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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.

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



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


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).


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.


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.


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

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