect on sub-distribution hazards of lacunar, large-artery occlusive, and cardioembolic strokes in both sexes, except for cardioembolic stroke in women.
Highlights
Ischemic stroke is one of the leading causes of long-term disability and mortality worldwide.[1]
Even in the fully-adjusted model that included known mediators, categories of cumulative average body mass index (BMI) were linearly positively associated with all the ischemic stroke subtypes in both sexes, except for cardioembolic stroke in women (Table 2)
We observed the significantly increased subdistribution hazard ratios (SHRs) of cardioembolic stroke in men whose cumulative average BMI was ≥30 kg=m2 (SHR 2.14; 95% confidence intervals (CIs), 1.34–3.41), and that of lacunar stroke in women whose cumulative average BMI were 27–
Summary
Ischemic stroke is one of the leading causes of long-term disability and mortality worldwide.[1]. Another study in Japan (n = 1,621, baseline year: 1961) did not find any associations except for a positive association between BMI and lacunar stroke in women, which was independent of known risk factors, including systolic blood pressure.[6] One explanation for the discrepancies might be that the mean BMIs and the compositions of ischemic stroke subtypes differ considerably between the two populations.[7,8,9] it might be due to differences in the way BMI was modeled: baseline only in the former[5] versus updated as time-dependent covariate in the latter.[6] BMI used in the latter study would mainly reflect a short-term effect of the exposure since BMI obtained in the nearest examinations before the events of cerebral infarction was related to the outcome. Conclusion: Cumulative average BMI showed a positive linear effect on sub-distribution hazards of lacunar, large-artery occlusive, and cardioembolic strokes in both sexes, except for cardioembolic stroke in women
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