Association of body mass index with mortality and functional outcome after acute ischemic stroke

Background: Obesity is an established risk factor for acute ischemic stroke (AIS), but its impact on clinical outcomes and mortality after AIS remains controversial. In this study, we evaluate the association of body mass index (BMI) on outcomes after mechanical thrombectomy (MT) for large vessel occlusion acute ischemic stroke (LVOS). Methods: We reviewed our prospective MT database for LVOS between 2015 and 2018. BMI was analyzed as a continuous and categorical variable with underweight BMI <18.5, normal BMI 18.5-24.9, overweight BMI 25-29.9, and obese BMI>30. Multivariate analysis was used to determine predictors of outcome. Results: 335 patients underwent MT with 7 (2.1%) patients classified as underweight, 107 (31.9%) normal, 141 (42.1%) overweight, and 80 (23.9%) obese. Compared to normal weight (reference), obese patients had higher rates of hypertension and hyperlipidemia, while underweight patients had higher rates of previous stroke and presentation NIHSS. The time from symptom onset to puncture, procedural techniques, and reperfusion success (>TICI 2b) was not significantly different between BMI categories. There was a significant inverse linear correlation between BMI and symptomatic hemorrhagic. In patients with successful reperfusion (>TICI 2b), there was also a significant bell-shaped relationship between BMI and functional independence (mRS < 3) with both low and high BMIs associated with worse outcomes. In patients without post-procedural symptomatic hemorrhage, there was a significant linear correlation between BMI and inpatient mortality. Conclusion: In LVOS patients treated with MT, BMI is inversely related with post-procedural symptomatic hemorrhage. Yet in those whom reperfusion is achieved, both lower and higher than normal BMI were associated with worse functional outcomes. Thus, the obesity paradox does not appear to pertain to mechanical thrombectomy, although larger prospective studies are necessary.

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Erratum to: Comparison of body mass index, waist circumference, and waist-height ratio in predicting functional outcome following ischemic stroke

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-017-1522-0 ◽

2017 ◽

Vol 44 (2) ◽

pp. 245-246

Author(s):

Kyusik Kang ◽

Wong-Woo Lee ◽

Jung-Ju Lee ◽

Jong-Moo Park ◽

Ohyun Kwon ◽

...

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Waist Circumference ◽

Functional Outcome ◽

Body Mass ◽

Height Ratio ◽

Waist Height Ratio

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Association of Body Mass Index and Mortality After Acute Ischemic Stroke

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.113.000129 ◽

2013 ◽

Vol 7 (1) ◽

pp. 64-69 ◽

Cited By ~ 22

Author(s):

L. E. Skolarus ◽

B. N. Sanchez ◽

D. A. Levine ◽

J. Baek ◽

K. A. Kerber ◽

...

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Body Mass

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Comparison of body mass index, waist circumference, and waist-height ratio in predicting functional outcome following ischemic stroke

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-017-1508-y ◽

2017 ◽

Vol 44 (2) ◽

pp. 238-244 ◽

Cited By ~ 3

Author(s):

Kyusik Kang ◽

Wong-Woo Lee ◽

Jung-Ju Lee ◽

Jong-Moo Park ◽

Ohyun Kwon ◽

...

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Waist Circumference ◽

Functional Outcome ◽

Body Mass ◽

Height Ratio ◽

Waist Height Ratio

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Association between body mass index and the effect of antihypertensive treatment on the long-term outcome of patients with acute ischemic stroke

Journal of the American Society of Hypertension ◽

10.1016/j.jash.2015.03.282 ◽

2015 ◽

Vol 9 (4) ◽

pp. e122

Author(s):

Konstantinos Tziomalos ◽

Stella Bouziana ◽

Marianna Spanou ◽

Stavroula Kostaki ◽

Maria Papadopoulou ◽

...

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Body Mass ◽

Antihypertensive Treatment ◽

Term Outcome ◽

Long Term Outcome

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Body mass index is a risk factor for hemorrhagic transformation in older ischemic stroke patients after intravenous thrombolysis: a single center retrospective study

10.21203/rs.2.293/v1 ◽

2019 ◽

Author(s):

Changqing Miao ◽

Xiaoyan Yin ◽

Chunying Mu ◽

Yan Qu ◽

Guogang Luo ◽

...

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Confidence Interval ◽

Acute Ischemic Stroke ◽

Body Mass ◽

Odds Ratio ◽

Intravenous Thrombolysis ◽

Hemorrhagic Transformation ◽

Stroke Patients ◽

Tomography Scan

Abstract Background: The aim of our study was to determine whether body mass index is a predictor of hemorrhagic transformation in acute ischemic stroke patients after intravenous thrombolysis. Methods: A retrospective observational study was conducted to recruit 261 participants from a single center in China (67.0% males, median age 65 years). A head computed tomography scan was performed after 24 hours to evaluate hemorrhagic transformation occurrence, and a computed tomography scan was performed immediately in cases of clinical worsening. Multivariate logistic regression was used to estimate the association between risk factors and hemorrhagic transformation in acute ischemic stroke patients after intravenous administration of recombinant tissue plasminogen activator. Results: Of 261 patients, 40 (15.3%) developed hemorrhagic transformation (55% males, median age 70 years). Body mass index was higher in patients with hemorrhagic transformation than in patients without hemorrhagic transformation (25.7 vs 23.7; P value, 0.013). The multivariate logistic regression model showed that body mass index was an independent predictor of hemorrhagic transformation in patients aged ≥ 73 years (odds ratio, 1.74; 95% confidence interval, 1.22-2.49) but not in patients aged < 73 years (odds ratio, 1.01; 95% confidence interval, 0.87-1.18). In addition, the odds ratio was 5.16 (95% confidence interval, 2.21-12.04) when the body mass index was ≥ 25 kg/m2 compared to a body mass index < 25 kg/m2. Conclusions: The present study demonstrated that body mass index was an independent predictor of hemorrhagic transformation in older acute ischemic stroke patients after intravenous thrombolysis. Keywords: Body mass index, Hemorrhagic transformation, Intravenous thrombolysis, Ischemic stroke, Older patients.

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Associations Between Body Mass Index and Risks in Elderly Patients With a First-Ever Acute Ischemic Stroke—Reply

Archives of Internal Medicine ◽

10.1001/archinte.163.8.980-b ◽

2003 ◽

Vol 163 (8) ◽

pp. 980

Author(s):

Tobias Kurth

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Elderly Patients ◽

Acute Ischemic Stroke ◽

Body Mass

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Abstract MP28: Egg Consumption is Positively Associated With Ischemic Stroke: The Million Veteran Program

Circulation ◽

10.1161/circ.141.suppl_1.mp28 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Luc Djousse ◽

Yuk-lam HO ◽

Timothy Treu ◽

Hugo J Aparicio ◽

Sudha Seshadri ◽

...

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Body Mass ◽

Linear Trend ◽

Incidence Rates ◽

Egg Consumption ◽

Relative Risks ◽

Diabetes Status ◽

Icd 10

Background: While observational data suggest a higher risk of coronary artery disease with frequent egg consumption, only limited and inconsistent data are available on the relation of egg consumption with stroke. Objective: To test the hypothesis that egg consumption is positively associated with the incidence of ischemic stroke among Veterans. Methods: The Million Veteran Program is an ongoing observational study designed to study genetic determinants of chronic diseases among Veterans (2011 to now). Egg consumption was self-reported at baseline using validated Willett food questionnaires. We used ICD 9 codes 433, 434, 436, 437.0, and 437.6 and ICD 10 codes I63, I65, I66, I67.2, I67.6 and I67.8 to identify ischemic stroke using previously validated algorithm and multivariable Cox proportional hazard model to estimate relative risks. Results: A total of 234,032 Veterans provided data on egg consumption and were free of stroke at baseline. Mean age at baseline was 65.6 (SD: 11.7) years and 91.6% (214,373 of 234,032) were men. Median egg consumption was 2-4 eggs per week. During a mean follow up of 3.2 years, a total of 5,747 new cases of fatal or non-fatal acute ischemic stroke occurred. Crude incidence rates for acute ischemic stroke were 6.5, 7.2, 7.1, 7.4, 8.0, and 8.3 cases per 1000 person-years for egg consumption of <1/month, 1-3/month, 1/week, 2-4/week, 5-6/week, and ≥ 1/day, respectively. Corresponding adjusted hazard ratios (95% CI) were 1.00 (ref), 1.10 (0.97-1.25), 1.10 (0.97-1.25), 1.13 (1.00 -1.27), 1.19 (1.04-1.37), and 1.25 (1.09-1.44) controlling for age, sex, ethnicity, body mass index, education, smoking, alcohol intake, and overall diet quality (p linear trend 0.0007). The egg-stroke relation was not modified by body mass index, sex, or diabetes status. Conclusion: Egg consumption is positively associated with incidence of acute ischemic stroke among Veterans.

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