The Journal of Clinical Endocrinology and Metabolism Journal Article

Association between Body Mass Index and Stroke Risk Among Patients with Type 2 Diabetes

September 16, 2019

Yun Shen, Lizheng Shi, Elizabeth Nauman, Peter T Katzmarzyk, Eboni G Price-Haywood, Alessandra N Bazzano, Somesh Nigam, Gang Hu
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 1, January 2020, dgz032
https://doi.org/10.1210/clinem/dgz032

Abstract

Context

Very few studies focused on the association between body mass index (BMI) and stroke risk among patients with diabetes.

Objective

We aimed to investigate the association between BMI and stroke risk in patients with type 2 diabetes.

Design

Demographic, anthropometric, laboratory, and medication information were extracted from the National Patient-Centered Clinical Research Network common data model.

Participants

We performed a retrospective cohort study of 67 086 patients with type 2 diabetes.

Main Outcome Measures

Incident stroke including both ischemic and hemorrhagic stroke were defined.

Results

During a mean follow up of 3.74 years. 8918 incident stroke events occurred. Multivariable-adjusted hazard ratios across different categories of BMI at baseline (18.5–24.9 [reference group], 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40 kg/m2) were 1.00, 0.92, 0.85, 0.74, and 0.63 (Ptrend <0.001) for total stroke; 1.00, 0.93, 0.88, 0.77, and 0.65 (Ptrend <0.001) for ischemic stroke; and 1.00, 0.79, 0.50, 0.50, and 0.41 (Ptrend <0.001) for hemorrhagic stroke, respectively. When we used an updated mean value of BMI, the graded inverse association of body mass index with stroke risk did not change. This linear association was consistent among patients of different subgroups. Further sensitivity analysis excluding patients who were diagnosed stroke within 6 months after first diagnosis of type 2 diabetes or including non-smokers only also confirmed our findings.

Conclusion

The present study found an inverse association between BMI and the risk of total, ischemic, and hemorrhagic stroke among patients with type 2 diabetes. More clinical and molecular insights are still needed in explaining these findings.

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