Body fat distribution and long-term risk of stroke mortality.

BACKGROUND AND PURPOSE Excess weight is an important determinant of cardiovascular disease, but the relationship between excess weight, its distribution, and stroke is yet unclear. We examined in a large prospective cohort study the association between body fat distribution and stroke mortality among middle-aged men. METHODS A cohort of male civil servants and municipal employees free of cardiovascular disease in Israel (n=9151) were followed up for mortality over 23 years. The subscapular skinfold (SSF) was used as a measure of trunk and overall obesity and the ratio of subscapular to triceps skinfold thickness (SFR) as an indicator of trunk versus peripheral distribution of body fat. RESULTS During the follow-up period, 316 died of stroke, and 865 died of coronary heart disease. The estimated age-adjusted hazard ratios (HRs) for stroke mortality, associated with 1 SD increment of SSF, was 1.12 (95% CI, 1.01 to 1.25) and for body mass index, 1.17 (1.06 to 1.30), but these associations were markedly weakened when adjusting for blood pressure. SFR was associated with an age-adjusted HR for stroke mortality of 1.14 (1.03 to 1.26). Further adjusting for systolic blood pressure, diabetes mellitus, cigarette smoking, and socioeconomic status (HR, 1.11; 1.01 to 1.23) as well as body mass index (HR, 1.11; 1.00 to 1.23) only mildly attenuated this association. Subjects with SFR in the upper quartile exhibited a approximately 1.5-fold higher adjusted HR (1.53; 1.10 to 2.12) compared with the lowest quartile. CONCLUSIONS Indices of body fat and body fat distribution predict long-term stroke and coronary heart disease mortality among middle-aged men. SFR, an indicator of trunk versus peripheral distribution of body fat, is associated with stroke mortality, independent of main mediators of the effect of obesity on health and of body mass index.