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

Abstract

Although obesity and diabetes mellitus, or diabetes, are independently associated with mortality-related events (e.g., all-cause mortality and cardiovascular-related mortality) following an ischemic stroke, little is known about the joint effect of obesity and diabetes on mortality-related events following an ischemic stroke. The aim of this study is to evaluate the joint effect of obesity and diabetes on mortality-related events in subjects with a recent ischemic stroke. Data from the multicenter Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial was analyzed for this study. The joint effect of obesity and diabetes on mortality-related events was estimated via Cox proportional hazards regression models. No difference in the hazard of all-cause mortality following an ischemic stroke was observed between obese subjects with diabetes and underweight/normal-weight subjects without diabetes. In contrast, obese subjects with diabetes had an increased hazard of cardiovascular-related mortality following an ischemic stroke compared with underweight/normal-weight subjects without diabetes. Additionally, there was evidence of an attributable proportion due to interaction as well as evidence of a highly statistically significant interaction on the multiplicative scale for cardiovascular-related mortality. In this clinical trial cohort of ischemic stroke survivors, obesity and diabetes synergistically interacted to increase the hazard of cardiovascular-related mortality.

Health Equity Among Black Women in the United States

“…The relatively high levels of morbidity and mortality among Black populations in the United States are, in large part, caused by obesity, which increases the risk of stroke and various CVDs. [36][37][38] Obesity is a major source of morbidity and mortality for all U.S. populations, but non-Hispanic Blacks have a higher age-adjusted prevalence of obesity than any other racial/ethnic group, with estimates ranging from 34% to 50%. 39 Patterns of obesity vary by many factors across and within races, including location, gender, and educational attainment.…”

“… 41 The high prevalence of obesity among Black women 36 , 37 impacts the prevalence rates of stroke and various CVDs. 38 …”

Diabetes mellitus and comorbidities – A cross-sectional study with control group based on nationwide ambulatory claims data

“…However, more severe forms of obesity, which are also more strongly associated with diabetes [ 35 ], already begin to decrease in the 60 to 69 age group in DEGS1 [ 34 ]. As there are published study results showing that accounting data predominantly document severe forms of obesity [ 36 ] and that persons suffering obesity and diabetes have an increased mortality [ 37 ], the results presented here indicating a high prevalence in young age groups combined with a decline occurring early in life are epidemiologically highly plausible.…”

Development and Validation of a Nomogram to Predict Type 2 Diabetes Mellitus in Overweight and Obese Adults: A Prospective Cohort Study from 82938 Adults in China

“…Evidence is mounting that high BMI causes the incidence of T2DM [ 8 – 10 ]. Coexistence of obesity/overweight and T2DM is associated with increased risk of stroke, angina, and coronary heart disease and constitutes a significant cardiovascular health burden [ 12 ]. Primary prevention and timely intervention are at the core of preventing or postponing onset of T2DM.…”

“…Previous cohort studies indicate that overweight and obese adults are 2.5 times more likely to develop T2DM than normal weight individuals [ 11 ]. Additionally, compared with overweight and obese adults or T2DM alone, patients with T2DM and overweight and obesity have an increased risk of cardiovascular-related mortality [ 12 ].…”