Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

Abstract

BackgroundObesity and diabetes mellitus, or diabetes, are independently associated with post-ischemic stroke outcomes (e.g., functional disability and all-cause mortality). Although obesity and diabetes are also associated with post-ischemic stroke outcomes, the joint effect of obesity and diabetes on these post-ischemic stroke outcomes has not been explored previously. The purpose of the current study was to explore whether the effect of obesity on post-ischemic stroke outcomes differed by diabetes status in a cohort of acute ischemic stroke subjects with at least a moderate stroke severity.MethodsData from the Interventional Management of Stroke (IMS) III clinical trial was analyzed for this post-hoc analysis. A total of 656 subjects were enrolled in IMS III and were followed for one year. The joint effects of obesity and diabetes on functional disability at 3-months and all-cause mortality at 1-year were examined.ResultsOf 645 subjects with complete obesity and diabetes information, few were obese (25.74%) or had diabetes (22.64%). Obese subjects with diabetes and non-obese subjects without diabetes had similar odds of functional disability at 3-months following an ischemic stroke (adjusted common odds ratio, 1.038, 95% CI: 0.631, 1.706). For all-cause mortality at 1-year following an ischemic stroke, obese subjects with diabetes had a similar hazard compared with non-obese subjects without diabetes (adjusted hazard ratio, 1.005, 95% CI: 0.559, 1.808). There was insufficient evidence to declare a joint effect between obesity and diabetes on either the multiplicative scale or the additive scale for both outcomes.ConclusionsIn this post-hoc analysis of data from the IMS III clinical trial of acute ischemic stroke patients with at least a moderate stroke severity, there was not sufficient evidence to determine that the effect of obesity differed by diabetes status on post-ischemic stroke outcomes. Additionally, there was not sufficient evidence to determine that either factor was independently associated with all-cause mortality. Future studies could differentiate between metabolically healthy and metabolically unhealthy patients within BMI categories to determine if the effect of obesity on post-stroke outcomes differs by diabetes status.

Association between abnormal body weight and stroke outcome: A meta‐analysis and systematic review

“…Of the remaining 196 articles assessed for eligibility, 163 articles were excluded for having the same study population ( n = 5); for having a sample size < 100 ( n = 3); for lack of data on obesity, overweight, or underweight ( n = 108); or for not investigating the concerned outcome of stroke ( n = 47). Finally, 33 articles including 84,660 patients were included in the full analysis [9–41]. The detailed process of study selection is shown in Figure 1.…”

“…Of underweight/normal weight, n = 1) [15,31,33]. Most of the studies did not report a significant result.…”

“…Outcome of patients with acute ischemic stroke who received thrombolysis therapy (0.54-6.21) b 0.90 (0.70-1.15) b 1.26 (0.86-1.86) b3-Obesity/nonobesity[14,15,18,31] …”

Impact of diabetes on clinical and safety outcomes in acute ischemic stroke patients receiving reperfusion therapy: A meta-analysis

“…44 This highlights the need for comprehensive and tailored management of patients with diabetes during the pandemic and beyond, 43 as well as in stroke patients with pre-existing diabetes who are at risk of poor outcomes after AIS. [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]…”

Determining the Joint Effect of Obesity and Diabetes on All-Cause Mortality and Cardiovascular-Related Mortality following an Ischemic Stroke

“…The population of interest for this work is ischemic stroke survivors. Previous work looking at all-cause mortality at 1 year in ischemic stroke patients [ 24 ] showed that there was insufficient evidence to determine that the effect of obesity differed by diabetes status. This study was limited because the study population included acute ischemic stroke patients with at least a moderate stroke severity who met study eligibility.…”