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The obesity paradox and survivors of ischemic stroke

Session Poster Session III - Friday 08:30 - 12:30

Speaker Peter Wohlfahrt

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2015

  • Topic : preventive cardiology
  • Sub-topic : Obesity
  • Session type : Poster Session

Authors : P Wohlfahrt (Prague,CZ), F Lopez-Jimenez (Rochester,US), A Krajcoviechova (Prague,CZ), M Jozifova (Prague,CZ), O Mayer (Pilsen,CZ), J Vanek (Pilsen,CZ), J Filipovsky (Pilsen,CZ), E Llano (Dallas,US), R Cifkova (Prague,CZ)

Authors:
P Wohlfahrt1 , F Lopez-Jimenez2 , A Krajcoviechova1 , M Jozifova1 , O Mayer3 , J Vanek3 , J Filipovsky3 , E Llano4 , R Cifkova1 , 1Thomayer University Hospital, Center for CV Prevention - Prague - Czech Republic , 2Mayo Clinic - Rochester - United States of America , 3Center of Preventive Cardiology, 2nd Department of Internal Medicine, Charles University, Medical Fa - Pilsen - Czech Republic , 4University of Texas Southwestern Medical School - Dallas - United States of America ,

Citation:

Background While obesity is a risk factor for stroke and achieving normal weight is advocated to decrease stroke risk, the risk associated with obesity and weight loss after stroke has not been well established.

Aim To assess the association of obesity at the time of stroke admission and weight loss after stroke with total mortality.

Methods We analyzed 736 consecutive patients (mean age 66±11 years, 58% male) hospitalized for their first ischemic stroke. Body weight at hospital admission and at the outpatient visit during follow-up was used in the analysis.

Results After multivariate adjustment, obesity at admission was associated with lower mortality risk as compared with normal weight (HR 0.50, p=0.03). At the outpatient visit, with a median follow-up time of 16 months, 21% of patients had lost >3kg of weight. Stroke severity, heart failure, transient ischemic attack and depression after stroke were independently associated with significant weight loss. Weight loss >3kg was associated with increased mortality risk (HR 5.87, p=0.001) independently of other factors. Similar results were seen when weight loss was defined as losing over 3% of baseline weight, (HR 4.97, p=0.004). Weight gain >5% of the baseline weight tended to be associated with better survival when compared with no weight change (long-rank test p=0.07).

Conclusions Normal weight at hospital admission and weight loss after ischemic stroke are independently associated with increased mortality. Overweight and obesity at baseline do not decrease the risk associated with weight loss.

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