Abstract
ObjectiveBoth metabolic syndrome (MetS) and obesity increase the risk of stroke. However, few studies have compared the risks of stroke associated with metabolically obese non-obese weight (MONW) and metabolically healthy obesity (MHO). This study aimed to compare the prevalence of stroke in MONW and MHO individuals.MethodsA total of 25,744 subjects aged ≥40 years were selected from the 2007–2014 Korean National Health and Nutrition Examination Survey. MetS was defined using 2001 National Cholesterol Education Program/Adult Treatment Panel III and 2005 American Heart Association/National Heart, Lung, and Blood Institute criteria. Non-obese weight and obesity were defined as a body mass index (BMI) <25 kg/m2 and ≥25 kg/m2, respectively. MONW was defined as meeting the MetS criteria with a BMI <25 kg/m2 and MHO was defined as not meeting the MetS criteria with a BMI ≥25 kg/m2.ResultsWomen with MONW had a higher prevalence of stroke than those with MHO (odds ratio [OR] = 2.27, 95% confidence interval [CI]: 1.45–3.57). The prevalence of stroke increased as the number of MetS components increased. The ORs for MONW with 3, 4, and 5 MetS components were 1.95 (95% CI: 1.19–3.21), 2.49 (95% CI: 1.46–4.24) and 2.74 (95% CI: 1.39–5.40), respectively.ConclusionsOur study findings may better emphasize the risk of stroke among more lean but unhealthy individuals, who appear healthy but may be suffering from MetS. These findings also highlight the need for stroke risk factor assessment in non-obese weight individuals.
Highlights
Both obesity and metabolic syndrome (MetS) are well known to increase the risks of coronary artery disease (CAD), stroke, and mortality.Regarding the associations of obesity with CAD, stroke, and mortality, a prospective cohort study found that overweight and obese individuals without MetS had an increased risk of cardiovascular events and death compared to normal weight individuals without MetS [1], and another prospective cohort study reported that obesity might increase the risk of incident CAD even in the presence of a healthy metabolic profile (HR: 3.08, 95% CI: 1.10– 8.68) [2]
Stroke prevalence according to obesity and MetS
The stroke prevalence remained higher in patients with MetS after adjusting for potential confounding factors (OR: 1.88, 95% CI: 1.53–2.30 for men; OR: 2.39, 95% CI: 1.90–3.01 for women)
Summary
Both obesity and metabolic syndrome (MetS) are well known to increase the risks of coronary artery disease (CAD), stroke, and mortality.Regarding the associations of obesity with CAD, stroke, and mortality, a prospective cohort study found that overweight and obese individuals without MetS had an increased risk of cardiovascular events and death compared to normal weight individuals without MetS (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.28–1.80; HR: 1.95, 95% CI: 1.14–3.34, respectively) [1], and another prospective cohort study reported that obesity might increase the risk of incident CAD even in the presence of a healthy metabolic profile (HR: 3.08, 95% CI: 1.10– 8.68) [2]. A recent study demonstrated that obesity is a risk factor for youngonset ischemic stroke (odds ratio [OR]: 1.57, 95% CI: 1.28–1.94) [3], and another study reported that obesity, even in the absence of overt metabolic aberrations, is associated with an increased all-cause mortality risk (HR: 2.80, 95% CI: 1.18–6.65) [4]. A prospective cohort study further demonstrated that MetS is associated with increased risks of both ischemic and hemorrhagic stroke (HR: 1.65, 95% CI: 1.43–2.82; HR: 1.42, 95% CI: 1.31– 2.71, respectively), and that survival rates decreased progressively as the number of MetS components increased [7]. Two prospective cohort studies found associations of MetS with an increased risk for ischemic stroke (OR: 5.15, 95% CI: 1.86–14.28) [9] and an increase in expanded cardiovascular disease (CVD)-related (CVD plus diabetes) mortality (HR: 1.27, 95% CI: 1.10–1.46) [10]
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