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Karger_ESC London_2013

22. European Stroke Conference 3 Etiology of stroke and risk factors A 14:50 - 15:00 The obesity paradox in stroke: Less previous strokes among overweight and obese stroke patients T.S. Olsen1, K.K. Andersen2 The Stroke Unit, Frederiksberg University Hospital, Frederiksberg, DENMARK1,Danish Cancer Society Research Center, Copenhagen, DENMARK2 Background: Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the stroke obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years follow-ing first stroke. In stroke the association between having a history of previous stroke and Body Mass Index (BMI) has never been studied. The aim of this investigation was in a large stroke cohort to study the association between having a history previous stroke and BMI. Methods: An administrative Danish quality-control registry designed to collect a predefined dataset on all hospitalized stroke patients in Denmark 2000-2010 includes 61 872 acute stroke patients with information on BMI in 38 506. Data include age, sex, civil status, stroke severity (Scandinavian Stroke Scale (SSS)), computed tomography and cardiovascular risk factors. We used multiple logistic regression models to compare risk of stroke being recurrent in the four BMI groups: un-derweight (BMI <18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25.0–29.9), obese (BMI ≥30.0). Results: There was 28 382 patients with complete covariate information; in 5571 patients (19.6%) stroke was recurrent. Multiple logistic regression analysis adjusting for age, stroke severity (SSS), sex, BMI, civil status and cardiovascular risk factors showed that being obese and overweight (using normal weight as reference) was associated with significantly lower risk of stroke being recurrent (obese OR 0.90 CI 0.82-0.98; overweight OR 0.89 CI 0.83- 0.96). Being underweight was associated with significantly higher risk of stroke being recurrent (OR 1.23 CI 1.06-1.43). Conclusions: The obesity paradox in stroke can be extended to include also stroke recurrence. Obese and overweight stroke patients had experienced less previous strokes than normal weight stroke patients. 2 Etiology of stroke and risk factors A 14:40 - 14:50 Vascular risk factor profile and prognosis of TIA and ischaemic stroke of undetermined aetiology versus other subtypes: 10-year result from the Oxford Vascular Study (OX-VASC) L.-X. Li1, N.L.M. Paul2, U.G. Schulz3, P.M. Rothwell4 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK, Oxford, UNITED KINGDOM1,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK, Oxford, UNITED KINGDOM2, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK, Ox-ford, UNITED KINGDOM3, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK, Oxford, UNITED KINGDOM4 BACKGROUND: One-third of TIA and ischaemic strokes are of undetermined aetiology, po-tentially undermining secondary prevention. It is suggested that these events may be due to oc-cult atheroma. If so, the risk factor profile should be closest to that of large-vessel events. METHODS: We studied the risk factor profile, co-morbid atherosclerotic disease and risk of acute coronary events by ischaemic stroke subtypes (TOAST) in a population-based cohort of TIA and stroke (Oxford Vascular Study). RESULTS: Among 2091 ischaemic TIA and strokes, large vessel events were most strong-ly associated with hypertension (age and sex adjusted OR=1.87, 95%CI 1.36-2.58, p=0.002), diabetes (1.50, 1.05-2.15, p=0.03), PVD (2.35, 1.56-3.53, p<0.0001), hyperlipidaemia (1.69, 1.28-2.23, p=0.001) and smoking (1.41, 1.05-1.90, p=0.02). Compared to large vessel events, undetermined events (671 - 32.1%) had less hypertension (0.44, 0.31-0.62, p<0.0001), diabetes (0.60, 0.40-0.90, p=0.01), MI (0.62, 0.38-0.99, p=0.05), PVD (0.25, 0.15-0.43, p<0.0001), hy-perlipidaemia (0.63, 0.46-0.85, p=0.003) and smoking (0.70, 0.51-0.98, p=0.02), and compared to other subtypes (cardioembolic and small vessel) they also had less hypertension (0.66, 0.53- 0.82, p<0.0001), MI (0.61, 0.43-0.87, p=0.01) and PVD (0.54, 0.33-0.86, p=0.01). In addition, >50% asymptomatic carotid stenosis was present in 26.0% of the large vessel events versus 5.1% undetermined events and the undetermined group had the lowest risk of acute coronary events during follow-up (age and sex adjusted HR vs. large-vessel = 0.24, 0.13-0.43, p<0.0001; vs. other subtypes - 0.52, 0.30-0.88, p=0.02). CONCLUSION: TIA and stroke of undetermined aetiology have a very different risk factor profile from large-vessel events and are the least “atherosclerotic” of all subtypes. Neither oc-cult atheroma nor traditional vascular risk factors appear to account for undetermined TIA and stroke. 50 © 2013 S. Karger AG, Basel Scientific Programme


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