title: Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study.
abstract: OBJECTIVE
  Obesity is well recognized as a risk factor for coronary heart disease and mortality. The relationship between abdominal obesity and ischemic stroke remains less clear. Our aim was to evaluate abdominal obesity as an independent risk factor for ischemic stroke in a multiethnic community.
  
  
  METHODS
  A population-based, incident case-control study was conducted July 1993 through June 1997 in northern Manhattan, New York, NY. Cases (n=576) of first ischemic stroke (66% >or=BORDER="0">65 years of age; 56% women; 17% whites; 26% blacks; 55% Hispanics) were enrolled and matched by age, sex, and race-ethnicity to stroke-free community controls (n=1142). All subjects were interviewed and examined and had measurements of waist-to-hip ratio (WHR). Odds ratios (ORs) of ischemic stroke were calculated with gender-specific quartiles (GQs) and gender-specific medians of WHR adjusted for stroke risk factors and body mass index (BMI).
  
  
  RESULTS
  Compared with the first quartile, the third and fourth quartiles of WHR had an increased risk of stroke (GQ3: OR, 2.4; 95% CI, 1.5 to 3.9; GQ4: OR, 3.0; 95% CI, 1.8 to 4.8) adjusted for other risk factors and BMI. Those with WHR equal to or greater than the median had an overall OR of 3.0 (95% CI, 2.1 to 4.2) for ischemic stroke even after adjustment for other risk factors and BMI. Increased WHR was associated with a greater risk of stroke in men and women and in all race-ethnic groups. The effect of WHR was stronger among younger persons (test for heterogeneity, P<0.0002) (<65 years of age: OR, 4.4; 95%CI, 2.2 to 9.0; >or=65 years of age: OR, 2.2; 95% CI, 1.4 to 3.2). WHR was associated with an increased risk among those with and without large-artery atherosclerotic stroke.
  
  
  CONCLUSIONS
  Abdominal obesity is an independent, potent risk factor for ischemic stroke in all race-ethnic groups. It is a stronger risk factor than BMI and has a greater effect among younger persons. Prevention of obesity and weight reduction need greater emphasis in stroke prevention programs.
authors.affiliation: Department of Neurology, Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY, USA.
authors.forename: Seung-Han
authors.initials: SH
authors.lastname: Suk
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: Jian F
authors.initials: JF
authors.lastname: Cheun
authors.forename: John G
authors.initials: JG
authors.lastname: Pittman
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Elkind
authors.forename: Myunghee C
authors.initials: MC
authors.lastname: Paik
mesh_terms: D000005:Abdomen; D017677:Age Distribution; D000368:Aged; D044383:Black People; D001824:Body Constitution; D015992:Body Mass Index; D002545:Brain Ischemia / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003710:Demography; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D009519:New York City / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology*; D044465:White People; D001741:Black or African American