Metabolic abnormalities, rather than body mass index, associated with increased risk of recurrent stroke in hospitalized stroke patients: a cross-sectional study

BACKGROUND: Metabolic abnormalities and body mass index (BMI) are apparent risk factors for recurrent stroke. For the prevention of recurrent stroke, which one is more important remains uncertain. This study aimed to compare metabolic phenotypes and BMI as indicators of recurrent stroke in Chinese hospitalized stroke patients. METHODS: In this cross-sectional population-based study, 856 hospitalized stroke patients from the First People’s Hospital of Changzhou, the Third Affiliated Hospital of Soochow University, were enrolled. We implemented the standardized questionnaire and biochemical measurements to collect participants’ data. Recurrent stroke was defined as new-onset stroke in patients with a definite history of previous stroke. Metabolic phenotypes were categorized based on the Adult Treatment Panel III criteria. Obesity was defined as BMI ≥25 kg/m(2). Multivariate logistic regression analyses were used for the association of recurrent stroke with metabolic abnormalities and BMI. RESULTS: Among the hospitalized stroke patients, the prevalence of recurrent stroke was 22.4%. Metabolic abnormalities, rather than BMI, were significantly associated with recurrent stroke. Compared with metabolically healthy patients, metabolically unhealthy patients had a 72% [odds ratio (OR) =1.72, 95% confidence interval (CI): 1.10–2.68] increased risk of recurrent stroke, regardless of BMI and other confounding factors. No statistical association between BMI and recurrent stroke was found. Furthermore, metabolic status significantly improved the risk prediction of recurrent stroke when combined with conventional risk factors (net reclassification index 17.6%, P=0.0047; integrated discrimination improvement 0.7%, P=0.014), whereas BMI did not. CONCLUSIONS: Recurrent stroke is likely associated with metabolic abnormalities rather than BMI. For the secondary prevention of stroke, controlling metabolic abnormalities is more crucial than controlling BMI in stroke patients. The longitudinal study and intervention study are warranted in the further.