Obesity and Abdominal Fat Markers in Patients with a History of Stroke and Transient Ischemic Attacks

J Stroke Cerebrovasc Dis. 2016 May;25(5):1141-1147. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.026. Epub 2016 Feb 22.


Background: Abdominal obesity is a well-recognized cardiovascular risk factor. Conflicting data concerning its significance with respect to stroke have been discussed in recent years. The objective of this study was to analyze the association between anthropometric parameters and the risk of stroke and transient ischemic attacks (TIAs) in German primary care.

Methods: Patient recruitment in this large-scale epidemiological study was performed in 3188 representative primary care offices in Germany. Among 6980 study participants, 1745 patients with a history of stroke or TIA were identified and matched for age and gender with 5235 regional controls. Associations between standard anthropometric measures such as body mass index (BMI), waist-to-hip ratio, waist circumference, waist-to-height ratio, and cerebrovascular risk were investigated using logistic regression analysis with adjustment for age, gender, and vascular risk factors.

Results: BMI showed no significant associations with the risk of stroke or TIA in any of the applied mathematical models. Markers of abdominal obesity were associated with an increased risk of stroke or TIA in the unadjusted model (waist circumference: odds ratio [OR] 1.15; 95% confidence interval [CI], 1.00-1.32; waist-to-hip ratio: OR 1.21; 95% CI, 1.05-1.38; waist-to-height ratio: OR 1.25; 95% CI, 1.09-1.44, comparisons between top and bottom tertiles). After adjustment for vascular risk factors, all associations were insignificant.

Conclusions: Abdominal obesity is a stronger predictor of risk of stroke or TIA than BMI. However, the association between abdominal obesity and the risk of stroke or TIA is not independent of other vascular risk factors. Stroke-related weight changes should be considered in longitudinal studies examining the role of obesity in cerebrovascular disease.

Keywords: Stroke; abdominal obesity; body mass index; risk factors; transient ischemic attack.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Fat / physiopathology*
  • Adiposity*
  • Aged
  • Aged, 80 and over
  • Anthropometry / methods*
  • Area Under Curve
  • Body Mass Index
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Germany / epidemiology
  • Humans
  • Ischemic Attack, Transient / diagnosis
  • Ischemic Attack, Transient / epidemiology*
  • Logistic Models
  • Male
  • Middle Aged
  • Obesity, Abdominal / diagnosis
  • Obesity, Abdominal / epidemiology*
  • Obesity, Abdominal / physiopathology
  • Odds Ratio
  • Predictive Value of Tests
  • Primary Health Care
  • Prognosis
  • ROC Curve
  • Risk Assessment
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Waist Circumference
  • Waist-Hip Ratio