Association of optimal combination drug treatment with obesity status among recent ischemic stroke patients: Results of the vitamin intervention for stroke prevention (VISP) trial

Jong Ho Park, Juneyoung Lee, Bruce Ovbiagele

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2 Citations (Scopus)

Abstract

Background and Purpose One explanation for the ‘obesity paradox’, where obese patients seem to have better cardiovascular outcomes than lean patients, is that obese patients display an identifiable high cardiovascular risk phenotype that may lead to receiving or seeking earlier/more aggressive treatment. Methods We analyzed a clinical trial dataset comprising 3643 recent (<120 days) ischemic stroke patients followed up for 2 years. Subjects were categorized as lean (body mass index [BMI], <25 kg/m2, n=1,006), overweight (25-29.9 kg/m2, n=1,493), or obese (≥30 kg/m2, n=1,144). Subjects were classified as level 0 to III depending on the number of secondary prevention prescriptions divided by the number of potentially indicated drugs (0=none of the indicated medications and III=all indicated medications as optimal combination drug treatment [OCT]). Independent associations between each BMI category and stroke/myocardial infarction/vascular death (major vascular events [MVEs]) and all-cause death were assessed. Results MVEs occurred in 17.4% of lean, 16.1% of overweight, and 17.1% of obese patients; death occurred in 7.3%, 5.5%, and 5.1%, respectively. Individuals with a higher BMI status received more OCT (45.8%, 51.7%, and 55.3%, respectively; P<0.001). In the lean patient group, multivariable adjusted Cox analyses, showed that compared with levels 0-I, level II and level III were linked to lower risk of MVEs (hazard ratio [HR] 0.55; 95% confidence interval [CI]: 0.32–0.95 and HR 0.48; 95% CI: 0.28−0.83, respectively) and death (0.44; 0.21–0.96 and 0.23; 0.10−0.54, respectively). Conclusions OCT for secondary prevention after an ischemic stroke is less frequent in lean (vs. obese) subjects, but when implemented is related to significantly better clinical outcomes.

Original languageEnglish
Pages (from-to)213-221
Number of pages9
JournalJournal of Stroke
Volume19
Issue number2
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Drug Combinations
Vitamins
Obesity
Stroke
Blood Vessels
Body Mass Index
Secondary Prevention
Therapeutics
Confidence Intervals
Prescriptions
Cause of Death
Myocardial Infarction
Clinical Trials
Phenotype
Pharmaceutical Preparations

Keywords

  • Body mass index
  • Death
  • Obesity
  • Secondary prevention
  • Stroke
  • Vascular events

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{06c0ec7e25ca4110b971582c6cdab7af,
title = "Association of optimal combination drug treatment with obesity status among recent ischemic stroke patients: Results of the vitamin intervention for stroke prevention (VISP) trial",
abstract = "Background and Purpose One explanation for the ‘obesity paradox’, where obese patients seem to have better cardiovascular outcomes than lean patients, is that obese patients display an identifiable high cardiovascular risk phenotype that may lead to receiving or seeking earlier/more aggressive treatment. Methods We analyzed a clinical trial dataset comprising 3643 recent (<120 days) ischemic stroke patients followed up for 2 years. Subjects were categorized as lean (body mass index [BMI], <25 kg/m2, n=1,006), overweight (25-29.9 kg/m2, n=1,493), or obese (≥30 kg/m2, n=1,144). Subjects were classified as level 0 to III depending on the number of secondary prevention prescriptions divided by the number of potentially indicated drugs (0=none of the indicated medications and III=all indicated medications as optimal combination drug treatment [OCT]). Independent associations between each BMI category and stroke/myocardial infarction/vascular death (major vascular events [MVEs]) and all-cause death were assessed. Results MVEs occurred in 17.4{\%} of lean, 16.1{\%} of overweight, and 17.1{\%} of obese patients; death occurred in 7.3{\%}, 5.5{\%}, and 5.1{\%}, respectively. Individuals with a higher BMI status received more OCT (45.8{\%}, 51.7{\%}, and 55.3{\%}, respectively; P<0.001). In the lean patient group, multivariable adjusted Cox analyses, showed that compared with levels 0-I, level II and level III were linked to lower risk of MVEs (hazard ratio [HR] 0.55; 95{\%} confidence interval [CI]: 0.32–0.95 and HR 0.48; 95{\%} CI: 0.28−0.83, respectively) and death (0.44; 0.21–0.96 and 0.23; 0.10−0.54, respectively). Conclusions OCT for secondary prevention after an ischemic stroke is less frequent in lean (vs. obese) subjects, but when implemented is related to significantly better clinical outcomes.",
keywords = "Body mass index, Death, Obesity, Secondary prevention, Stroke, Vascular events",
author = "Park, {Jong Ho} and Juneyoung Lee and Bruce Ovbiagele",
year = "2017",
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doi = "10.5853/jos.2016.01347",
language = "English",
volume = "19",
pages = "213--221",
journal = "Journal of Stroke",
issn = "2287-6391",
publisher = "Korean Stroke Society",
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TY - JOUR

T1 - Association of optimal combination drug treatment with obesity status among recent ischemic stroke patients

T2 - Results of the vitamin intervention for stroke prevention (VISP) trial

AU - Park, Jong Ho

AU - Lee, Juneyoung

AU - Ovbiagele, Bruce

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background and Purpose One explanation for the ‘obesity paradox’, where obese patients seem to have better cardiovascular outcomes than lean patients, is that obese patients display an identifiable high cardiovascular risk phenotype that may lead to receiving or seeking earlier/more aggressive treatment. Methods We analyzed a clinical trial dataset comprising 3643 recent (<120 days) ischemic stroke patients followed up for 2 years. Subjects were categorized as lean (body mass index [BMI], <25 kg/m2, n=1,006), overweight (25-29.9 kg/m2, n=1,493), or obese (≥30 kg/m2, n=1,144). Subjects were classified as level 0 to III depending on the number of secondary prevention prescriptions divided by the number of potentially indicated drugs (0=none of the indicated medications and III=all indicated medications as optimal combination drug treatment [OCT]). Independent associations between each BMI category and stroke/myocardial infarction/vascular death (major vascular events [MVEs]) and all-cause death were assessed. Results MVEs occurred in 17.4% of lean, 16.1% of overweight, and 17.1% of obese patients; death occurred in 7.3%, 5.5%, and 5.1%, respectively. Individuals with a higher BMI status received more OCT (45.8%, 51.7%, and 55.3%, respectively; P<0.001). In the lean patient group, multivariable adjusted Cox analyses, showed that compared with levels 0-I, level II and level III were linked to lower risk of MVEs (hazard ratio [HR] 0.55; 95% confidence interval [CI]: 0.32–0.95 and HR 0.48; 95% CI: 0.28−0.83, respectively) and death (0.44; 0.21–0.96 and 0.23; 0.10−0.54, respectively). Conclusions OCT for secondary prevention after an ischemic stroke is less frequent in lean (vs. obese) subjects, but when implemented is related to significantly better clinical outcomes.

AB - Background and Purpose One explanation for the ‘obesity paradox’, where obese patients seem to have better cardiovascular outcomes than lean patients, is that obese patients display an identifiable high cardiovascular risk phenotype that may lead to receiving or seeking earlier/more aggressive treatment. Methods We analyzed a clinical trial dataset comprising 3643 recent (<120 days) ischemic stroke patients followed up for 2 years. Subjects were categorized as lean (body mass index [BMI], <25 kg/m2, n=1,006), overweight (25-29.9 kg/m2, n=1,493), or obese (≥30 kg/m2, n=1,144). Subjects were classified as level 0 to III depending on the number of secondary prevention prescriptions divided by the number of potentially indicated drugs (0=none of the indicated medications and III=all indicated medications as optimal combination drug treatment [OCT]). Independent associations between each BMI category and stroke/myocardial infarction/vascular death (major vascular events [MVEs]) and all-cause death were assessed. Results MVEs occurred in 17.4% of lean, 16.1% of overweight, and 17.1% of obese patients; death occurred in 7.3%, 5.5%, and 5.1%, respectively. Individuals with a higher BMI status received more OCT (45.8%, 51.7%, and 55.3%, respectively; P<0.001). In the lean patient group, multivariable adjusted Cox analyses, showed that compared with levels 0-I, level II and level III were linked to lower risk of MVEs (hazard ratio [HR] 0.55; 95% confidence interval [CI]: 0.32–0.95 and HR 0.48; 95% CI: 0.28−0.83, respectively) and death (0.44; 0.21–0.96 and 0.23; 0.10−0.54, respectively). Conclusions OCT for secondary prevention after an ischemic stroke is less frequent in lean (vs. obese) subjects, but when implemented is related to significantly better clinical outcomes.

KW - Body mass index

KW - Death

KW - Obesity

KW - Secondary prevention

KW - Stroke

KW - Vascular events

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