Durgesh Chaudhary1, Ayesha Khan1, Mudit Gupta2, Yirui Hu3, Jiang Li4, Vida Abedi4,5, Ramin Zand1. 1. Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, United States of America. 2. Phenomic Analytics and Clinical Data Core, Geisinger Health System, Danville, Pennsylvania, United States of America. 3. Department of Population Health Sciences, Geisinger Health System, Danville, Pennsylvania, United States of America. 4. Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, Pennsylvania, United States of America. 5. Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia, United States of America.
Abstract
BACKGROUND AND PURPOSE: Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a "protective" effect on survival after stroke while other studies have debunked the "obesity paradox". This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic stroke patients using a large dataset extracted from different resources including electronic health records. METHODS: This was a retrospective cohort study of consecutive ischemic stroke patients captured in our Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic stroke patients in different BMI categories was analyzed using Kaplan Meier survival curves. The predictors of mortality at one-year were assessed using a stratified Cox proportional hazards model. RESULTS: Among 6,703 first-time ischemic stroke patients, overweight and obese patients were found to have statistically decreased hazard ratio (HR) compared to the non-overweight patients (overweight patients- HR = 0.61 [95% CI, 0.52-0.72]; obese patients- HR = 0.56 [95% CI, 0.48-0.67]). Predictors with a significant increase in the hazard ratio for one-year mortality were age at the ischemic stroke event, history of neoplasm, atrial fibrillation/flutter, diabetes, myocardial infarction and heart failure. CONCLUSION: Our study results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.
BACKGROUND AND PURPOSE:Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a "protective" effect on survival after stroke while other studies have debunked the "obesity paradox". This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic strokepatients using a large dataset extracted from different resources including electronic health records. METHODS: This was a retrospective cohort study of consecutive ischemic strokepatients captured in our Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic strokepatients in different BMI categories was analyzed using Kaplan Meier survival curves. The predictors of mortality at one-year were assessed using a stratified Cox proportional hazards model. RESULTS: Among 6,703 first-time ischemic strokepatients, overweight and obesepatients were found to have statistically decreased hazard ratio (HR) compared to the non-overweight patients (overweight patients- HR = 0.61 [95% CI, 0.52-0.72]; obesepatients- HR = 0.56 [95% CI, 0.48-0.67]). Predictors with a significant increase in the hazard ratio for one-year mortality were age at the ischemic stroke event, history of neoplasm, atrial fibrillation/flutter, diabetes, myocardial infarction and heart failure. CONCLUSION: Our study results support the obesity paradox in ischemic strokepatients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obesepatients in comparison to non-overweight patients.
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