Effect of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack

MU Jingli; XU Qingyun; WANG Ruili; YANG Pinni; CHENG Ming; WANG Dan; ZHANG Jin; WANG Yinnan; ZHAO Xingquan; CHANG Liguo; WANG Aili

doi:10.7619/jcmp.20232721

Journal of Clinical Medicine in Practice > 2024 > 28(2): 1-7, 12. > DOI: 10.7619/jcmp.20232721

MU Jingli, XU Qingyun, WANG Ruili, YANG Pinni, CHENG Ming, WANG Dan, ZHANG Jin, WANG Yinnan, ZHAO Xingquan, CHANG Liguo, WANG Aili. Effect of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack[J]. Journal of Clinical Medicine in Practice, 2024, 28(2): 1-7, 12. DOI: 10.7619/jcmp.20232721

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Effect of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack

1.
Liaocheng Third People's Hospital of Shandong Province, Liaocheng, Shandong, 252000
2.
Department of Epidemiology and Health Statistics, School of Public Health of Suzhou Medical College of Soochow University, Suzhou, Jiangsu, 215123
3.
Center for Disease Control and Prevention of Suzhou Industrial Park of Jiangsu Province, Suzhou, Jiangsu, 751599

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Received Date: August 27, 2023
Revised Date: November 06, 2023
Available Online: January 25, 2024

Graphical Abstract

Abstract

Abstract

Objective
To investigate the impact of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack (TIA).
Methods
A total of 366 patients with acute mild ischemic stroke or moderate-high risk TIA who carried CYP2C19 loss-of-function alleles were included in the study. Baseline data were collected at admission, and clinical outcomes were collected within 3 months post-onset (primary outcomes: stroke recurrences within 3 months post-onset; secondary outcomes: composite outcome of stroke recurrence or death within 3 months post-onset, vascular events, and quality of life within 3 months). Kaplan-Meier method was used to plot the cumulative incidence curve of outcomes. Multivariate Cox proportional hazards model and multivariate Logistic regression model were used to evaluate the relationship between overweight and clinical outcomes within 3 months post-onset in patientswith ischemic stroke or TIA. The integrated discrimination improvement index (IDI) and net reclassification improvement index (NRI) were calculated to assess the predictive value of adding body mass index (BMI, whether overweight or not) based on traditional models for predicting the prognosis of acute ischemic stroke or TIA.
Results
After 3 months of follow-up, 28 patients had stroke recurrence, 1 patient died, and 31 patients had vascular events. The Kaplan-Meier cumulative incidence curve showed that the cumulative incidences of stroke recurrence, stroke recurrence or death, and vascular events after 3 months of onset were lower in overweight patients compared with non-overweight patients (Log-rank P < 0.05). Multivariate analysis showed that compared with non-overweight patients, overweight patients had significantly reduced risks of stroke recurrence within 3 months (HR=0.24; 95%CI, 0.08 to 0.71), composite outcome of stroke recurrence or death (HR=0.24; 95%CI, 0.08 to 0.69), and vascular events (HR=0.22; 95%CI, 0.07 to 0.63), and significantly improved quality of life within 3 months (OR=0.39; 95%CI, 0.20 to 0.76). The IDI and NRI calculations showed that compared with traditional models, the new model adding BMI (whether overweight) had significantly improved predictive ability for the prognosis of acute ischemic stroke or TIA.
Conclusion
Overweight may be a protective factor for the prognosis of TIA patients with acute mild ischemic stroke or moderate-high risk who carry CYP2C19 loss-of-function alleles. Compared with non-overweight patients, overweight patients have reduced risks of stroke recurrence, composite outcome of stroke recurrence or death, and vascular events within 3 months post-onset, and improved quality of life within 3 months post-onset.
- body mass index,
- ischemic stroke,
- transient ischemic attack,
- prognosis,
- stroke recurrence,
- obesity paradox

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References (33)

References

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Effect of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack