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Gang Hu, MD, PhD; Jaakko Tuomilehto, MD, PhD; Karri Silventoinen, PhD; Cinzia Sarti, MD, PhD; Satu Männistö, PhD; Pekka Jousilahti, MD, PhD

Arch Intern Med. 2007;167(13):1420-1427.

Background  Adiposity is an established risk factor for cardiovascular disease, but the relationship of adiposity with the risk of cerebrovascular disease is still to some extent unclear.

Methods  We prospectively investigated the association of different indicators of adiposity (body mass index [BMI] [calculated as weight in kilograms divided by height in meters squared], waist circumference, and waist-hip ratio) with total and type-specific stroke incidence among 49 996 Finnish participants who were aged 25 to 74 years and free of coronary heart disease and stroke at baseline.

Results  During a 19.5-year follow-up, 3228 people developed an incident stroke event (674 hemorrhagic and 2554 ischemic). Compared with normal-weight men (BMI, 18.5-24.9), the multivariate-adjusted (age, study year, smoking, physical activity, educational level, family history of stroke, and alcohol drinking) hazard ratios among lean (BMI, < 18.5), overweight (BMI, 25.0-29.9), and obese (BMI,  30.0) men were 0.74 (95% confidence interval [CI], 0.18-2.96), 1.23 (95% CI, 1.10-1.37), and 1.59 (95% CI, 1.37-1.83) for total stroke, and 0.49 (95% CI, 0.07-3.50), 1.27 (95% CI, 1.12-1.44), and 1.70 (95% CI, 1.45-2.00) for ischemic stroke, respectively. Among women, the corresponding hazard ratios were 1.87 (95% CI, 1.12-3.14), 1.08 (95% CI, 0.95-1.22), and 1.30 (95% CI, 1.14-1.50) for total stroke, and 1.81 (95% CI, 0.97-3.41), 1.11 (95% CI, 0.96-1.28), and 1.41 (95% CI, 1.21-1.64) for ischemic stroke. Abdominal adiposity, defined as the highest quartile of waist circumference or waist-hip ratio, was associated with a greater risk of total and ischemic stroke in men but not in women.

Conclusions  Body mass index was a risk factor for total and ischemic stroke in men and women. Abdominal adiposity was a risk factor for total and ischemic stroke only in men.

Author Affiliations: Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute (Drs Hu, Tuomilehto, Sarti, Männistö, and Jousilahti), and Department of Public Health, University of Helsinki (Drs Hu, Tuomilehto, and Silventoinen), Helsinki, Finland; South Ostrobothnia Central Hospital, Seinäjoki, Finland (Dr Tuomilehto); and School of Public Health, University of Tampere, Tampere, Finland (Dr Jousilahti).

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