Increased visceral adipose tissue as a potential risk factor in patients with embolic stroke of undetermined source (ESUS).

Antti T Muuronen,Juha Onatsu,Pirjo Mustonen,Pekka Jäkälä,Ritva Vanninen,Petri Sipola,Johanna Kuusisto,Mikko Taina,Jarkko Marttila,Marja Hedman,Stefan Kiechl

doi:10.1371/journal.pone.0120598

Antti T Muuronen, Juha Onatsu + Show 9 more

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https://doi.org/10.1371/journal.pone.0120598

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Journal: PloS one	Publication Date: Mar 10, 2015
Citations: 15	License type: CC BY 4.0

Affiliation: Kuopio University Hospital

Abstract

PurposeThe etiology of an ischemic stroke remains undetermined in 20–35% of cases and many patients do not have any of the conventional risk factors. Increased visceral adipose tissue (VAT) is a suggested new risk factor for both carotid artery atherosclerosis (CAA) and atrial fibrillation (AF), but its role in the remaining stroke population is unknown. We assessed the amount of VAT in patients with embolic stroke of undetermined source (ESUS) after excluding major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke.MethodsAltogether 58 patients (mean age 57.7±10.2 years, 44 men) with ischemic stroke of unknown etiology but without CAA, known AF or small vessel disease underwent computed tomography angiography and assessment of VAT. For comparison VAT values from three different reference populations were used. Conventional risk factors (smoking, hypertension, diabetes, increased total and LDL-cholesterol, decreased HDL-cholesterol) were also registered.ResultsMean VAT area was significantly higher in stroke patients (205±103 cm2 for men and 168±99 cm2 for women) compared to all reference populations (P<0.01). 50% of male and 57% of female patients had an increased VAT area. In male patients, VAT was significantly higher despite similar body mass index (BMI). Increased VAT was more common than any of the conventional risk factors.ConclusionIncreased VAT was found in over half of our patients with ESUS suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients.

Highlights

Stroke is the leading cause of long-term disability, the second leading cause of death and a major consumer of healthcare resources worldwide [1,2,3,4]
Increased visceral adipose tissue (VAT) was found in over half of our patients with embolic stroke of undetermined source (ESUS) suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients
To the best of our knowledge, no previous study has investigated the prevalence of VAT in a population with ESUS, i.e. in which atherosclerosis, small vessel disease or known atrial fibrillation (AF) are excluded as stroke etiologies

Summary

Introduction

Stroke is the leading cause of long-term disability, the second leading cause of death and a major consumer of healthcare resources worldwide [1,2,3,4]. Patients with embolic stroke of undetermined source (ESUS) are a subset of patients with cryptogenic stroke who have embolic strokes and sufficient diagnostic assessment to exclude major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke [8]. Obesity is a well-known risk factor for all cardiovascular diseases and stroke, and it increases the risk of all-cause mortality [9]. The increased visceral fat type in particular has been stated to increase the risk of stroke and other cardiovascular diseases [12,13,14,15,16]. To the best of our knowledge, no previous study has investigated the prevalence of VAT in a population with ESUS, i.e. in which atherosclerosis, small vessel disease or known AF are excluded as stroke etiologies

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Conclusion