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J Epidemiol. 2019 Sep 5;29(9):325-333. doi: 10.2188/jea.JE20170298. Epub 2018 Dec 15.

Body Mass Index and Risks of Incident Ischemic Stroke Subtypes: The Japan Public Health Center-Based Prospective (JPHC) Study.

Author information

1
Department of Public Health, Fujita Health University.
2
Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine.
3
Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
4
Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba.
5
Program for Nursing and Health Sciences, Ehime University Graduate School of Medicine.
6
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.
7
Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center.

Abstract

BACKGROUND:

The association of body mass index (BMI) with risks of ischemic stroke subtypes have not been established.

METHODS:

Cumulative average BMI was calculated using self-reported body weight and height obtained from baseline (Cohort I in 1990, and Cohort II from 1993-1994) and 5- and 10-year questionnaire surveys of Japan Public Health Center-based prospective (JPHC) study. A total of 42,343 men and 46,413 women aged 40-69 years were followed-up for the incidence of lacunar, large-artery occlusive, and cardioembolic strokes. A sub-distribution hazard model was used to estimate sub-distribution hazard ratios (SHRs) and the 95% confidence intervals (CIs).

RESULTS:

During a median of 20.0 years of follow-up, we documented 809 and 481 lacunar, 395 and 218 large-artery occlusive, and 568 and 298 cardioembolic strokes in men and women, respectively. After adjustment for baseline age, updated smoking, alcohol consumption, leisure-time physical activity, and histories of hypertension, dyslipidemia, and diabetes mellitus, cumulative average BMI was positively linearly associated with lacunar (trend P = 0.007), large-artery occlusive (trend P = 0.002), and cardioembolic (trend P < 0.001) strokes in men, and with lacunar (trend P < 0.001) and large-artery occlusive (trend P = 0.003) strokes in women. There were approximately two-fold excess risk of cardioembolic stroke in both sexes and of lacunar and large-artery occlusive strokes in women for cumulative average BMI ≥30 kg/m2 compared to BMI 23-<25 kg/m2.

CONCLUSION:

Cumulative average BMI showed a positive linear effect on sub-distribution hazards of lacunar, large-artery occlusive, and cardioembolic strokes in both sexes, except for cardioembolic stroke in women.

KEYWORDS:

body mass index; cohort study; general population; ischemic stroke subtypes; sub-distribution hazard ratio

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