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Women with Overweight/Obesity as Teens, Young Adults Face Higher Risk of Cerebrovascular Disease Later in Life

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In contrast, men did not face the same increased risk of cerebrovascular disease later in life, reported authors of a new study.

Women with Overweight/Obesity as Teens, Young Adults Face Higher Risk of Cerebrovascular Disease Later in Life / Image credit: ©Rytis/AdobeStock

©Rytis/AdobeStock

A new analysis of more than 5 decades of health data shows that overweight and obesity in adolescence and young adulthood is independently associated with adult cerebrovascular diseases among women, but not men.1

Findings from the study conducted in Finland demonstrated that women with overweight or obesity at ages 14 or 31 years had an increased risk of cerebrovascular disease, particularly ischemic stroke, before the age of 55, irrespective of their earlier or later body mass index (BMI), suggesting a sustained risk throughout adolescence and young adulthood.1

“Our findings suggest that being overweight may have long-term health effects even if the excess weight is temporary,” lead author Ursula Mikkola, an investigator in the Research Unit of Population Health at the University of Oulu in Finland, said in an American Heart Association press release. “Health care professionals should pay attention to overweight and obesity in young people and work with them to develop healthier eating patterns and physical activity. However, conversations with teens and young adults about weight should be approached in a non-judgmental and non-stigmatizing manner.”2

The data were published online June 6, 2024, in the journal Stroke.

According to Mikkola and colleagues, while risk factors for cerebrovascular disease in adulthood are well known, there has been limited research on risk factors throughout the lifespan, especially focusing on the impact of BMI during critical developmental stages. To fill this gap in knowledge, they conducted the current prospective cohort study using long-term data from participants in the Northern Finland Birth Cohort 1966. Researchers aimed to assess the effect of BMI and its changes in adolescence and young adulthood on early onset cerebrovascular disease.1

The Northern Finland Birth Cohort 1966 is a prospective, general population-based birth cohort that contains data on 12 055 pregnant women and their 12 058 children who were born alive in 2 northern provinces of Finland in 1966. Data collection began antenatally and has been regularly followed up since then.

The current study was conducted between 1980 and 2020, and included 10 491 participants, of whom 5185 were women. Height, weight, and BMI measurements were taken at ages 14 and 31 years. Investigators used sex- and age-specific BMI ranges to define overweight and obesity, and they extracted data on ischemic and hemorrhagic cerebrovascular diseases between ages 14 and 54 years from national hospital and death registers. Participants were followed until their first cerebrovascular event, death, moving abroad, or the end of 2020, whichever occurred first, researchers noted.1

BMI data were collected through postal questionnaires and clinical examinations. Mikkola and coauthors identified associations between BMI or its changes and cerebrovascular events after adjusting for sex, smoking, educational level, BMI at the other time point, and age at menarche for women.1

Findings1

According to the study, the length of follow-up from age 14 years onward was 372 675 person-years and 189 093 person-years from age 31 years onward. The mean follow-up time per participant was 38.8 years from age 14 years onward and 22.8 years from age 31 years onward.

Among the 10 491 participants, 452 (4.7%) experienced cerebrovascular disease during the follow-up. Of the participants who experienced cerebrovascular disease, 141 (31.2%) had ischemic strokes and 180 (39.8%) had transient ischemic attacks. Furthermore, the median age at onset was 47.1 years for ischemic stroke and 48.9 years for transient ischemic attacks.

Risk of ischemic cerebrovascular disease. Results showed that the risk of ischemic cerebrovascular disease increased for women with overweight at age 14 (HR 2.49,95% CI 1.44–4.31) and at age 31 (HR 2.13, 95% CI 1.14–3.97). Women with obesity at age 14 (HR 1.87, 95% CI 0.76–4.58) and at age 31 (HR 2.67, 95% CI 1.26–5.65) also exhibited an elevated risk of ischemic cerebrovascular disease, with normal weight as the reference. Both associations were independent of participants’ earlier or later BMI. Similar associations were not observed among men, Mikkola and colleagues added.

Risk of hemorrhagic cerebrovascular disease. At age 31, women with obesity had a higher risk of hemorrhagic cerebrovascular disease (HR 3.49, 95% CI 1.13–10.7) as well as men with obesity (HR 5.75, 95% CI 1.43–23.1).

Sex-specific associations. At age 14, the risk of any cerebrovascular disease related to overweight was 2.09-times higher among girls than boys (95% CI 1.06-4.15). Similarly, at age 31, investigators found that the risk of ischemic cerebrovascular disease related to obesity was 6.96-times higher among women than men (95% CI 1.36-35.7).

The observed association of an association between overweight or obesity in childhood and later cerebrovascular disease underscores the importance of maintaining healthy weights during childhood and adolescence, Mikkola et al wrote. “The mechanisms underlying these sex-specific associations remain to be elucidated,” they added.

Researchers highlighted several limitations to their study, including a lack of complete BMI data during adolescence and young adulthood and the study population being relatively homogeneous and entirely Finnish, so the findings may not be fully generalizable to other populations.

In an accompanying editorial, Larry Goldstein, MD—a professor at the Kentucky Neuroscience Institute—noted that the current study “adds to the body of data related to risk factors for stroke in young adults. Although it is tempting to assume that reductions in overweight/obesity in younger populations would translate into lower stroke rates in young adults, this remains to be proven.”3


References:

  1. Mikkola U, Rissanen I, Kivelä M, et al. Overweight in adolescence and young adulthood in association with adult cerebrovascular disease: The NFBC1966 study. Stroke. Published online June 6, 2024. doi:10.1161/STROKEAHA.123.045444
  2. Women with excess weight as a teen or young adult may have higher stroke risk by age 55. News item. American Heart Association. June 6, 2024. Accessed June 11, 2024. https://newsroom.heart.org/news/women-with-excess-weight-as-a-teen-or-young-adult-may-have-higher-stroke-risk-by-age-55
  3. Goldstein LB. Weighing the effect of overweight/obesity on stroke risk. Stroke. Published online June 6, 2024. doi:10.1161/STROKEAHA.124.047353

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