title: Increased visceral adipose tissue as a potential risk factor in patients with embolic stroke of undetermined source (ESUS).
abstract: OBJECTIVE
  The etiology of an ischemic stroke remains undetermined in 20-35% of cases and many patients do not have any of the conventional risk factors. Increased visceral adipose tissue (VAT) is a suggested new risk factor for both carotid artery atherosclerosis (CAA) and atrial fibrillation (AF), but its role in the remaining stroke population is unknown. We assessed the amount of VAT in patients with embolic stroke of undetermined source (ESUS) after excluding major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke.
  
  
  METHODS
  Altogether 58 patients (mean age 57.7 ± 10.2 years, 44 men) with ischemic stroke of unknown etiology but without CAA, known AF or small vessel disease underwent computed tomography angiography and assessment of VAT. For comparison VAT values from three different reference populations were used. Conventional risk factors (smoking, hypertension, diabetes, increased total and LDL-cholesterol, decreased HDL-cholesterol) were also registered.
  
  
  RESULTS
  Mean VAT area was significantly higher in stroke patients (205 ± 103 cm2 for men and 168 ± 99 cm2 for women) compared to all reference populations (P < 0.01). 50% of male and 57% of female patients had an increased VAT area. In male patients, VAT was significantly higher despite similar body mass index (BMI). Increased VAT was more common than any of the conventional risk factors.
  
  
  CONCLUSIONS
  Increased VAT was found in over half of our patients with ESUS suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients.
authors.affiliation: Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland.
authors.forename: Antti T
authors.initials: AT
authors.lastname: Muuronen
authors.affiliation: Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Taina
authors.affiliation: Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland; Kuopio University Hospital, Heart Center, Kuopio, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Hedman
authors.affiliation: Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland.
authors.forename: Jarkko
authors.initials: J
authors.lastname: Marttila
authors.affiliation: Kuopio University Hospital, Department of Medicine, Kuopio, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Kuusisto
authors.affiliation: Kuopio University Hospital, Neuro Center, Kuopio, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Onatsu
authors.affiliation: Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland; University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland.
authors.forename: Ritva
authors.initials: R
authors.lastname: Vanninen
authors.affiliation: Kuopio University Hospital, Neuro Center, Kuopio, Finland; University of Eastern Finland, Institute of Clinical Medicine, Unit of Neurology, Kuopio, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jäkälä
authors.affiliation: Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland; University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Sipola
authors.affiliation: Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Mustonen
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D004617:Embolism / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000473:pathology; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000473:pathology