Different Obesity Paradox Of Ischemic Stroke Without And With Atrial Fibrillation

초록

Background: A paradoxical relationship between stroke and obesity (also known as the 'obesity paradox’) in the general population is still controversial. Objective: The aim of this study was to investigate whether the association between general obesity, abdominal obesity and ischemic stroke was different in patients without and with AF. Methods: Total 506,181 adults (mean age 47.7 ± 14.4 years, 253,487 men [50.1%]) without ischemic stroke from Korea National Health Insurance Service database from 2009 to 2014 were evaluated. General obesity and abdominal obesity were assessed with body mass index (BMI) and waist circumference (WC). Results: During a mean follow-up of 3.9 ± 1.3 years, 9,282 participants developed ischemic stroke. In non-AF subjects, general obesity decreased the risk of stroke in non-AF subjects with adjusted hazard ratio (HR) of 1.17 (95% CI, 1.02-1.34) for underweight suggesting obesity paradox. Abdominal obesity increased the risk of stroke with adjusted HR of 1.07 (95% CI, 1.05-1.09) for per 1-standard deviation (9.4 cm) increase in WC, and with adjusted HR of 1.12 (95% CI, 1.06-1.18) for abdominal obesity. However, in AF patient, general obesity had no association with stroke, and abdominal obesity increased the risk of stroke only in women AF less than 55 years old (adjusted HR 2.20, 95% CI, 1.29-3.73, p=0.030). Conclusion: Obesity paradox of general obesity was observed in non-AF subject, but not in AF patients. However, abdominal obesity increased the risk of stroke without showing obesity paradox in non-AF, and middle aged AF women. This result suggests that controversy of obesity paradox of stroke might be related with the proportion of AF population.