Obesity and long-term outcomes after incident stroke: a prospective population-based cohort study.

Adolescent Adult Cohort Studies Humans Obesity / epidemiology Overweight / epidemiology Prospective Studies Stroke / epidemiology
body mass index electronic health records real-world evidence stroke stroke-obesity paradox

Journal

Journal of cachexia, sarcopenia and muscle
ISSN: 2190-6009
Titre abrégé: J Cachexia Sarcopenia Muscle
Pays: Germany
ID NLM: 101552883

Informations de publication

Date de publication:
12 2021
Historique:
revised: 16 08 2021
received: 04 07 2021
accepted: 05 09 2021
pubmed: 29 9 2021
medline: 29 1 2022
entrez: 28 9 2021
Statut: ppublish

Résumé

The association between obesity, major adverse cardiovascular events (MACE), and mortality in patients with incident stroke is not well established. We assessed the relationship between body mass index (BMI) and MACE in patients with incident stroke. The population-based cohort study identified 30 702 individuals from the Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases from the United Kingdom. Individuals were aged ≥18 years with incident stroke between 1-1-1998 and 31-12-2017, a BMI recorded within 24 months before incident stroke, and no prior history of MACE. BMI was categorized as underweight (<18.5 kg/m At baseline, 1217 (4.0%) were underweight, 10 783 (35.1%) had a normal BMI, 10 979 (35.8%) had overweight, 5206 (17.0%) had obesity Class I, 1749 (5.7%) Class II, and 768 (2.5%) Class III. In multivariable analysis, higher BMI were associated with lower risk of subsequent MACE [overweight: HR 0.96, 95% CI 0.93-0.99)]; PVD [overweight: 0.65 (0.49-0.85); obesity Class III: 0.19 (0.50-0.77)]; cardiovascular-related death [overweight: 0.80 (0.74-0.86); obesity Class I: 0.79 (0.71-0.88); Class II: 0.80 (0.67-0.96)]; and all-cause mortality [overweight: 0.75 (0.71-0.79); obesity Class I: 0.75 (0.70-0.81); Class II: 0.77 (0.68-0.86)] when compared to those with normal BMI. The results were similar irrespective of sex, diabetes mellitus, smoking or cancer at time of incident stroke. In patients with incident stroke, overweight or obesity were associated with a more favourable prognosis for subsequent MACE, PVD, and mortality, irrespective of sex, diabetes mellitus, smoking, or cancer at baseline. As with other cohort studies, our study demonstrates an association. Randomized control trials should be considered to robustly evaluate the impact of weight management recommendations on subsequent cardiovascular outcomes in stroke survivors.

Sections du résumé

BACKGROUND
The association between obesity, major adverse cardiovascular events (MACE), and mortality in patients with incident stroke is not well established. We assessed the relationship between body mass index (BMI) and MACE in patients with incident stroke.
METHODS
The population-based cohort study identified 30 702 individuals from the Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases from the United Kingdom. Individuals were aged ≥18 years with incident stroke between 1-1-1998 and 31-12-2017, a BMI recorded within 24 months before incident stroke, and no prior history of MACE. BMI was categorized as underweight (<18.5 kg/m
RESULTS
At baseline, 1217 (4.0%) were underweight, 10 783 (35.1%) had a normal BMI, 10 979 (35.8%) had overweight, 5206 (17.0%) had obesity Class I, 1749 (5.7%) Class II, and 768 (2.5%) Class III. In multivariable analysis, higher BMI were associated with lower risk of subsequent MACE [overweight: HR 0.96, 95% CI 0.93-0.99)]; PVD [overweight: 0.65 (0.49-0.85); obesity Class III: 0.19 (0.50-0.77)]; cardiovascular-related death [overweight: 0.80 (0.74-0.86); obesity Class I: 0.79 (0.71-0.88); Class II: 0.80 (0.67-0.96)]; and all-cause mortality [overweight: 0.75 (0.71-0.79); obesity Class I: 0.75 (0.70-0.81); Class II: 0.77 (0.68-0.86)] when compared to those with normal BMI. The results were similar irrespective of sex, diabetes mellitus, smoking or cancer at time of incident stroke.
CONCLUSIONS
In patients with incident stroke, overweight or obesity were associated with a more favourable prognosis for subsequent MACE, PVD, and mortality, irrespective of sex, diabetes mellitus, smoking, or cancer at baseline. As with other cohort studies, our study demonstrates an association. Randomized control trials should be considered to robustly evaluate the impact of weight management recommendations on subsequent cardiovascular outcomes in stroke survivors.

Identifiants

DOI: 10.1002/jcsm.12818 PMID: 34581015 PMC: PMC8718037
pubmed: 34581015
doi: 10.1002/jcsm.12818
pmc: PMC8718037
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

2111-2121

Subventions

Organisme : Department of Health
Pays : United Kingdom

Informations de copyright

© 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

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Auteurs

Ralph K Akyea (RK)

Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK.
ORCID: 0000-0003-4529-8237

Wolfram Doehner (W)

Berlin Institute of Health, Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany.
Department of Internal Medicine and Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.
Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.

Barbara Iyen (B)

Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK.

Stephen F Weng (SF)

Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK.

Nadeem Qureshi (N)

Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK.

George Ntaios (G)

Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Obesity and long-term outcomes after incident...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Obesity and long-term outcomes after incident...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Obesity and long-term outcomes after incident...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Obesity and long-term outcomes after incident...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Obésité › Obesity and long-term outcomes after incident...
questionsmedicales.fr › Phénomènes physiologiques › Constitution physique › Apparence corporelle › Surpoids › Obesity and long-term outcomes after incident...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Obesity and long-term outcomes after incident...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Obesity and long-term outcomes after incident...