Overweight, Obesity, and Survival After Stroke in the Framingham Heart Study

Aparicio, Hugo J.; Himali, Jayandra J.; Beiser, Alexa; Davis‐Plourde, Kendra; Vasan, Ramachandran S.; Kase, Carlos S.; Wolf, Philip A.; Seshadri, Sudha

doi:10.1161/jaha.116.004721

Cited by 41 publications

(35 citation statements)

References 25 publications

(45 reference statements)

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“…One other explanation might be that the follow-up time in our study was not long enough to see the impact of hypertension and dyslipidemia on mortality. The association between obesity and all-cause mortality is still controversial [45, 46]. This may due to the diagnostic criterion for obesity is different across studies, and most of our obesity participants had a BMI of 28.0 to < 35 kg/m 2 , which was considered as mild obesity.…”

Section: Discussionmentioning

confidence: 99%

The major causes and risk factors of total and cause-specific mortality during 5.4-year follow-up: the Shanghai Changfeng Study

Hao

et al. 2019

Eur J Epidemiol

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To investigate the major causes and predictive factors of death in a middle-aged and elderly Chinese population. A total of 6591 residents aged ≥ 45 years from Shanghai Changfeng community were followed up for an average of 5.4 years. The causes of death were coded according to the 10th Revision of International Classification of Diseases. The mortality rate was calculated by person-years of follow up and age-standardized according to the 2010 Chinese census data. Multivariable-adjusted Cox proportional hazards model was performed to investigate the predictors of all-cause and cause-specific mortality. During the total follow-up of 35,739 person-years, 370 deaths were documented (157 from malignant neoplasms, 70 from heart diseases, 68 from cerebrovascular diseases, 75 from other causes). The age-standardized all-cause mortality rate was 798.2 per 100,000 person-years (927.9 among men and 716.7 among women). Results from multivariable analyses showed that aging, diabetes, and osteoporosis at baseline were independent predictors of all-cause mortality, with hazard ratios (HR) of 1.11 (95% CI 1.10–1.13), 1.91 (1.51–2.42), and 1.71 (1.24–2.35), respectively. The population attributable risk percent of diabetes and osteoporosis was 19.7% and 11.7%, respectively. Cigarette smoking was associated with a higher risk of all-cause mortality in men (HR and 95%CI 1.44, 1.01–2.06). In women, diabetes and osteoporosis were related to a higher risk of cardiovascular mortality (3.27, 1.82–5.88 and 1.89, 1.04–3.46, respectively). While in men, osteoporosis was related to a higher risk of malignant neoplasms mortality (2.39, 1.07–5.33). Malignant neoplasms, heart diseases, and cerebrovascular diseases are the leading causes of death. Aging, smoking, underweight, diabetes, and osteoporosis are independent predictors of premature death among middle-aged and elderly Chinese community population. Moreover, there may have been some differences in the causes and predictors of premature death between men and women.

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Section: Discussionmentioning

confidence: 99%

The major causes and risk factors of total and cause-specific mortality during 5.4-year follow-up: the Shanghai Changfeng Study

Hao

et al. 2019

Eur J Epidemiol

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“…This proportion is similar to our finding of 26% (95%CI, 24-29) in this study from five Brazilian cities. Table 5 shows the prevalence of patients with stroke being overweight or obese, from different countries and periods 21,22,23,24,25,26,27 . Our findings were similar to a Finland cohort 22 but higher than those from Germany and China 23,24,25,26,27 .…”

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confidence: 99%

Prevalence of obesity among stroke patients in five Brazilian cities: a cross-sectional study

Vicente

Cabral

Nagel³

et al. 2018

Arq. Neuro-Psiquiatr.

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Objective: There is gap in knowledge about obesity prevalence in stroke patients from low-and middle-income countries. Therefore, we aimed to measure the prevalence of overweight and obesity status among patients with incident stroke in Brazil. Methods: In a crosssectional study, we measured the body mass index (BMI) of ischemic and hemorrhagic stroke patients. The sample was extracted in 2016, from the cities of Sobral (CE), Sertãozinho (SP), Campo Grande (MS), Joinville (SC) and Canoas (RS). Results: In 1,255 patients with first-ever strokes, 64% (95% CI, 62-67) were overweight and 26% (95%CI, 24-29) were obese. The obesity prevalence ranged from 15% (95%CI, 9-23) in Sobral to 31% (95%CI, 18-45) in Sertãozinho. Physical inactivity ranged from 53% (95%CI, 43-63) in Sobral to 80% (95%CI, 73-85) in Canoas. Conclusions: The number of overweight patients with incident stroke is higher than the number of patients with stroke and normal BMI. Although similar to other findings in high-income countries, we urgently need better policies for obesity prevention.Keywords: obesity; prevalence; stroke, epidemiology; cross-sectional studies RESUMO Objetivo: Há uma lacuna de conhecimento sobre a prevalência de obesidade em pacientes com AVC (acidente vascular cerebral) de países de baixa e média renda. Portanto, objetivamos medir a prevalência de sobrepeso e obesidade entre pacientes com AVC no Brasil. Métodos: Em um estudo transversal, medimos o índice de massa corporal (IMC) em pacientes com AVC isquêmico e hemorrágico. A amostra foi extraída em 2016, nas cidades de Sobral (CE), Sertãozinho (SP), Campo Grande (MS), Joinville (SC) e Canoas (RS). Resultados: Entre 1255 casos de AVC, 64% (95%CI, 62-67) apresentavam sobrepeso e 26% (95%CI, 24-29) obesidade. A prevalência de obesidade variou de 15% (95%CI, 9-23) em Sobral a 31% (95%CI, 18-45) em Sertãozinho. Conclusões: A quantidade de pacientes com AVC e IMC anormal é maior do que a de pacientes com AVC e IMC normal. Embora esta prevalência seja similar às de países de alta renda, precisamos urgentemente de melhores políticas de prevenção da obesidade. Atividade física deveria ser parte da prescrição médica.Palavras-chave: obesidade; prevalência; acidente vascular cerebral, epidemiologia; estudos transversais Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese 1 . Once associated with high-income countries, obesity is now also prevalent in low-and middle-income countries 1 . In Brazil, a study by the Ministry of Health in 2011, showed that 48% of the population was either overweight (33%) or obese (15%) 2 . In 2006, these figures were 22.7% and 11.4% 2,3 . Because obesity is believed to cause a number of established risk factors for cardiovascular diseases such as hypertension, dyslipidemia and diabetes, the growing prevalence of obesity is assumed to increase the global cardiovascular disease burden 4 . For instance, in adults, the risk for ischemic stroke increases almost linear...

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“…Although the finding is likely the result of bias 26 , it has caused physicians to question the benefit of weight management after stroke. 27,28 Our study has a few limitations. First, participants in clinical trials tend to have higher adherence to risk factor management as compared with participants in a primary care setting.…”

Section: Discussionmentioning

confidence: 93%

Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity

Dearborn

Viscoli

Young

et al. 2019

Stroke

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Background and Purpose: The proportion of patients with acute ischemic stroke or transient ischemic attack (TIA) and obesity who successfully achieve goals for weight reduction recommended by major professional organizations is unknown. Methods: We examined the experience of participants in the placebo group of the Insulin Resistance Intervention after Stroke (IRIS) trial with a body mass index (BMI) ≥30 kg/m 2 at entry. Patients were age 40 or greater, with a qualifying stroke or TIA within 180 days of randomization and documented insulin resistance without diabetes. Weights at baseline and at years 1 and 2 after entry were analyzed to determine the proportion of patients achieving a 5% weight loss and/or achievement of BMI <27 kg/m 2. Results: Of 1937 subjects assigned to placebo, 855 (44%) had obesity at entry. Median age of these 855 subjects was 60 years (interquartile range, 53 to 68), 41% were women and median time from stroke/TIA to trial entry was 79 days. Among 788 subjects in the trial at one year, 166 (21%) had lost at least 5% of their starting weight and 12 (2%) had achieved a BMI <27 kg/m 2. 109 (14%) participants gained at least 5% of their baseline weight at one year. Among 744 subjects in the trial at two years, 185 (25%) had lost at least 5% of their baseline weight, and 23 (3%) had achieved a BMI <27 kg/m 2. 140 (19%) participants gained at least 5% of their starting weight at two years. Conclusions: Only one-quarter of obese patients with a recent ischemic stroke or TIA lost a clinically significant amount of weight after their vascular event. Many patients gained weight. Enhancing weight loss after ischemic stroke or TIA may help improve functional outcome and

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Overweight, Obesity, and Survival After Stroke in the Framingham Heart Study

Cited by 41 publications

References 25 publications

The major causes and risk factors of total and cause-specific mortality during 5.4-year follow-up: the Shanghai Changfeng Study

The major causes and risk factors of total and cause-specific mortality during 5.4-year follow-up: the Shanghai Changfeng Study

Prevalence of obesity among stroke patients in five Brazilian cities: a cross-sectional study

Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity

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