Abstract Details

Title The Obesity Paradox Characterizes Outcome from Acute Ischemic Stroke: Evidence from 1033 Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-031

Objective

To delineate the relationship between body mass index (BMI) and 90 day outcomes in a large cohort of patients with acute ischemic stroke (AIS).

Background

A survival advantage among individuals with higher body mass index has been observed for diverse acute illnesses, and termed the “obesity paradox.” Prior stroke studies of the obesity paradox phenomenon have been underpowered and yielded mixed results.

Design/Methods

We analyzed all AIS patients enrolled in the multicenter NIH FAST-MAG acute stroke trial. Outcomes at 3 months analyzed were: (1) death; (2) disability or death (modified Rankin Scale, mRS 2-6); and (3) low stroke-related quality of life (Stroke Impact Scale, SIS <70). Relations with BMI were analyzed univariately and in multivariate models adjusting for 12 additional prognostic variables.

Results Among 1033 AIS patients, age was 71y (±13), 45.1% female, NIHSS 10.6 (±8.3), and BMI 27.5 (±5.6). Risk of death declined linearly with higher BMI (for BMI as continuous variable: unadjusted p=0.02, adjusted p=0.004), Odds ratios (adjusted) for mortality declined across the BMI categories of underweight, normal, overweight, obese, and severely obese: 1.67 (0.57-4.88), 0.85 (0.53-1.36), 0.54 (0.29-1.04), and 0.38 (0.16-0.88), Risk of disability had a U-shaped relation to BMI (quadratic p=0.02). Odds ratios for disability or death for underweight, normal, overweight, obese, and severely obese declined through the first 4 categories: 1.19, 1.00, 0.78, 0.72, 0,96. This relation was attenuated after adjustment for other prognostic factors (p=0.27). Similar, but nonsignificant, trends were seen for low stroke-related quality of life.

Conclusions Outcome from acute ischemic stroke is characterized by an obesity paradox: elevated BMI is associated with reduced 3 month mortality over all, and reduced disability over most, weight ranges. Potential mechanisms including nutritional reserve aiding survival during prolonged illness and greater frequency of atherosclerotic than thromboembolic infarcts in individuals with higher body mass.

Authors/Disclosures
Zuolu Liu, MD (CPMC Comprehensive Stroke Care Center) PRESENTER	No disclosure on file
Nerses Sanossian, MD, FAAN (Department of Neurology, USC)	Dr. Sanossian has received personal compensation for serving as an employee of Univeristy of Southern California. Dr. Sanossian has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Sanossian has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Sanossian has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Portola. The institution of Dr. Sanossian has received research support from Diffusion Pharma.
Sidney Starkman, MD, FAAN (UCLA Emergency Medicine Center)	No disclosure on file
Scott Hamilton	No disclosure on file
	No disclosure on file
David S. Liebeskind, MD, FAAN (Neurovascular Imaging Research Core at UCLA)	Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker.
Latisha Sharma, MD (UCLA Comprehensive Stroke Center)	Dr. Sharma has nothing to disclose.
	No disclosure on file
	No disclosure on file
Robin A. Conwit, MD, FAAN	Dr. Conwit has nothing to disclose.
Jeffrey L. Saver, MD, FAAN (UCLA Health)	Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boehringer Ingelheim (prevention only). Dr. Saver has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association. Dr. Saver has received stock or an ownership interest from Rapid Medical.

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