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A large waist circumference, which is known to raise the risk of cardiovascular disease, may also increase the risk for TIAs and stroke, a study suggests.

A large waist circumference, which is known to raise the risk of cardiovascular disease, may also increase the risk for transient ischemic attacks (TIAs) and stroke, according to a study from Germany published online on August 14 in Stroke: Journal of the American Heart Association.

In an AHA statement, study leader Dr. Tobias Back of Saxon Hospital Arnsdorf in Arnsdorf/Dresden suggested that physicians "measure patients' waistlines and use the waist-to-hip ratio (WHR) to estimate stroke risk. World Health Organization-defined categories of WHR or waist circumference should be used."

Dr. Back also emphasized the importance of considering "the whole vascular risk profile to minimize or modify all possible factors contributing to coronary heart disease, stroke and peripheral artery disease."

The study team evaluated the contribution of obesity and abdominal fat mass to the risk of stroke/TIA in 379 adults with a history of stroke/TIA and 758 sex- and age-matched controls.

In adjusted analyses, several markers of abdominal obesity correlated strongly with the risk of stroke/TIA, they report. For example, individuals with the highest WHR had 7.69 times the risk of these events compared to those with the lowest WHR.

"If the waist-to-hip ratio values were greater than 0.97 for men and 0.84 for women, then individuals faced almost eight times increased risk for stroke compared to individuals with a WHR less than 0.92 in men or less than 0.78 in women," Back stated.

Increased waist circumference also showed a strong association with stroke/TIA. If the waist circumference was greater than 40.2 inches for men or 34.6 inches for women, the risk of stroke increased more than four times compared to individuals with normal waistline measures, according to the researchers.

The findings also suggest that the waist-to-stature ratio (WSR; waist circumference divided by height) "is an appropriate measure to assess the risk of stroke and TIA comparable to waist circumference, but further studies are needed to clarify which marker is the most robust to predict total or subtype-specific cerebrovascular risks."

The current study, the investigators note, also shows that markers of abdominal adiposity are better predictors of stroke and TIA than body mass index (BMI). "By using different statistical approaches, it was confirmed that waist-to-hip ratio appeared to be the strongest predictor of stroke and TIA risk," Dr. Back said.

Stroke 2009