Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, Seoul, Korea.
Neurology. 2012 Aug 28;79(9):856-63. doi: 10.1212/WNL.0b013e318266fad1. Epub 2012 Aug 15.
Paradoxical longevity in obese patients with established disease has been documented in various conditions. We aimed to find whether such a relationship exists in ischemic stroke patients, with stratified analyses according to time of death after stroke, age, and cause of death.
The Korean Stroke Registry (KSR) is a nationwide, multicenter, prospective registry of acute stroke. For 7.5 years, data on 34,132 patients with acute ischemic stroke were collected through KSR, and their mortality information was ascertained through a governmental statistical office. We assessed relative hazard of mortality according to obesity status.
Stroke survivors whose body mass index (BMI) values were lower than the chosen reference level of 20-23 had increased risks of long-term mortality (hazard ratio [HR] of 1.36 and 95% confidence interval [CI] of 1.25-1.48 for BMI ≤18.5; HR of 1.14 and 95% CI of 1.03-1.26 for BMI 18.5-20), whereas obese stroke patients had decreased risks of mortality (HR of 0.83 and 95% CI of 0.74-0.92 for BMI 27.5-30; HR of 0.77 and 95% CI of 0.63-0.93 for BMI 30-32.5). Inverse association between obesity status and mortality was not evident until 90 days after stroke but became significant 1 year after onset of stroke. Such an association was more prominent in stroke patients who were less than 65 years old, but it remained constant in all age groups. The paradoxical relationship remained significant, regardless of causes of death.
Our results documented obesity paradox in stroke survivors, regardless of age and causes of death, and it became evident a sufficient time after stroke onset.
在各种情况下，已经有研究证明肥胖患者即使患有既定疾病，其寿命也可能出现反常延长。本研究旨在探讨这种相关性是否存在于缺血性脑卒中患者中，并进行了按卒中后死亡时间、年龄和死因分层的分析。
韩国卒中注册研究（Korean Stroke Registry，KSR）是一项全国性、多中心、前瞻性的急性卒中登记研究。在 7.5 年的时间里，通过 KSR 收集了 34132 例急性缺血性卒中患者的数据，并通过政府统计办公室确定了他们的死亡信息。我们评估了根据肥胖状况，死亡的相对风险。
体重指数（BMI）值低于所选参考水平（20-23）的卒中幸存者，其长期死亡风险增加（BMI≤18.5 时的危险比 [HR]为 1.36，95%置信区间 [CI]为 1.25-1.48；BMI 为 18.5-20 时的 HR 为 1.14，95%CI 为 1.03-1.26），而肥胖的卒中患者死亡风险降低（BMI 为 27.5-30 时的 HR 为 0.83，95%CI 为 0.74-0.92；BMI 为 30-32.5 时的 HR 为 0.77，95%CI 为 0.63-0.93）。这种肥胖状况与死亡率之间的负相关关系直到卒中后 90 天才变得明显，但在卒中发作 1 年后变得显著。这种相关性在年龄小于 65 岁的卒中患者中更为明显，但在所有年龄组中都保持不变。无论死因如何，这种矛盾的关系仍然显著。
无论年龄和死因如何，本研究结果均证明了卒中幸存者中存在肥胖悖论，且这种相关性在卒中发作后足够长的时间后才变得明显。
