Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

Colleen Bauza,Renee’ H Martin,Marvella E Ford,Gayenell Magwood,Anbesaw Selassie,Sharon D Yeatts,Keith Borg

doi:10.1186/s12902-018-0255-1

Abstract

BackgroundObesity and diabetes mellitus, or diabetes, are independently associated with post-ischemic stroke outcomes (e.g., functional disability and all-cause mortality). Although obesity and diabetes are also associated with post-ischemic stroke outcomes, the joint effect of obesity and diabetes on these post-ischemic stroke outcomes has not been explored previously. The purpose of the current study was to explore whether the effect of obesity on post-ischemic stroke outcomes differed by diabetes status in a cohort of acute ischemic stroke subjects with at least a moderate stroke severity.MethodsData from the Interventional Management of Stroke (IMS) III clinical trial was analyzed for this post-hoc analysis. A total of 656 subjects were enrolled in IMS III and were followed for one year. The joint effects of obesity and diabetes on functional disability at 3-months and all-cause mortality at 1-year were examined.ResultsOf 645 subjects with complete obesity and diabetes information, few were obese (25.74%) or had diabetes (22.64%). Obese subjects with diabetes and non-obese subjects without diabetes had similar odds of functional disability at 3-months following an ischemic stroke (adjusted common odds ratio, 1.038, 95% CI: 0.631, 1.706). For all-cause mortality at 1-year following an ischemic stroke, obese subjects with diabetes had a similar hazard compared with non-obese subjects without diabetes (adjusted hazard ratio, 1.005, 95% CI: 0.559, 1.808). There was insufficient evidence to declare a joint effect between obesity and diabetes on either the multiplicative scale or the additive scale for both outcomes.ConclusionsIn this post-hoc analysis of data from the IMS III clinical trial of acute ischemic stroke patients with at least a moderate stroke severity, there was not sufficient evidence to determine that the effect of obesity differed by diabetes status on post-ischemic stroke outcomes. Additionally, there was not sufficient evidence to determine that either factor was independently associated with all-cause mortality. Future studies could differentiate between metabolically healthy and metabolically unhealthy patients within BMI categories to determine if the effect of obesity on post-stroke outcomes differs by diabetes status.

Highlights

Obesity and diabetes mellitus, or diabetes, are independently associated with post-ischemic stroke outcomes
There was not sufficient evidence to determine that the effect of obesity differed by diabetes status on functional disability at 3-months, or on all-cause mortality at 1-year, following an ischemic stroke on either the multiplicative scale or the additive scale
Obesity [7, 13,14,15,16,17,18,19] and diabetes [21,22,23,24,25,26] have been previously shown to be independently associated with all-cause mortality following a stroke, there was not sufficient evidence to determine that each factor was independently associated with allcause mortality after adjusting for potential confounders in this cohort of acute ischemic stroke patients with at least a moderate stroke severity

Summary

Introduction

Diabetes, are independently associated with post-ischemic stroke outcomes (e.g., functional disability and all-cause mortality). Obesity is a modifiable risk factor for ischemic stroke [27, 28], the reported effects of obesity on poststroke outcomes of functional disability and of all-cause mortality have been conflicting. As a result of these findings, the American Heart Association and American Stroke Association recommend all individuals who are diagnosed with an ischemic stroke be screened for obesity [5] These agencies do not recommend weight reduction for overweight or obese individuals due to the null results of the Look Action for Health in Diabetes trial, a clinical trial that randomized overweight and obese individuals with type 2 diabetes to intensive behavioral intervention or usual care to compare the risk of vascular events (e.g., stroke, myocardial infarction, or vascular death) [5, 32]. In contrast to the conflicting reported effects of obesity on functional disability and all-cause mortality following a stroke, prior studies have established that diabetes is consistently associated with higher rates of functional disability [10,11,12] and higher risk of all-cause mortality [21,22,23,24,25,26] following a stroke

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