Affiliation:
1. From the Department of Neurology (S.-H.S., R.L.S., B.B.-A., J.F.C., J.G.P., M.S.E.), Sergievsky Center (R.L.S.), Department of Socio-Medical Science (B.B.-A.), and Department of Biostatistics (J.F.C., M.C.P.), Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY; and the Department of Neurology, Wonkwang University College of Medicine, Chonpuk, South Korea (S.-H.S.)
Abstract
Background and Purpose—
Obesity is well recognized as a risk factor for coronary heart disease and mortality. The relationship between abdominal obesity and ischemic stroke remains less clear. Our aim was to evaluate abdominal obesity as an independent risk factor for ischemic stroke in a multiethnic community.
Methods—
A population-based, incident case-control study was conducted July 1993 through June 1997 in northern Manhattan, New York, NY. Cases (n=576) of first ischemic stroke (66% ≥65 years of age; 56% women; 17% whites; 26% blacks; 55% Hispanics) were enrolled and matched by age, sex, and race-ethnicity to stroke-free community controls (n=1142). All subjects were interviewed and examined and had measurements of waist-to-hip ratio (WHR). Odds ratios (ORs) of ischemic stroke were calculated with gender-specific quartiles (GQs) and gender-specific medians of WHR adjusted for stroke risk factors and body mass index (BMI).
Results—
Compared with the first quartile, the third and fourth quartiles of WHR had an increased risk of stroke (GQ3: OR, 2.4; 95% CI, 1.5 to 3.9; GQ4: OR, 3.0; 95% CI, 1.8 to 4.8) adjusted for other risk factors and BMI. Those with WHR equal to or greater than the median had an overall OR of 3.0 (95% CI, 2.1 to 4.2) for ischemic stroke even after adjustment for other risk factors and BMI. Increased WHR was associated with a greater risk of stroke in men and women and in all race-ethnic groups. The effect of WHR was stronger among younger persons (test for heterogeneity,
P
<0.0002) (<65 years of age: OR, 4.4; 95%CI, 2.2 to 9.0; ≥65 years of age: OR, 2.2; 95% CI, 1.4 to 3.2). WHR was associated with an increased risk among those with and without large-artery atherosclerotic stroke.
Conclusions—
Abdominal obesity is an independent, potent risk factor for ischemic stroke in all race-ethnic groups. It is a stronger risk factor than BMI and has a greater effect among younger persons. Prevention of obesity and weight reduction need greater emphasis in stroke prevention programs.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Reference45 articles.
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2. The Disease Burden Associated With Overweight and Obesity
3. National Heart Lung and Blood Institute. The Practical Guide: Identification Evaluation and Treatment of Overweight and Obesity in Adults . Available at: http://www.nhlbi.nih.gov/guidelines/obesity/practgde.htm Accessed February 2 2002.
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