Editor's Choice
CARDIOLOGY / CLINICAL RESEARCH
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
This study investigated the complex relationship between an elevated body mass index (BMI) and stroke risk in Europe amidst rising obesity rates and an aging population.

Material and methods:
A joinpoint regression model was used to fit the data on stroke mortality rates attributed to an elevated BMI. The age period cohort model was used to analyze the effects of age, period, and birth cohort on trends in stroke prevalence related to an elevated BMI from 1990–2019 in the European context. A Bayesian age-period-cohort model was used to project age-standardized stroke mortality attributed to elevated BMI in Europe from 2020 to 2044.

Results:
Stroke mortality rates attributed to an elevated BMI displayed a wave-like declining trend in Europe, decreasing from 21.73/100,000 in 1990 to 14.01/100,000 in 2019. The most substantial decline in stroke mortality rate occurred between 2003 and 2013 (age period cohort analysis: –4.10%, 95% CI: –4.44 to –3.75; p < 0.001). Male mortality rates decreased from 21.48/100,000 in 1990 to 15.45/100,000 in 2019, while female rates declined more significantly from 21.40/100,000 in 1990 to 12.48/100,000 in 2019. Age-standardized stroke mortality due to elevated BMI is projected to decline in Europe over the next 25 years. Age-standardized stroke mortality due to increased BMI is expected to continue declining in Europe over the next 25 years, with projected reductions of 12.99% in males and 13.01% in females by 2044.

Conclusions:
From 1990 to 2019, stroke mortality rates associated with elevated BMI in Europe steadily increased. However, projections suggest a slight decline in the near future. Given these trends, there is an urgent need to enhance weight management for stroke patients and increase public health awareness, particularly among men and the elderly, to reduce stroke-related mortality.
REFERENCES (23)
1.
Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine 2020; 48: 561-6.
 
2.
Lindsay MP, Norrving B, Sacco RL, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2019. Int.
 
3.
J Stroke 2019; 14: 806-17.
 
4.
Peng S, Liu X, Cao W, et al. Global, regional, and national time trends in mortality for stroke, 1990-2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention. Int J Cardiol 2023; 383: 117-31.
 
5.
Wafa HA, Wolfe CDA, Emmett E, Roth GA, Johnson CO, Wang Y. Burden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke 2020; 51: 2418-27.
 
6.
Strazzullo P, D’Elia L, Cairella G, Garbagnati F, Cappuccio FP, Scalfi L. Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke 2010; 41: e418-26.
 
7.
Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects); Lu Y, Hajifathalian K, Ezzati M, Woodward M, Rimm EB, Danaei G. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet 2014; 383: 970-83.
 
8.
Mirrakhimov E, Bektasheva E, Isakova J, et al. Association of leptin receptor gene Gln223Arg polymorphism with insulin resistance and hyperglycemia in patients with metabolic syndrome. Arch Med Sci 2023; 20: 54-60.
 
9.
Zhang P, Yan XL, Qu Y, Guo ZN, Yang Y. Association between abnormal body weight and stroke outcome: a meta-analysis and systematic review. Eur J Neurol 2021; 28: 2552-64.
 
10.
Jin Z, Wang Z, Wang R, et al. Global burden and epidemic trends of gout attributable to high body mass index from 1990 to 2019. Arch Med Sci 2024; 20: 71-80.
 
11.
Janssen F, Bardoutsos A, Vidra N. Obesity prevalence in the long-term future in 18 European countries and in the USA. Obes Facts 2020; 13: 514-27.
 
12.
Pineda E, Sanchez-Romero LM, Brown M, et al. Forecasting future trends in obesity across Europe: the value of improving surveillance. Obes Facts 2018; 11: 360-71.
 
13.
Holford TR. The estimation of age, period and cohort effects for vital rates. In: Biometrics. Washington. International Biometric Society 1983; 311-324.
 
14.
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795-820.
 
15.
GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024; 23: 973-1003.
 
16.
Bersano A, Gatti L. Pathophysiology and treatment of stroke: present status and future perspectives. Int J Mol Sci 2023; 24: 14848.
 
17.
Wang JC, Bennett M. Aging and atherosclerosis: mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circ Res 2012; 111: 245-59.
 
18.
Chaudhary D, Khan A, Gupta M, et al. Obesity and mortality after the first ischemic stroke: Is obesity paradox real? PLoS One 2021; 16: e0246877.
 
19.
Gu M, Xiao L, Wang J, et al. Obesity and poststroke fatigue: a 2-year longitudinal study. Neurol Ther 2021; 10: 955-69.
 
20.
Lee SH, Jung JM, Park MH. Obesity paradox and stroke outcomes according to stroke subtype: a propensity score-matched analysis. Int J Obes 2023; 47: 669-76.
 
21.
Capodaglio P, Ilieva E, Oral A, et al.; UEMS-PRM EBPP Methodological Group. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with obesity and related comorbidities. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2017; 53: 611-24.
 
22.
Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism 2019; 92: 98-107.
 
23.
Rakhmatullin AR, Kutlubaev MA, Kutlubaeva RF, Ozerova AI. Sotsial’no-ekonomicheskie faktory i tserebral’nyi insul’t [Socioeconomic factors and stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122: 45-51.
 
eISSN:1896-9151
ISSN:1734-1922
Journals System - logo
Scroll to top