Abstract
ObjectivesWe examined the association between obesity and early-onset cryptogenic ischemic stroke (CIS) and whether fat distribution or sex altered this association. Materials and MethodsThis prospective, multi-center, case-control study included 345 patients, aged 18-49 years, with first-ever, acute CIS. The control group included 345 age- and sex-matched stroke-free individuals. We measured height, weight, waist circumference, and hip circumference. Obesity metrics analyzed included body mass index (BMI), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), and a body shape index (ABSI). Models were adjusted for age, level of education, vascular risk factors, and migraine with aura. ResultsAfter adjusting for demographics, vascular risk factors, and migraine with aura, the highest tertile of WHR was associated with CIS (OR for highest versus lowest WHR tertile 2.81, 95%CI 1.43-5.51; P=0.003). In sex-specific analyses, WHR tertiles were not associated with CIS. However, using WHO WHR cutoff values (>0.85 for women, >0.90 for men), abdominally obese women were at increased risk of CIS (OR 2.09, 95%CI 1.02-4.27; P=0.045). After adjusting for confounders, WC, BMI, WSR, or ABSI were not associated with CIS. ConclusionsAbdominal obesity measured with WHR was an independent risk factor for CIS in young adults after rigorous adjustment for concomitant risk factors.
Highlights
In young, under 55-year-old adults, ischemic stroke occurs relatively rarely, but the incidence has markedly increased over the past few decades,[1,2] making it an even major global health problem
A study from 2015 that focused on young adults showed that an elevated body mass index (BMI) was associated with an increased risk of ischemic stroke, but this association was not significant after adjusting for confounders; that study lacked indicators of abdominal obesity.[11]
Diabetes mellitus was excluded, due to its low frequency. †Definition includes individuals classified as overweight or obese those with patent foramen ovale (PFO) tended to have a higher risk of cryptogenic ischemic stroke (CIS) than those without PFO, but we found no significant interaction between the waist-to-hip ratio (WHR) and PFO (P=0.526) (Supplemental Table 7)
Summary
Under 55-year-old adults, ischemic stroke occurs relatively rarely, but the incidence has markedly increased over the past few decades,[1,2] making it an even major global health problem. Despite standardized, modern-day diagnostic procedures, in 33-50% of early-onset ischemic strokes, the etiology remains cryptogenic.[3,4]. The age-inclusive INTERSTROKE study demonstrated that an elevated waist-to-hip ratio (WHR) increased the risk of all strokes, examining both ischemic and hemorrhagic stroke as one group in young adults.[10] A study from 2015 that focused on young adults showed that an elevated body mass index (BMI) was associated with an increased risk of ischemic stroke, but this association was not significant after adjusting for confounders; that study lacked indicators of abdominal obesity.[11] A recent Israeli study found an association with a high adolescent BMI with an increased stroke risk in young adulthood, and lacked indicators of abdominal obesity.[12]
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