Obesity and the Risk of Cryptogenic Ischemic Stroke in Young Adults
Nina Jaakonmäki, Marialuisa Zedde, Tomi Sarkanen, Nicolas Martinez‐Majander, Suvi Tuohinen, Juha Sinisalo, Essi Ryödi, Jaana Autere, Marja Hedman, Ulla Junttola, Jaana K. Huhtakangas, Teresa Grimaldi Capitello, Rosario Pascarella, Annika Nordanstig, Odd Bech‐Hanssen, Christine Holbe, Raila Busch, Annette Fromm, Pauli Ylikotila, Esme Ekizoğlu Turgut, Isabel Amorim, Kristina Ryliškienė, Lauri Tulkki, Laura Amaya‐Pascasio, Radim Líčeník, Phillip Ferdinand, Georgios Tsivgoulis, Dalius Jatužis, Liisa Kõrv, Janika Kõrv, Alessandro Pezzini, Ana Catarina Fonseca, Nilüfer Yeşilot, Risto O. Roine, Ulrike Waje‐Andreassen, Bettina von Sarnowski, Petra Redfors, Juha Huhtakangas, Heikki Numminen, Pekka Jäkälä, Jukka Putaala
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.