Impact of Obesity and the Metabolic Syndrome on Risk Factors in African American Stroke Survivors

Abstract

Background: The rates of obesity and the metabolic syndrome and the impact on traditional vascular risk factors in African American stroke survivors are unknown. Objective: To describe the relationships between body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) and hypertension, dyslipidemia, and diabetes mellitus. Design: We classified 1711 subjects as underweight (BMI, Ͻ18.5), normal (BMI, 18.5-24.9), overweight (BMI, 25.0-29.9), or obesity class 1 (BMI, 30.0-34.9), 2 (BMI, 35.0-39.9), or 3 (BMI, Ͼ40.0). We compared the proportions with hypertension, dyslipidemia, and diabetes mellitus and control of these factors by clinical history and results of physical examination and laboratory analysis across BMI groups. Setting: Multicentered clinical trial. Patients: African American subjects with previous ischemic stroke. Main Outcome Measures: Rates of obesity and the metabolic syndrome, odds ratios (ORs) of associated vascular risk factors at baseline, and relationship to longitudinal risk factor control. Results: Overall, 76% were overweight or obese (70% of men and 81% of women). Hypertension, dyslipidemia, and diabetes mellitus were all present in 43.3% of men and 29.1% of women with obesity class 3. The ORs for having the metabolic syndrome were 2.14 (95% confidence interval [CI], 1.52-3.01) for class 1, 1.92 (95% CI, 1.26-2.91) for class 2, and 1.98 (95% CI, 1.27-3.09) for class 3 obesity. In addition, increasing BMI was negatively associated with systolic (PϽ.001) and diastolic (PϽ.001) blood pressure and glycemic control (PϽ.001). Conclusion: Our analysis of the data from the African American Antiplatelet Stroke Prevention Study supports the association of increasing risk factor profiles with increasing weight in African American stroke survivors.

Excess body weight and risk of first‐ever acute ischaemic non‐embolic stroke in elderly subjects

“…A recent meta‐analysis of the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), which included only those patients who received placebo, showed that patients with the MetS were at increased risk of major coronary events irrespective of their Framingham‐calculated 10‐year risk score category [41]. The association of MetS presence with stroke risk in older patients has also been recognized [16,42–45]. In the present study, interaction analysis indicated that abdominal obesity as a component of the MetS (coded either by increased BMI or increased WC) contributed significantly to the prediction for stroke dependent upon the presence of the MetS.…”

Excess body weight and risk of first‐ever acute ischaemic non‐embolic stroke in elderly subjects

“…A recent meta‐analysis of the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), which included only those patients who received placebo, showed that patients with the MetS were at increased risk of major coronary events irrespective of their Framingham‐calculated 10‐year risk score category [41]. The association of MetS presence with stroke risk in older patients has also been recognized [16,42–45]. In the present study, interaction analysis indicated that abdominal obesity as a component of the MetS (coded either by increased BMI or increased WC) contributed significantly to the prediction for stroke dependent upon the presence of the MetS.…”

Obesity and Recurrent Vascular Risk After a Recent Ischemic Stroke

“…A post hoc analysis of another secondary stroke prevention trial did find an association between obesity and risk of stroke recurrence, but this trial comprised approximately 1700 black subjects, and its results may not necessarily be generalizable to the broader population of patients with ischemic stroke. 13 There are several potential explanations for the lack of association between body habitus and recurrent stroke risk in our study. First, most of the epidemiological studies showing that obesity is an independent risk factor for stroke incidence and mortality were done in the general population without illness.…”

Impact of metabolic syndrome on prognosis of symptomatic intracranial atherostenosis

“…30 Whereas a standardized fasting approach to obtaining lipid levels and glucose in WASID would have enhanced precision of the triglyceride and glucose metabolism criteria, other studies have also utilized casual glucose levels for defining MetS. 15 We performed a sensitivity analysis in which the MetS criteria were modified to conform more closely to the WHO definition and found similar results. Moreover, our sensitivity analysis showed that using a different definition for abnormal glucose metabolism as part of the MetS criteria produced similar results.…”

“…This prevalence rate is similar to that noted in a recent study of Korean patients with intracranial stenosis 11 but is much higher than the 25% rate observed in a secondary stroke prevention study conducted among African Americans. 15 This difference may be due to the single racial group evaluated in that study and its wider eligibility criteria to include strokes due to small vessel disease. 15 Of note in our study was that our main definition of MetS (when defined by the current physiologic state of the patient) was more frequent in whites than nonwhites (p ϭ 0.04).…”

Excess body weight and risk of first‐ever acute ischaemic non‐embolic stroke in elderly subjects

“…A recent meta‐analysis of the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), which included only those patients who received placebo, showed that patients with the MetS were at increased risk of major coronary events irrespective of their Framingham‐calculated 10‐year risk score category [41]. The association of MetS presence with stroke risk in older patients has also been recognized [16,42–45]. In the present study, interaction analysis indicated that abdominal obesity as a component of the MetS (coded either by increased BMI or increased WC) contributed significantly to the prediction for stroke dependent upon the presence of the MetS.…”

Obesity and Recurrent Vascular Risk After a Recent Ischemic Stroke

“…A post hoc analysis of another secondary stroke prevention trial did find an association between obesity and risk of stroke recurrence, but this trial comprised approximately 1700 black subjects, and its results may not necessarily be generalizable to the broader population of patients with ischemic stroke. 13 There are several potential explanations for the lack of association between body habitus and recurrent stroke risk in our study. First, most of the epidemiological studies showing that obesity is an independent risk factor for stroke incidence and mortality were done in the general population without illness.…”

Impact of metabolic syndrome on prognosis of symptomatic intracranial atherostenosis

“…30 Whereas a standardized fasting approach to obtaining lipid levels and glucose in WASID would have enhanced precision of the triglyceride and glucose metabolism criteria, other studies have also utilized casual glucose levels for defining MetS. 15 We performed a sensitivity analysis in which the MetS criteria were modified to conform more closely to the WHO definition and found similar results. Moreover, our sensitivity analysis showed that using a different definition for abnormal glucose metabolism as part of the MetS criteria produced similar results.…”

“…This prevalence rate is similar to that noted in a recent study of Korean patients with intracranial stenosis 11 but is much higher than the 25% rate observed in a secondary stroke prevention study conducted among African Americans. 15 This difference may be due to the single racial group evaluated in that study and its wider eligibility criteria to include strokes due to small vessel disease. 15 Of note in our study was that our main definition of MetS (when defined by the current physiologic state of the patient) was more frequent in whites than nonwhites (p ϭ 0.04).…”

Excess body weight and risk of first‐ever acute ischaemic non‐embolic stroke in elderly subjects

“…A recent meta‐analysis of the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), which included only those patients who received placebo, showed that patients with the MetS were at increased risk of major coronary events irrespective of their Framingham‐calculated 10‐year risk score category [41]. The association of MetS presence with stroke risk in older patients has also been recognized [16,42–45]. In the present study, interaction analysis indicated that abdominal obesity as a component of the MetS (coded either by increased BMI or increased WC) contributed significantly to the prediction for stroke dependent upon the presence of the MetS.…”

Obesity and Recurrent Vascular Risk After a Recent Ischemic Stroke

“…A post hoc analysis of another secondary stroke prevention trial did find an association between obesity and risk of stroke recurrence, but this trial comprised approximately 1700 black subjects, and its results may not necessarily be generalizable to the broader population of patients with ischemic stroke. 13 There are several potential explanations for the lack of association between body habitus and recurrent stroke risk in our study. First, most of the epidemiological studies showing that obesity is an independent risk factor for stroke incidence and mortality were done in the general population without illness.…”

Impact of metabolic syndrome on prognosis of symptomatic intracranial atherostenosis

“…30 Whereas a standardized fasting approach to obtaining lipid levels and glucose in WASID would have enhanced precision of the triglyceride and glucose metabolism criteria, other studies have also utilized casual glucose levels for defining MetS. 15 We performed a sensitivity analysis in which the MetS criteria were modified to conform more closely to the WHO definition and found similar results. Moreover, our sensitivity analysis showed that using a different definition for abnormal glucose metabolism as part of the MetS criteria produced similar results.…”

“…This prevalence rate is similar to that noted in a recent study of Korean patients with intracranial stenosis 11 but is much higher than the 25% rate observed in a secondary stroke prevention study conducted among African Americans. 15 This difference may be due to the single racial group evaluated in that study and its wider eligibility criteria to include strokes due to small vessel disease. 15 Of note in our study was that our main definition of MetS (when defined by the current physiologic state of the patient) was more frequent in whites than nonwhites (p ϭ 0.04).…”