title: Associations of obesity measures with subtypes of ischemic stroke in the ARIC Study.
abstract: BACKGROUND
  Associations between obesity and lacunar, nonlacunar thrombotic, and cardioembolic stroke are not firmly established.
  
  
  METHODS
  Body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR) were recorded at baseline between 1987 and 1989 in the Atherosclerosis Risk in Communities (ARIC) Study for 13 549 black and white adults who were aged from 45 to 64 years and had no history of cardiovascular disease or cancer. The incidence of ischemic stroke subtypes was ascertained from surveillance of hospital records over a median follow-up of 16.9 years. Cox proportional hazards regression analyses adjusted for age, sex, race, education, smoking status and cigarette years, usual ethanol intake, and leisure time sports index were used to estimate hazard ratios (HRs).
  
  
  RESULTS
  The ARIC sample at baseline was 43.8% men and 27.3% blacks; mean age was 53.9 years. Mean BMI, waist circumference, and WHR were 27.7 kg/m(2), 96.8 cm, and 0.92, respectively. The associations of lacunar (n = 138), nonlacunar (n = 338), and cardioembolic (n = 122) ischemic stroke incidence with obesity measures were all generally positive and linear. The HRs for the highest versus lowest quintile of the 3 obesity measures ranged from 1.43-2.21 for lacunar stroke, 1.90-2.16 for nonlacunar stroke, and 2.37-2.91 for cardioembolic stroke.
  
  
  CONCLUSIONS
  Although different pathophysiological mechanisms may exist, the incidences of lacunar, nonlacunar, and cardioembolic stroke were all significantly positively associated with the degree of obesity, regardless of the measure used.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA. yatsuya@gmail.com
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuya
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.forename: Kari E
authors.initials: KE
authors.lastname: North
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.forename: June
authors.initials: J
authors.lastname: Stevens
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
mesh_terms: D044383:Black People / Q000706:statistics & numerical data; D015992:Body Mass Index; D002545:Brain Ischemia / Q000145:classification / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D049629:Waist-Hip Ratio / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American