title: Obesity and recurrent vascular risk after a recent ischemic stroke.
abstract: OBJECTIVE
  Although obesity is an established risk factor for the occurrence of a primary stroke, little is known about the impact of baseline obesity on recurrent vascular risk among patients with recently symptomatic cerebrovascular disease. We evaluated the association of obesity with future vascular risk in patients with a recent history of stroke.
  
  
  METHODS
  We analyzed the database of a multicenter trial involving 20 332 patients with recent ischemic stroke followed for 2.5 years. Subjects were divided into 3 groups according to recognized body mass index categories representing lean, overweight, and obese. Primary outcome was time to first recurrent stroke and secondary outcome time to stroke, myocardial infarction, or vascular death. The independent association of obesity with outcome was assessed by controlling for other known risk factors.
  
  
  RESULTS
  Of 20 246 eligible subjects, 4805 (24%) were obese. After adjusting for confounders, compared with the lean group, being overweight (hazard ratio, 0.95; 95% CI, 0.85-1.06) or obese (hazard ratio, 0.95; 95% CI, 0.83-1.08) was not associated with increased recurrent stroke risk, but being overweight (hazard ratio, 0.84; 95% CI, 0.77-0.92) or obese (hazard ratio, 0.86; 95% CI, 0.77-0.96) was associated with lower risk of a major vascular event.
  
  
  CONCLUSIONS
  Obesity is not related to recurrent stroke risk, but obese patients with stroke are at lower overall vascular risk than their leaner counterparts, supporting the widely held notion of the existence of a cardiovascular "obesity paradox."
authors.affiliation: Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, MC 9127, San Diego, CA 92103, USA. ovibes@ucsd.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Philip M
authors.initials: PM
authors.lastname: Bath
authors.forename: Daniel
authors.initials: D
authors.lastname: Cotton
authors.forename: Richard
authors.initials: R
authors.lastname: Vinisko
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D012008:Recurrence; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology