Association between Body Mass Index and Stroke Risk Among Patients with Type 2 Diabetes

Abstract Context Very few studies focused on the association between body mass index (BMI) and stroke risk among patients with diabetes. Objective We aimed to investigate the association between BMI and stroke risk in patients with type 2 diabetes. Design Demographic, anthropometric, laboratory, and medication information were extracted from the National Patient-Centered Clinical Research Network common data model. Participants We performed a retrospective cohort study of 67 086 patients with type 2 diabetes. Main Outcome Measures Incident stroke including both ischemic and hemorrhagic stroke were defined. Results During a mean follow up of 3.74 years. 8918 incident stroke events occurred. Multivariable-adjusted hazard ratios across different categories of BMI at baseline (18.5–24.9 [reference group], 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40 kg/m2) were 1.00, 0.92, 0.85, 0.74, and 0.63 (Ptrend <0.001) for total stroke; 1.00, 0.93, 0.88, 0.77, and 0.65 (Ptrend <0.001) for ischemic stroke; and 1.00, 0.79, 0.50, 0.50, and 0.41 (Ptrend <0.001) for hemorrhagic stroke, respectively. When we used an updated mean value of BMI, the graded inverse association of body mass index with stroke risk did not change. This linear association was consistent among patients of different subgroups. Further sensitivity analysis excluding patients who were diagnosed stroke within 6 months after first diagnosis of type 2 diabetes or including non-smokers only also confirmed our findings. Conclusion The present study found an inverse association between BMI and the risk of total, ischemic, and hemorrhagic stroke among patients with type 2 diabetes. More clinical and molecular insights are still needed in explaining these findings.

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Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes

Journal of Stroke ◽

10.5853/jos.2019.01704 ◽

2020 ◽

Vol 22 (1) ◽

pp. 87-98 ◽

Cited By ~ 2

Author(s):

Yun Shen ◽

Lizheng Shi ◽

Elizabeth Nauman ◽

Peter Katzmarzyk ◽

Eboni Price-Haywood ◽

...

Keyword(s):

Type 2 Diabetes ◽

Hemorrhagic Stroke ◽

Hemoglobin A1c ◽

Stroke Risk ◽

Diabetes Management ◽

Reference Group ◽

Research Network ◽

Lipid Lowering ◽

Common Data Model

Background and Purpose The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare systems.Methods We performed a retrospective cohort study of 27,113 African Americans and 40,431 whites with type 2 diabetes. Demographic, anthropometric, laboratory, and medication information were abstracted from the National Patient-Centered Clinical Research Network common data model. Incident stroke events including both ischemic and hemorrhagic stroke were defined.Results During a mean follow-up period of 3.79±1.68 years, 7,735 patients developed stroke (6,862 ischemic and 873 hemorrhagic). Multivariable-adjusted hazard ratios across levels of HbA1c at baseline (<6.0%, 6.0% to 6.9% [reference group], 7.0% to 7.9%, 8.0% to 8.9%, 9.0% to 9.9%, and ≥10%) were 1.07, 1.00, 1.13, 1.23, 1.27, and 1.37 (Ptrend <0.001) for total stroke, 1.02, 1.00, 1.13, 1.20, 1.24, and 1.35 (Ptrend <0.001) for ischemic stroke, and 1.40, 1.00, 1.14, 1.47, 1.47, and 1.51 (Ptrend=0.002) for hemorrhagic stroke. When we used an updated mean value of HbA1c, the U-shaped association of HbA1c with stroke risk did not change. This U-shaped association was consistent among patients of different subgroups. The U-shaped association was more pronounced among patients taking antidiabetic, lipid-lowering, and antihypertensive medications compared with those without these medications.Conclusions These data suggest that diabetes management may have to be individualized according to the guideline recommendations rather than intensively attempting to lower HbA1c.

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Body Mass Index and Stroke Risk Among Patients With Type 2 Diabetes Mellitus

Stroke ◽

10.1161/strokeaha.114.006718 ◽

2015 ◽

Vol 46 (1) ◽

pp. 164-169 ◽

Cited By ~ 15

Author(s):

Weiqin Li ◽

Peter T. Katzmarzyk ◽

Ronald Horswell ◽

Yonggang Zhang ◽

Wenhui Zhao ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Type 2 Diabetes Mellitus ◽

Body Mass ◽

Stroke Risk

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Abstract P253: Body Mass Index and Heart Failure among Patients with Type 2 Diabetes

Circulation ◽

10.1161/circ.131.suppl_1.p253 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Gang Hu ◽

Peter Katzmarzyk ◽

Ronald Horswell ◽

Yujie Wang ◽

Jolene Johnson ◽

...

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Body Mass ◽

Reference Group ◽

Smoking Status ◽

Positive Association ◽

University Hospital ◽

Diabetic Patients

Background: Epidemiologic data on the association between body mass index (BMI) and heart failure (HF) risk among diabetic patients is rare. Aim: To investigate the association between BMI and HF risk among patients with type 2 diabetic in the Louisiana State University Hospital-based Longitudinal study (LSUHLS). Methods: We performed a prospective cohort study of risk for HF among 31,155 patients of type 2 diabetes (11,468 men and 19,687 women). Cox proportional hazards regression models were used to estimate the association of different levels of BMI with HF risk. Results: During a mean follow-up of 7.8 years, 5,834 subjects developed HF (2,379 men and 3,455 women). The multivariable-adjusted (age, race, smoking, income and type of insurance) hazard ratios of HF associated with BMI levels (18.5-22.9, 23-24.9, 25-29.9 [reference group], 30-34.9, 35-39.9, and ≥40 kg/m2) at baseline were 0.95, 1.00, 1.00, 1.16, 1.64, and 2.02 (Ptrend <0.001) for men, and 1.16, 1.16, 1.00, 1.23, 1.55, and 2.01 (Pnon-linear <0.001) for women, respectively. When we used an updated mean value of BMI, the association of HF risk with BMI did not change. When stratified by age, race, smoking status and use of anti-diabetic drugs, the positive association among men and the J-shaped association among women were still present. Conclusions: Our study suggests a positive association between BMI and HF risk among men, and a J-shaped association between BMI and HF risk among women with type 2 diabetes.

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