High, low BMI resulted in significant risk for deep intracerebral hemorrhage
Biffi A. Stroke. 2011;doi:10.1161/strokeaha.111.617225.
Patients with low or high extremes of BMI were at increased risk for having a deep intracerebral hemorrhage. No association was reported on lobar intracerebral hemorrhage, however.
The single-center, prospective study involved 384 consecutive patients with intracerebral hemorrhage (ICH) — 196 with deep and 188 with lobar ICH — and 388 controls enrolled during a 6-year period. Researchers used CT to determine ICH characterization and patients’ height and weight to calculate BMI. Low BMI was defined as less than 18.5 kg/m² and high BMI was more than 30 kg/m².
Overall, patients with either low (OR=1.76; P=.011) or high BMI (OR=1.75; P=.013) were at increased risk for deep ICH, with the following characteristics associated with risk in univariate analysis: age, sex, hypertension, CAD, diabetes, hyperlipidemia and alcohol consumption of more than 3 oz per day. Neither univariate nor multivariate analysis revealed either BMI extremes to be linked with lobar ICH. The association with ICH was particularly prominent in men who had an OR of 2.85 (P=.041) vs. women who did not have an association (OR=0.89; P=.54).
“Our results suggest that BMI differentially influences risk of lobar and deep ICH, consistent with the hypothesis that BMI influences specific vascular pathologies that lead to ICH,” the researchers wrote. “In particular, these findings are most likely related to biological differences between cerebral amyloid angiopathy-related lobar ICH and hypertensive deep ICH.”
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Intima-media thickness in carotid artery predicted CV outcomes
Polak J. N Engl J Med. 2011;365:213-221.
Intima-media thickness of the common and internal carotid artery was an independent predictor of CV events, according to an analysis of the Framingham Offspring Study.
The study also found that maximum intima-media thickness had significant, although modest, predictive power of the risk factors and also benefited risk classification.
In all, 2,965 participants (mean age, 58 years; 55% women) who had no history of CVD were included in the analysis.
During a mean follow-up of 7.2 years, 10% of the population experienced a CV event, including events related to CHD, peripheral arterial disease, stroke and HF, which was predicted by risk factors of the Framingham risk score. With every 1 standard deviation increase in intima-media thickness of the common carotid artery, the adjusted HR for CVD was 1.13 (95% CI, 1.02-1.24), whereas the HR for the maximum intima-media thickness was more pronounced (1.21; 95% CI, 1.13-1.29).
Additionally, the researchers reported that the net reclassification index rose significantly after the addition of intima-media thickness of the internal carotid artery (P<.001) but not the common carotid artery (P=.99).
“Our results show that plaque in the internal carotid artery, either measured as part of the continuous intima-media thickness or assumed to be present if the thickness exceeds a set point of 1.5 mm, offers modest incremental value to the Framingham risk score in predicting CV events,” they concluded. “We believe the intima-media thickness of the internal carotid artery should be measured in addition to the thickness of the common carotid artery for purposes of CV risk assessment.”
Polak et al continue to provide important insights into the impact of carotid intima-media thickness on CV risk. In this large cohort followed prospectively, the impact of carotid intima-media thickness was only helpful in addition to the Framingham Risk Score using internal carotid artery intima-media thickness measurements. This is interesting, as several previous publications have suggested that the common carotid artery intima-media thickness values are of equal predictive value in determining CV risk. Although the Framingham Risk Score performed well in determining future CV risk, adding increase in internal carotid artery intima-media thickness can help in further assessing future CV risk.
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