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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00563

Body mass index and prognosis in ischemic stroke patients with type 2 diabetes mellitus

 Hyungjong Park1, 2, Hyung Woo Lee1,  Joonsang Yoo2, Hye Sun Lee3,  HYO SUK NAM1,  Young Dae Kim1 and Ji Hoe Heo1*
  • 1Department of Neurology, College of Medicine, Yonsei university, South Korea
  • 2Department of Neurology, School of Medicine, Keimyung University, South Korea
  • 3Biostatistics Collaboration Unit, College of Medicine, Yonsei University, South Korea

Overweight contributes to type 2 diabetes mellitus (T2DM) development. Although the obesity paradox has been suggested in many vascular diseases, little information is available about stroke patients with T2DM. We investigated whether body mass index (BMI) has a differential impact on the incidence of major adverse cardiovascular events (MACE) in patients with ischemic stroke and T2DM. Methods: This retrospective study used a prospective cohort of patients with acute ischemic stroke, and included consecutive patients with T2DM after excluding those with active cancer or who died within 1 month of an index stroke. We investigated the long-term risk of MACE (stroke, myocardial infarction, unstable angina, coronary revascularization procedure, and death) according to BMI. Results: Among the 1338 patients, MACE occurred in 415 patients (31.1%) during a median follow-up of 3.6 years. Compared to the normal weight group, MACE occurred more frequently in the underweight group (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.01-2.38), but less frequently in the overweight group (adjusted HR 0.87, 95% CI: 0.70-1.08) and obese group (adjusted HR 0.58, 95% CI 0.41-0.86) group. In analyses of association between BMI and each component of MACE, stroke and cardiovascular mortality indicated an L- and a U-shaped pattern, respectively. However, fatal or non-fatal stroke showed an inverse pattern, and fatal or non-fatal cardiovascular events showed a reversed J-shaped pattern. Discussions: This study showed the overall presence of the obesity paradox in stroke patients with T2DM. However, obese patients had different risks of cardiovascular events and stroke.

Keywords: ischemic stroke, Diabetes Mellitus, Obesity, Body Mass Index, Major adverse cardiac event, Mortality

Received: 18 Mar 2019; Accepted: 10 May 2019.

Edited by:

Raimund Helbok, Innsbruck Medical University, Austria

Reviewed by:

Aristeidis H. Katsanos, University of Ioannina, Greece
Carl J. Lavie, Ochsner Medical Center, United States  

Copyright: © 2019 Park, Lee, Yoo, Lee, NAM, Kim and Heo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD, PhD. Ji Hoe Heo, Department of Neurology, College of Medicine, Yonsei university, Seoul, South Korea, jhheo@yuhs.ac