scholarly journals Hypothetical Lifestyle Strategies in Middle-Aged Women and the Long-Term Risk of Stroke

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1381-1387 ◽  
Author(s):  
Priyanka Jain ◽  
Claudia K. Suemoto ◽  
Kathryn Rexrode ◽  
JoAnn E. Manson ◽  
James M. Robins ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Red Meat ◽  
Lifestyle Changes ◽  
Middle Aged ◽  
Stroke Incidence ◽  
Dietary Strategies ◽  
Processed Red Meat

Background and Purpose— Long-term effect of lifestyle changes on stroke incidence has not been estimated in randomized trials. We used observational data to estimate the incidence of stroke under hypothetical lifestyle strategies in the NHS (Nurses’ Health Study). Methods— We considered 3 nondietary strategies (smoking cessation, exercising ≥30 min/d, gradual body mass index reduction if overweight/obese) and several dietary strategies (eating ≥3 servings/wk of fish, ≤3 servings/wk of unprocessed red meat, no processed red meat, ≥1 servings/d of nuts, etc). We used the parametric g-formula to estimate the 26-year risk of stroke under these strategies. Results— In 59 727 women, mean age 52 years at baseline in 1986, the estimated 26-year risks under no lifestyle interventions were 4.7% for total stroke, 2.4% for ischemic stroke, and 0.7% for hemorrhagic stroke. Under the combined nondietary interventions, the estimated 26-year risk of total stroke was 3.5% (95% CI, 2.6%–4.3%) and ischemic stroke was 1.6% (95% CI, 1.1%–2.1%). Smaller reductions in total stroke risk were estimated under isolated dietary strategies of increased intake of fish and nuts and reduced intake of unprocessed red meat. Ischemic stroke risk was lower under reduced intake of unprocessed and processed red meat, and hemorrhagic stroke risk was lower under a strategy of increased fish consumption. Conclusions— In this population of middle-aged women, sustained, lifestyle modifications were estimated to reduce the 26-year risk of total stroke by 25% and ischemic stroke by 36%. Sustained dietary modifications were estimated to reduce the 26-year risk of total stroke by 23%.

Abstract TMP104: The Effect of Hypothetical Lifestyle Strategies on the Long-term Risk of Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Priyanka Jain ◽  
Claudia K Suemoto ◽  
Kathryn Rexrode ◽  
Goodarz Danaei ◽  
Miguel A Hernan
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Red Meat ◽  
Term Effect ◽  
Time Varying ◽  
Long Term Effect ◽  
Estimated Risk ◽  
Dietary Strategies ◽  
Processed Red Meat

Randomized trials have examined the short-term effects of lifestyle interventions on the risk of stroke. Using observational data to estimate the long-term effect of such strategies requires valid adjustment for time-varying confounders- such as hypertension- that are affected by prior lifestyle risk factors. We estimated the long-term effect of hypothetical lifestyle strategies on risk of stroke using data from the Nurses’ Health Study, a prospective cohort. We followed 60,390 women, aged 52 years on average at baseline, from 1986 to 2010. We used a Monte Carlo simulation to estimate the 24-year risk of stroke had all participants followed three non-dietary lifestyle strategies: smoking cessation, exercising (≥30 minutes/day), reducing body mass index (BMI) by 5% every two years if overweight/obese; as well as several dietary strategies including: eating ≥ 3 servings/week of fish, eating ≤ 3 servings/week of unprocessed red meat, eating no processed red meat, eating ≥ 5 servings/day of fruits and vegetables, among others. We used the parametric g-formula to adjust for baseline and time-varying confounders, comparing the estimated risk of stroke under our specified strategies of interest to the same had all participants followed a “do-nothing” strategy. The observed 24-year risks of total, ischemic and hemorrhagic stroke in this cohort were 2.9%, 2.2% and 0.6%. The estimated risk of total stroke was 25% lower (95% CI: 5% to 46%) under a combination of all three non-dietary strategies, the most effective being exercise (19% lower risk) and smoking cessation (5% lower risk). Of the dietary strategies, eating ≤ 3 servings of unprocessed red meat reduced the estimated risk of total stroke by 4% (1% to 7%). The risk of ischemic stroke under all three non-dietary strategies was 36% lower (15% to 59%), but risk of hemorrhagic stroke did not materially change. Exercise reduced the estimated risk of ischemic stroke by 29% (7% to 56%) and lowering BMI by 4% (0% to 8%). Additionally, ischemic stroke risk was lowered by 9% (0% to 19%) by decreasing intake of processed red meat and 6% (2% to 10%) by decreasing intake of unprocessed red meat. In summary, lifestyle modifications were estimated to reduce the 24-year risk of total stroke by up to 25% in this population of middle-aged women.

Long-term stroke incidence in proximal thoracic aorta aneurysm survivors

2019 ◽  
Vol 15 (4) ◽  
pp. 421-428
Author(s):  
Jin-Yi Hsu ◽  
Yuan-Chih Su ◽  
Jen-Hung Wang ◽  
Boon Lead Tee
Keyword(s):  
Ischemic Stroke ◽  
Thoracic Aorta ◽  
Hemorrhagic Stroke ◽  
Study Cohort ◽  
Research Database ◽  
Term Care ◽  
Term Survival ◽  
Stroke Incidence ◽  
Increased Risk

Background Aneurysm of proximal thoracic aorta (pTAA) is an often indolent, yet fatal disease. Although advancements in aneurysmal repair techniques have increased long-term survival rates, studies have proven that there are increases in perioperative risk for stroke incidence after pTAA surgery. Conversely, there is little evidence regarding the long-term stroke incidence in pTAA individuals, which strongly influences the morbidity, mortality, and usage of antithrombotic agents. Methods Using the Taiwan National Health Insurance Research Database, a nationwide population-based cohort, we recruited 3013 pTAA survivors hospitalized from 1 January 2000 to 31 December 2012. To ensure study cohort quality, only patients aged 20 years and above who underwent aneurysmal repair surgery are included. The control cohort is identified by matching background features (comorbidities, age, gender) at a 1:4 ratio through the use of frequency matching. The primary outcomes include incidence of ischemic stroke and intracranial hemorrhage one month after aneurysmal repair surgery. Results The mortality of pTAA survivors is nearly twice of the matched controls despite aneurysmal repair (28.5 % vs. 15.2%, p < 0.001). Long-term follow-up of participants indicated that pTAA survivors had a higher risk for hemorrhage stroke (adjusted hazard ratio (aHR): 1.93; 95% confidence interval (CI): 1.47–2.53), but no significant increase in risk for ischemic stroke (aHR: 1.07; 95% CI: 0.92–1.25). Hemorrhagic stroke occurrence was found to be associated with age and diabetes mellitus. Comparison on hemorrhagic stroke subtypes between study and matched cohorts showed no statistical differences in intracerebral hemorrhage and subarachnoid hemorrhage. Conclusions Despite the advancement of aneurysmal repair surgery, this study suggests that pTAA patients may still face an increased risk of hemorrhage stroke. Further investigation is warranted to provide better long-term care for the pTAA population.

scholarly journals Impact of Pre-eclampsia/eclampsia on Hemorrhagic and Ischemic Stroke Risk: A 17 years Follow-up Nationwide Cohort Study

2021 ◽  
Author(s):  
Chi-Jou Chuang ◽  
Wen-Yen Chiou ◽  
Hsuan-Ju Yang ◽  
Shih-Kai Hung ◽  
Moon-Sing Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Time Trend ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Research Database ◽  
Exact Matching ◽  
Ischemic Stroke Risk

Objective No study ever investigated the long-term risk of stroke in women with pre-eclampsia/eclampsia. The purpose of this study is to explore long-term stroke risks, differentiating subtypes and their time trends. Design Nationwide population-based cohort study Methods Between 2000 and 2017, 1,384,427 pregnant women were registered in the National Health Insurance Research Database in Taiwan. After excluding women with previous stroke history and exact matching with all confounders, 6,053 women with pre-eclampsia/eclampsia and 24,212 controls were recruited. Main Outcome Measures Hemorrhagic and ischemic strokes after child-birth Results Over the 17-year follow-up, the adjusted hazard ratio (aHR) for stroke in women with a history of pre-eclampsia/eclampsia was 2.05 (95% confidence interval, CI = 1.67-2.52, p<0.001). The 17 years overall risks of both ischemic and hemorrhagic stroke were 1.98 and 3.45, respectively (p<0.001). The stroke subtypes, hemorrhagic and ischemic, had different time trend risks, and hemorrhagic stroke risks kept higher than that of ischemic stroke. The ischemic stroke risk peaked during 1-3 years after childbirth (aHR=3.09). The hemorrhagic stroke risk peaked during 3-5 years (aHR=7.49). Conclusions Stroke risk persisted even after decades, for both ischemic and hemorrhagic subtypes. Women with pre-eclampsia/eclampsia history should be aware of the long-term risk of stroke. Tweetable abstract Both ischemic and hemorrhagic stroke risks persisted high even after decades, while their time trend risks were different. Keywords: pre-eclampsia/eclampsia; ischemic stroke; hemorrhagic stroke

scholarly journals Association between Migraine and the Risk of Stroke: A Bayesian Meta-Analysis

2021 ◽  
Vol 13 (7) ◽  
pp. 3759
Author(s):  
Kim-Ngan Ta-Thi ◽  
Kai-Jen Chuang ◽  
Chyi-Huey Bai
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Credible Interval ◽  
Fixed Effect Model ◽  
Bayesian Approaches ◽  
Effect Model ◽  
Newcastle Ottawa Scale ◽  
Form Quality

There are still inconsistent results about association between migraine and stroke risk in studies. This paper was to review findings on the association between migraine (with or without aura) and stroke risk. We searched articles in the Embase and PubMed up to January 2021. Two independent reviewers extracted basic data from individual studies using a standardized form. Quality of studies was also assessed using the Newcastle–Ottawa Scale. We conducted a meta-analysis, both classical and Bayesian approaches. We identified 17 eligible studies with a sample size more than 2,788,000 participants. In the fixed effect model, the results demonstrated that migraine was positively associated with the risk of total stroke, hemorrhagic stroke, and ischemic stroke. Nevertheless, migraine was associated with only total stroke in the random effects model (risk ratio (RR) 1.31, 95%CI: 1.06–1.62). The probability that migraine increased total stroke risk was 0.978 (RR 1.31; 95% credible interval (CrI): 1.01–1.72). All types of migraine were not associated with ischemic stroke and hemorrhagic stroke. Under three prior distributions, there was no association between migraine and the risk of ischemic stroke or hemorrhagic stroke. Under the non-informative prior and enthusiastic prior, there was a high probability that migraine was associated with total stroke risk.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

Abstract MP052: Lifestyle Factors and Antihypertensive Treatment on the Risks of Ischemic and Haemorrhagic Stroke

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Gang Hu ◽  
Yurong Zhang ◽  
Pekka Jousilahti ◽  
Yujie Wang ◽  
Riitta Antikainen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antihypertensive Treatment ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Healthy Lifestyle ◽  
Antihypertensive Drugs ◽  
Vegetable Consumption ◽  
Lifestyle Factors ◽  
Lifestyle Factor ◽  
Causal Pathway

Background Although hypertension is a potential intermediate factor on the causal pathway of lifestyle factor with stroke risk, the joint relationship between healthy lifestyle and antihypertensive treatment with stroke risk is unclear. Methods We prospectively investigated the individual and joint effects of healthy lifestyle factors and antihypertensive treatment on total and type-specific stroke risk among 36,686 Finnish participants who were 25 to 74 years old and free of coronary heart disease and stroke at baseline. The Cox proportional hazards model was used to evaluate the associations between healthy lifestyle factors and hypertension subgroups with stroke risk. Results During a mean follow-up of 13.7 years, 1,478 people developed an incident stroke event (1,167 ischemic and 311 hemorrhagic). The risk of stroke was significantly decreased in people adhered to ≥3 healthy lifestyle factors (never smoking, normal weight, moderate/high level of physical activity, vegetable consumption ≥3 times/week, and light/moderate alcohol drinking) compared with those adhered to <3 healthy lifestyle factors and this association was present among participants with different hypertensive status. The risk of stroke was significantly increased in all hypertensive subgroups compared with the normotensive group. Compared with hypertensive subjects who did not use antihypertensive drugs and were adhered to ≥3 healthy lifestyle factors, the multivariable-adjusted hazard ratios in hypertensive subjects who used antihypertensive drugs and were adhered to <3 healthy lifestyle factors were 1.39 (95% CI 1.04-1.86) for total stroke, 1.42 (1.03-1.97) for ischemic stroke, 1.37 (0.72-2.58) for hemorrhagic stroke in men, and 2.27 (1.71-3.01) for total stroke, 2.31 (1.69-3.16) for ischemic stroke, 2.21 (1.16-4.23) for hemorrhagic stroke in women, respectively. Only hypertensive men but not women who used antihypertensive drugs and were adhered to ≥3 healthy lifestyle factors had decreased risks of total and ischemic stroke compared with those who did not use antihypertensive drugs and were adhered to <3 healthy lifestyle factors. Conclusions The present study demonstrates our study demonstrates that a healthy lifestyle significantly decreases the risks of total, ischemic and hemorrhagic stroke in different hypertensive status in both men and women. A healthy lifestyle may be more effective in preventing stroke than antihypertensive treatment in hypertensive subjects.

Abstract P530: Health Beliefs Shaped by Experiences of Socioeconomic Deprivation and Psychosocial Distress is Critical to Maintaining Lifestyle Choices for Reducing Stroke Risk: A Mixed Methods Analysis

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Shwetha A George ◽  
Rita V Krishnamurthi ◽  
Suzanne Barker-Collo ◽  
Valery L Feigin
Keyword(s):  
Health Beliefs ◽  
Food Choice ◽  
Role Model ◽  
Stroke Risk ◽  
Dietary Habits ◽  
Psychosocial Distress ◽  
Socioeconomic Deprivation ◽  
Risk Behaviours ◽  
Stroke Incidence

Introduction: 9 out of 10 stroke events are attributable to modifiable (including lifestyle) risk factors. Therefore, long-term preventative health behaviour changes (PHBCs) is critical for reducing stroke incidence. However, current, New Zealand (NZ) education-based behavioral interventions report a high participant non-response rate or relapse into risk-behaviours within 6 months. In this regard, this study is the first to explore influences of psychosocial distress, socioeconomic deprivation and health beliefs influences on motivation for initiating/maintaining PHBC in the NZ population. Methods: (1) Qualitative interviews were conducted with 40 NZ participants recruited from the Reducing the International Burden of Stroke Using Mobile Technology E-health research program. Participants' perceived stroke susceptibility, barriers to/benefits of PHBCs and managing psychosocial distress were explored. Recorded and transcribed interviews were then thematically analysed. (2) Quantitative: 200 participants completed questionnaires on dietary habits and food choice motivations. Hierarchical regression modelling was performed to evaluate influences of socioeconomic deprivation on food choices. Results: (1) Participants acknowledged the beneficial effects of PHBCs in reducing stroke risk. Notwithstanding, performing PHBC during chronic stress/anxiety was challenging due to the instant, short-term relief gained through risk behaviours. Interactions with peers who actively engaged in risk behaviours and inadequate support systems limited self-efficacy in sustaining PHBCs. Mitigating future health risks and being a positive role model were some of the perceived benefits of maintaining PHBCs. (2) The degree of individual deprivation significantly predicted consumption of risk reducing foods (e.g., fruits) (F(4,168)=11.24, R 2 =0.20, p<0.000). After adjusting for demographic variables, individual and community deprivation was found to significantly predict food choice motivations based on familiarity (F(4,168)=2.97, R 2 =0.07, p<0.05; F(5,164)=2.27, R 2 =0.07, p<0.05), price (F(4,168)=13.36, R 2 =0.24, p<0.001; F(5,164)=10.29, R 2 =0.24, p<0.001), natural content (F(4,168)=4.28, R 2 =0.10, p<0.01; F(5,164)=3.97, R 2 =0.11, p<0.01), ethical acceptability (F(4,168)=2.80, R 2 =0.06, p<0.05; F(5,164)=2.66, R 2 =0.08, p<0.05) and convenience (F(4,168)=3.92, R 2 =0.09, p<0.01; F(5,164)=3.09, R 2 =0.09, p<0.05). Nutritional knowledge was also significantly predicted by individual (F(4,168)=4.08, R 2 =0.09, p<0.01) and community (F(5,164)=3.25, R 2 =0.09, p<0.01) deprivation. Conclusions: Motivation for sustaining PHBCs can be impeded by socioeconomic deprivation and psychosocial distress. Long-term PHBC maintenance may then be optimised by client-centred strategies as opposed to conventional, education-based prevention paradigms.

scholarly journals Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan

Neurology ◽  
2020 ◽  
Vol 94 (11) ◽  
pp. e1112-e1121 ◽  
Author(s):  
Tina H.T. Chiu ◽  
Huai-Ren Chang ◽  
Ling-Yi Wang ◽  
Chia-Chen Chang ◽  
Ming-Nan Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Lower Risk ◽  
Hemorrhagic Stroke ◽  
Vegetarian Diet ◽  
Dietary Vitamin ◽  
Vitamin B ◽  
Study Cohort ◽  
Research Database ◽  
Stroke Incidence

ObjectiveTo determine how a vegetarian diet affects stroke incidence in 2 prospective cohorts and to explore whether the association is modified by dietary vitamin B12 intake.MethodsParticipants without stroke in the Tzu Chi Health Study (cohort 1, n = 5,050, recruited in 2007–2009) and the Tzu Chi Vegetarian Study (cohort 2, n = 8,302, recruited in 2005) were followed until the end of 2014. Diet was assessed through food frequency questionnaires in both cohorts at baseline. Stroke events and baseline comorbidities were identified through the National Health Insurance Research Database. A subgroup of 1,528 participants in cohort 1 were assessed for serum homocysteine, vitamin B12, and folate. Associations between vegetarian diet and stroke incidences were estimated by Cox regression with age as time scale, adjusted for sex, education, smoking, alcohol, physical activities, body mass index (only in cohort 1), hypertension, diabetes, dyslipidemia, and ischemic heart diseases.ResultsVegetarians had lower serum vitamin B12 and higher folate and homocysteine than nonvegetarians. In cohort 1, 54 events occurred in 30,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of ischemic stroke (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.08–0.88). In cohort 2, 121 events occurred in 76,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of overall stroke (HR, 0.52; 95% CI, 0.33–0.82), ischemic stroke (HR, 0.41; 95% CI, 0.19–0.88), and hemorrhagic stroke (HR, 034; 95% CI, 0.12–1.00). Our explorative analysis showed that vitamin B12 intake may modify the association between vegetarian diet and overall stroke (p interaction = 0.046).ConclusionTaiwanese vegetarian diet is associated with a lower risk of ischemic and hemorrhagic strokes.

scholarly journals Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

2019 ◽  
Vol 12 ◽  
pp. 175628641986483 ◽  
Author(s):  
Ru Jian Jonathan Teoh ◽  
Chi-Jung Huang ◽  
Chi Peng Chan ◽  
Li-Yin Chien ◽  
Chih-Ping Chung ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Statin Therapy ◽  
Sequential Analysis ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Stroke Survivors ◽  
Composite Endpoints

Background: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. Methods: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and conclusiveness of the available evidence in the meta-analysis. To evaluate the overall effectiveness, the net composite endpoints were derived by totaling ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), myocardial infarction, and cardiovascular mortality. Results: A total of 17 trials with 11,576 subjects with previous ischemic stroke, TIA, or ICH were included, in which statin therapy increased the risk of hemorrhagic stroke (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.07–1.87), but reduced the risk of ischemic stroke (RR, 0.85; 95% CI, 0.75–0.95). For the net composite endpoints, statin therapy was associated with a 17% risk reduction (95% CI, 12–21%; number needed to treat = 6). With a control event rate 2% and RR increase 40%, the TSA suggested a conclusive signal of an increased risk of hemorrhagic stroke in stroke survivors taking statin. However, with the sensitivity analysis by changing assumptions, the conclusions about hemorrhagic stroke risk were less robust. Conclusions: Statin therapy in poststroke patients increased the risk of hemorrhagic stroke but effectively reduced ischemic stroke risk. Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or TIA. However, more studies are required to investigate the conclusiveness of the increased hemorrhagic stroke risk revealed in our study.

scholarly journals Association of Body Mass Index with Ischemic and Hemorrhagic Stroke

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2343
Author(s):  
Masahiro Shiozawa ◽  
Hidehiro Kaneko ◽  
Hidetaka Itoh ◽  
Kojiro Morita ◽  
Akira Okada ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Body Mass ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Cox Regression ◽  
Cubic Spline ◽  
Overweight And Obesity ◽  
Dependent Manner ◽  
Men And Women

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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