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Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants.

Abstract

BACKGROUND AND PURPOSE

A systematic review of the prospective studies addressing the relationship of overweight and obesity to major stroke subtypes is lacking. We evaluated the occurrence of a graded association between overweight, obesity, and incidence of ischemic and hemorrhagic stroke by a meta-analysis of cohort studies.

METHODS

A search of online databases and relevant reviews was performed. Inclusion criteria were original article in English, prospective study design, follow-up > or = 4 years, indication of number of subjects exposed, and number of events across body mass index categories. Crude unadjusted relative risk (RR) and 95% CI were calculated for each study for overweight or obese compared with normal-weight categories. Log-transformed values and SE were used to calculate the pooled RR with random effects models; publication bias was checked. Additional analyses were performed using the multivariate estimates of risk reported in the individual studies.

RESULTS

Twenty-five studies were included, with 2 274 961 participants and 30 757 events. RR for ischemic stroke was 1.22 (95% CI, 1.05-1.41) for overweight and 1.64 (95% CI, 1.36-1.99) for obesity, whereas RR for hemorrhagic stroke was 1.01 (95% CI, 0.88-1.17) and 1.24 (95% CI, 0.99-1.54), respectively. Subgroup and meta-regression analyses ruled out gender, population average age, body mass index and blood pressure, year of recruitment, year of study publication, and length of follow-up as significant sources of heterogeneity. The additional analyses relying on the published multivariate estimates of risk provided qualitatively similar results.

CONCLUSIONS

Overweight and obesity are associated with progressively increasing risk of ischemic stroke, at least in part, independently from age, lifestyle, and other cardiovascular risk factors.

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  • Authors+Show Affiliations

    ,

    Department of Clinical and Experimental Medicine, ESH Excellence Center for Hypertension, "Federico II" University Medical School, via S. Pansini, 5, 80131 Naples, Italy. strazzul@unina.it

    , , , ,

    Source

    Stroke 41:5 2010 May pg e418-26

    MeSH

    Body Weight
    Cohort Studies
    Humans
    Incidence
    Obesity
    Overweight
    Prospective Studies
    Risk Factors
    Stroke

    Pub Type(s)

    Comparative Study
    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    20299666

    Citation

    Strazzullo, Pasquale, et al. "Excess Body Weight and Incidence of Stroke: Meta-analysis of Prospective Studies With 2 Million Participants." Stroke, vol. 41, no. 5, 2010, pp. e418-26.
    Strazzullo P, D'Elia L, Cairella G, et al. Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke. 2010;41(5):e418-26.
    Strazzullo, P., D'Elia, L., Cairella, G., Garbagnati, F., Cappuccio, F. P., & Scalfi, L. (2010). Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke, 41(5), pp. e418-26. doi:10.1161/STROKEAHA.109.576967.
    Strazzullo P, et al. Excess Body Weight and Incidence of Stroke: Meta-analysis of Prospective Studies With 2 Million Participants. Stroke. 2010;41(5):e418-26. PubMed PMID: 20299666.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. AU - Strazzullo,Pasquale, AU - D'Elia,Lanfranco, AU - Cairella,Giulia, AU - Garbagnati,Francesca, AU - Cappuccio,Francesco P, AU - Scalfi,Luca, Y1 - 2010/03/18/ PY - 2010/3/20/entrez PY - 2010/3/20/pubmed PY - 2010/5/19/medline SP - e418 EP - 26 JF - Stroke JO - Stroke VL - 41 IS - 5 N2 - BACKGROUND AND PURPOSE: A systematic review of the prospective studies addressing the relationship of overweight and obesity to major stroke subtypes is lacking. We evaluated the occurrence of a graded association between overweight, obesity, and incidence of ischemic and hemorrhagic stroke by a meta-analysis of cohort studies. METHODS: A search of online databases and relevant reviews was performed. Inclusion criteria were original article in English, prospective study design, follow-up > or = 4 years, indication of number of subjects exposed, and number of events across body mass index categories. Crude unadjusted relative risk (RR) and 95% CI were calculated for each study for overweight or obese compared with normal-weight categories. Log-transformed values and SE were used to calculate the pooled RR with random effects models; publication bias was checked. Additional analyses were performed using the multivariate estimates of risk reported in the individual studies. RESULTS: Twenty-five studies were included, with 2 274 961 participants and 30 757 events. RR for ischemic stroke was 1.22 (95% CI, 1.05-1.41) for overweight and 1.64 (95% CI, 1.36-1.99) for obesity, whereas RR for hemorrhagic stroke was 1.01 (95% CI, 0.88-1.17) and 1.24 (95% CI, 0.99-1.54), respectively. Subgroup and meta-regression analyses ruled out gender, population average age, body mass index and blood pressure, year of recruitment, year of study publication, and length of follow-up as significant sources of heterogeneity. The additional analyses relying on the published multivariate estimates of risk provided qualitatively similar results. CONCLUSIONS: Overweight and obesity are associated with progressively increasing risk of ischemic stroke, at least in part, independently from age, lifestyle, and other cardiovascular risk factors. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/20299666/full_citation L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.109.576967?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -