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.