Nina Jaakonmäki1, Marialuisa Zedde2, Tomi Sarkanen3, Nicolas Martinez-Majander4, Suvi Tuohinen5, Juha Sinisalo5, Essi Ryödi6, Jaana Autere7, Marja Hedman8, Ulla Junttola9, Jaana K Huhtakangas10, Teresa Grimaldi11, Rosario Pascarella12, Annika Nordanstig13, Odd Bech-Hanssen14, Christine Holbe15, Raila Busch16, Annette Fromm17, Pauli Ylikotila18, Esme Ekizoglu Turgut19, Isabel Amorim20, Kristina Ryliskiene21, Lauri Tulkki4, Laura Amaya Pascasio22, Radim Licenik23, Phillip Ferdinand24, Georgios Tsivgoulis25, Dalius Jatužis21, Liisa Kõrv26, Janika Kõrv26, Alessandro Pezzini27, Ana Catarina Fonseca20, Nilufer Yesilot19, Risto O Roine18, Ulrike Waje-Andreassen17, Bettina von Sarnowski15, Petra Redfors13, Juha Huhtakangas9, Heikki Numminen3, Pekka Jäkälä7, Jukka Putaala4. 1. Kuopio University Hospital, Neurocenter Neurology, Finland and University of Eastern Finland, Kuopio University Hospital, P.O.B 100, FI-70029 KYS, Finland. Electronic address: ninajaa@student.uef.fi. 2. Neurology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy. 3. Department of Neurology, Tampere University Hospital, Tampere, Finland and Faculty of Medicine and Health Technology, Tampere University, Finland. 4. Neurology, Helsinki University Hospital, and University of Helsinki, Finland. 5. Cardiology, Helsinki University Hospital and University of Helsinki. 6. Tampere Heart Hospital, Tampere, Finland. 7. Kuopio University Hospital, Neurocenter Neurology, Finland and University of Eastern Finland, Kuopio University Hospital, P.O.B 100, FI-70029 KYS, Finland. 8. Kuopio University Hospital Heart Center. 9. Clinical Neuroscience Research Unit and Department of Neurology, Oulu University Hospital, Finland. 10. Clinical Neuroscience Research Unit, Oulu University Hospital, Finland. 11. Cardiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy. 12. Neuroradiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy. 13. Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden. 14. Department of Clinical Physiology, Institute of Medicine, the Sahlgrenska Academy, University of Gothernburg. 15. Department of Neurology, University Medicine Greifswald, Greifswald, Germany. 16. Department of Internal Medicine B (Cardiology), University Medicine Greifswald, Greifswald, Germany. 17. Department of Neurology, Haukeland University Hospital, Bergen, Norway. 18. Department of Neurology, Neurocenter, Turku University Hospital, University of Turku, Finland. 19. Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Turkey. 20. epartment of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. 21. Vilnius University, Centre of Neurology, Lithuania. 22. Stroke Centre, Department of Neurology, Torrecádenas University Hospital. Health Research Centre, University of Almería, Almería, Spain. 23. Peterborough City Hospital, UK. 24. Royal Stoke University Hospital, UK. 25. Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece. 26. Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia. 27. Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy.
Abstract
OBJECTIVES: We examined the association between obesity and early-onset cryptogenic ischemic stroke (CIS) and whether fat distribution or sex altered this association. MATERIALS AND METHODS: This prospective, multi-center, case-control study included 345 patients, aged 18-49 years, with first-ever, acute CIS. The control group included 345 age- and sex-matched stroke-free individuals. We measured height, weight, waist circumference, and hip circumference. Obesity metrics analyzed included body mass index (BMI), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), and a body shape index (ABSI). Models were adjusted for age, level of education, vascular risk factors, and migraine with aura. RESULTS: After adjusting for demographics, vascular risk factors, and migraine with aura, the highest tertile of WHR was associated with CIS (OR for highest versus lowest WHR tertile 2.81, 95%CI 1.43-5.51; P=0.003). In sex-specific analyses, WHR tertiles were not associated with CIS. However, using WHO WHR cutoff values (>0.85 for women, >0.90 for men), abdominally obese women were at increased risk of CIS (OR 2.09, 95%CI 1.02-4.27; P=0.045). After adjusting for confounders, WC, BMI, WSR, or ABSI were not associated with CIS. CONCLUSIONS: Abdominal obesity measured with WHR was an independent risk factor for CIS in young adults after rigorous adjustment for concomitant risk factors.
OBJECTIVES: We examined the association between obesity and early-onset cryptogenic ischemic stroke (CIS) and whether fat distribution or sex altered this association. MATERIALS AND METHODS: This prospective, multi-center, case-control study included 345 patients, aged 18-49 years, with first-ever, acute CIS. The control group included 345 age- and sex-matched stroke-free individuals. We measured height, weight, waist circumference, and hip circumference. Obesity metrics analyzed included body mass index (BMI), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), and a body shape index (ABSI). Models were adjusted for age, level of education, vascular risk factors, and migraine with aura. RESULTS: After adjusting for demographics, vascular risk factors, and migraine with aura, the highest tertile of WHR was associated with CIS (OR for highest versus lowest WHR tertile 2.81, 95%CI 1.43-5.51; P=0.003). In sex-specific analyses, WHR tertiles were not associated with CIS. However, using WHO WHR cutoff values (>0.85 for women, >0.90 for men), abdominally obese women were at increased risk of CIS (OR 2.09, 95%CI 1.02-4.27; P=0.045). After adjusting for confounders, WC, BMI, WSR, or ABSI were not associated with CIS. CONCLUSIONS: Abdominal obesity measured with WHR was an independent risk factor for CIS in young adults after rigorous adjustment for concomitant risk factors.