Association of Body Mass Index with Ischemic and Hemorrhagic Stroke
Masahiro Shiozawa1, Hidehiro Kaneko1,2, Hidetaka Itoh1
1The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
Insights
Overweight and obesity increase stroke and ischemic stroke risk in both men and women. Underweight, overweight, and obesity are linked to higher hemorrhagic stroke risk in men, but not women.
Area of Science:
- Cardiovascular epidemiology
- Public health
- Metabolic disorders
Background:
- Limited data exist on the association between body mass index (BMI) and stroke incidence.
- Understanding BMI's role in stroke risk is crucial for public health interventions.
- Sex-specific differences in BMI and stroke risk require further investigation.
Purpose of the Study:
- To examine the association between BMI and incident stroke (ischemic or hemorrhagic).
- To clarify the relationship between underweight, overweight, and obesity and stroke risk, stratified by sex.
Main Methods:
- Analysis of the JMDC Claims Database (January 2005 - April 2020) including 2,740,778 healthy individuals.
- Categorization of participants into underweight, normal weight, overweight, and obese groups based on BMI.
- Utilized Cox regression models and restricted cubic spline (RCS) functions to assess BMI-stroke associations.
Main Results:
- Overweight and obesity were associated with a higher incidence of total and ischemic stroke in both sexes.
- Underweight, overweight, and obesity were linked to increased hemorrhagic stroke incidence in men, but not in women.
- Ischemic stroke risk increased with BMI in a dose-dependent manner for both sexes; hemorrhagic stroke risk showed a U-shaped relationship with BMI in men.
Conclusions:
- Overweight and obesity are significant risk factors for stroke and ischemic stroke in both men and women.
- Specific BMI categories present distinct risks for hemorrhagic stroke, particularly in men.
- Findings aid in refining stroke risk stratification based on body mass index.
Abstract:
Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38-53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2-24.8) kg/m2). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), or obese (BMI ≥ 30 kg/m2). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0-32.9), 28.1 (27.6-28.5), and 5.5 (5.3-5.7) per 10,000 person-years in men, whereas 25.7 (25.1-26.2), 22.5 (22.0-23.0), and 4.0 (3.8-4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.
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