Obesity and long‐term outcomes after incident stroke: a prospective population‐based cohort study

Akyea, Ralph Kwame; Doehner, Wolfram; Iyen, Barbara; Weng, Stephen; Qureshi, Nadeem; Ntaios, George

doi:10.1002/jcsm.12818

Cited by 20 publications

(16 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This analysis confirms several previous reports which showed that increasing BMI was associated with better outcomes in patients with existing cardiovascular disease 4 . The study extends current knowledge by showing that in patients with cardiovascular disease, this association of body weight and outcome is not influenced by the level of metabolic health, that is, the presence of classical metabolic risk factors including dyslipidaemia, diabetes mellitus or arterial hypertension 14–16 . Indeed, similar findings were reported in patients with diabetes mellitus 17 or pre‐diabetes 18 …”

Section: Discussionsupporting

confidence: 90%

Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: A nationwide population‐based cohort study

Akyea,

Ntaios,

Doehner

2023

J cachexia sarcopenia muscle

Self Cite

View full text Add to dashboard Cite

BackgroundThe association between metabolic syndrome and increased cardiovascular disease (CVD) risk is well‐established. However, in patients with incident CVD, the relationship between obesity, metabolic health, and subsequent CVD and mortality outcomes are less well‐established. This study investigated the association between body mass index (BMI), metabolic health and the risk of subsequent cardiovascular mortality and morbidity outcomes in patients with incident CVD events.MethodsThis cohort study identified 130 685 patients from the nationwide Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases in the United Kingdom. Patients were ≥18 years with incident CVD [coronary heart disease (CHD), stroke, or peripheral vascular disease (PVD)] between 1 January 1998 and 31 December 2017. BMI (in kg/m2) was categorized as underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9) and obese (≥30). Within each BMI category, patients were grouped by increasing count of 1, 2 or 3 metabolic risk factors [RF] (dyslipidaemia, diabetes mellitus and hypertension) and were regarded as metabolically unhealthy while absence of these factors was considered metabolically healthy (MH). Multivariable Cox regression was used to assess the risk (hazard ratio with 95% confidence interval) of subsequent outcomes (non‐fatal CHD, stroke, PVD, incident heart failure, CVD‐mortality and all‐cause mortality) in BMI subgroups with incremental count of metabolic RFs.ResultsDuring a median follow‐up of 13.0 years, a higher BMI was associated with reduced risk for stroke, PVD, CVD‐mortality and all‐cause mortality within each metabolic risk category, while increasing metabolic RFs within each BMI subgroup accounted for increasing risks. When compared with patients with normal BMI and no RF, CVD‐mortality risk in overweight patients with no RF was 0.76 (0.70–0.84), and in obese patients with no RF was 0.85 (0.76–0.96). The respective risk for all‐cause mortality in patients with overweight and no RF was 0.69 (0.65–0.72), and in obese patients with no RF was 0.75 (0.70–0.79). Subsequent outcomes of stroke and PVD showed similar trends. In contrast, the risk of subsequent non‐fatal CHD events and incident HF increased with higher BMI and with incremental metabolic risk factors within each BMI category. Underweight was constantly associated with increased risk for all outcomes regardless of the presence of metabolic RFs except for non‐fatal CHD events.ConclusionsIn patients with incident CVD, overweight and obesity were related to a more favourable prognosis for subsequent stroke, PVD and mortality (CVD‐related and all‐cause) irrespective of the presence of other metabolic risk factors.

show abstract

Section: Discussionsupporting

confidence: 90%

Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: A nationwide population‐based cohort study

Akyea,

Ntaios,

Doehner

2023

J cachexia sarcopenia muscle

Self Cite

View full text Add to dashboard Cite

show abstract

“…On the other hand, there is a paradox in incident stroke patients associated with obesity or overweight. In these patients, the prognosis is more favorable for major adverse cardiovascular events, such as coronary heart disease, recurrent stroke, peripheral vascular disease, heart failure, and cardiovascular-related mortality [ 97 ]. In the treatment of these patients with obesity and CVDs, semaglutide has been evaluated by the Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity (SELECT) study [ 98 ].…”

Section: Dynapenic and Sarcopenic Obesity And Their Association With ...mentioning

confidence: 99%

Associations of Dynapenic Obesity and Sarcopenic Obesity with the Risk of Complications in COVID-19

Mayoral

Matías-Cervantes

Pérez-Campos

et al. 2022

IJMS

View full text Add to dashboard Cite

Ageing is associated with changes in body composition, such as low muscle mass (sarcopenia), decreased grip strength or physical function (dynapenia), and accumulation of fat mass. When the accumulation of fat mass synergistically accompanies low muscle mass or reduced grip strength, it results in sarcopenic obesity and dynapenic obesity, respectively. These types of obesity contribute to the increased risk of cardiovascular disease and mortality in the elderly, which could increase the damage caused by COVID-19. In this review, we associated factors that could generate a higher risk of COVID-19 complications in dynapenic obesity and sarcopenic obesity. For example, skeletal muscle regulates the expression of inflammatory cytokines and supports metabolic stress in pulmonary disease; hence, the presence of dynapenic obesity or sarcopenic obesity could be related to a poor prognosis in COVID-19 patients.

show abstract

“…Currently, the association between obesity, metabolic dysfunction, neuroinflammation, and mortality in stroke patients is not well-established; however, some cohort studies have shown a correlation between body mass index and abdominal obesity with ischemic and hemorrhagic stroke (Shiozawa et al 2021 ; Akyea et al 2021 ; Jaakonmäki et al 2022 ). For all these reasons, this review aims to analyze how obesity-related systemic inflammation can affect microglial response in the CNS, prime them, leading to increased stroke-associated neuronal damage secondary to obesity and chronic neuroinflammation, linking them as risk factors that decrease survival and worsening patient’s prognosis as correlated in epidemiological studies (Shiozawa et al 2021 ; Akyea et al 2021 ; Jaakonmäki et al 2022 ). Herein, we review the roles of microglia and their functional interactions and regulatory mechanisms in obesity and stroke, and how obesity-primed microglia could enhance stroke-associated damage.…”

Section: Introductionmentioning

confidence: 99%

Possible Implications of Obesity-Primed Microglia that Could Contribute to Stroke-Associated Damage

et al. 2023

View full text Add to dashboard Cite

Microglia, the resident macrophages of the central nervous system, are essential players during physiological and pathological processes. Although they participate in synaptic pruning and maintenance of neuronal circuits, microglia are mainly studied by their activity modulating inflammatory environment and adapting their phenotype and mechanisms to insults detected in the brain parenchyma. Changes in microglial phenotypes are reflected in their morphology, membrane markers, and secreted substances, stimulating neighbor glia and leading their responses to control stimuli. Understanding how microglia react in various microenvironments, such as chronic inflammation, made it possible to establish therapeutic windows and identify synergic interactions with acute damage events like stroke. Obesity is a low-grade chronic inflammatory state that gradually affects the central nervous system, promoting neuroinflammation development. Obese patients have the worst prognosis when they suffer a cerebral infarction due to basal neuroinflammation, then obesity-induced neuroinflammation could promote the priming of microglial cells and favor its neurotoxic response, potentially worsening patients’ prognosis. This review discusses the main microglia findings in the obesity context during the course and resolution of cerebral infarction, involving the temporality of the phenotype changes and balance of pro- and anti-inflammatory responses, which is lost in the swollen brain of an obese subject. Graphical Abstract Obesity enhances proinflammatory responses during a stroke. Obesity-induced systemic inflammation promotes microglial M1 polarization and priming, which enhances stroke-associated damage, increasing M1 and decreasing M2 responses.

show abstract

Obesity and long‐term outcomes after incident stroke: a prospective population‐based cohort study

Cited by 20 publications

References 29 publications

Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: A nationwide population‐based cohort study

Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: A nationwide population‐based cohort study

Associations of Dynapenic Obesity and Sarcopenic Obesity with the Risk of Complications in COVID-19

Possible Implications of Obesity-Primed Microglia that Could Contribute to Stroke-Associated Damage

Contact Info

Product

Resources

About