Km. Rexrode et al., A PROSPECTIVE-STUDY OF BODY-MASS INDEX, WEIGHT CHANGE, AND RISK OF STROKE IN WOMEN, JAMA, the journal of the American Medical Association, 277(19), 1997, pp. 1539-1545
Objective.-To examine the associations of body mass index (BMI) and we
ight change with risk of stroke in women. Setting and Design.-Prospect
ive cohort study among US female registered nurses participating in th
e Nurses' Health Study. Participants.-A total of 116 759 women aged 30
to 55 years in 1976 who were free from diagnosed coronary heart disea
se, stroke, and cancer. Main Outcome Measure.-Incidence of ischemic st
roke, hemorrhagic stroke (subarachnoid or intraparenchymal hemorrhage)
, and total stroke. Results.-During 16 years of follow-up, 866 total s
trokes (including 403 ischemic strokes and 269 hemorrhagic strokes) we
re documented. In multivariate analyses adjusted for age, smoking, pos
tmenopausal hormone use, and menopausal status, women with increased B
MI (greater than or equal to 27 kg/m(2)) had significantly increased r
isk of ischemic stroke, with relative risks (RRs) of 1.75 (95% confide
nce interval [CI], 1.17-2.59) for BMI of 27 to 28.9 kg/m(2); 1.90 (95%
CI, 1.28-2.82) for BMI of 29 to 31.9 kg/m(2); and 2.37 (95% CI, 1.60-
3.50) for BMI of 32 kg/m(2) or more (P for trend<.001), as compared wi
th those with a BMI of less than 21 kg/m(2). For hemorrhagic stroke th
ere was a nonsignificant inverse relation between obesity and hemorrha
gic stroke, with the highest risk among women in the leanest BMI categ
ory (P for trend=.20). For total stroke the RRs were somewhat attenuat
ed compared with those for ischemic stroke but remained elevated for w
omen with higher BMI (P for trend<.001). In multivariate analyses that
also adjusted for BMI at age 18 years, weight gain from age 18 years
until 1976 was associated with an RR for ischemic stroke of 1.69 (95%
CI, 1.26-2.29) for a gain of 11 to 19.9 kg and 2.52 (95% CI, 1.80-3.52
) for a gain of 20 kg or more (P for trend<.001), as compared with wom
en who maintained stable weight (loss or gain <5 kg). Although weight
change was not related to risk of hemorrhagic stroke (P for trend=.20)
, a direct relationship was observed between weight gain and total str
oke risk (P for trend<.001). Conclusions.-These prospective data indic
ate that both obesity and weight gain in women are important risk fact
ors for ischemic and total stroke but not hemorrhagic stroke. The rela
tionship between obesity and total stroke depends on the distribution
of stroke subtypes in the population.