Physicians' Academy for Cardiovascular Education

BMI of 27-28 kg/m2 and little abdominal obesity best for patients with cerebrovascular disease

Relation between adiposity and vascular events, malignancy, and mortality in patients with stable cerebrovascular disease

Jaspers NEM, Dorresteijn JAN, van der Graaf Y, et al, on behalf of the SMART Study Group - International Journal of Obesity 2017; published online ahead of print


A high BMI has been associated with higher survival rates in patients with cardiovascular disease (CVD), a finding that is known as the “obesity paradox” [1]. However, BMI cannot distinguish between sources or locations of body mass, whereas the amount of metabolically active abdominal adipose tissue is more accurately reflected by waist circumference and ultrasound measurements of intra-abdominal fat [2,3]. Moreover, BMI has been shown to have a non-linear (U- or J-shaped) relation with mortality, but previous studies assessing clinical outcomes in patients with cerebrovascular disease did not account for the possibility of non-linear trends [4].

In this study, the association between clinical measurements (BMI and waist circumference) and ultrasound visceral adipose tissue thickness (VAT) and subcutaneous adipose tissue thickness (SAT) [5] on risk of vascular events, vascular mortality, malignancy and all-cause mortality was evaluated in patients with clinically stable cerebrovascular disease (CeVD), while considering the possibility of non-linear relations. The source of patient data was the SMART cohort (n=1767 CeVD patients between 2000 and 2015), an ongoing, prospective study, evaluating the management of atherosclerotic disease and cardiovascular (CV) risk factors. CeVD was defined as either a primary referral diagnosis of ischemic stroke, TIA or retinal infarction, or as a medical history of stroke, TIA or carotid artery operation. Median follow-up was 6.8 years. All patients were clinically stable, not being admitted to a hospital at the time of baseline examination, not having a short life-expectancy and with a Rankin Score of ≤3.

The composite outcome of vascular events was fatal or non-fatal ischemic stroke, intracerebral hemorrhage, myocardial infarction (MI) or fatal abdominal aortic aneurysm rupture or fatal congestive heart failure (HF).

Main results


In clinically stable patients with cerebrovascular disease, the lowest risk of incident malignancy, vascular events and mortality was associated with a BMI of 27-28 kg/m2. Moreover, the lowest risk of all-cause mortality was observed for a waist-circumference of 84.0 cm for women and 94.8 cm for men. These data reinforce the importance of little abdominal obesity.


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Find this article online at International Journal of Obesity