Abstract WP218: Obesity, Burden of Cerebral Small Vessel Disease and Outcomes After Lacunar Stroke:The Secondary Prevention of Small Subcortical Strokes(SPS3) Trial

Background: Obesity is a recognized risk factor for stroke. But, it is uncertain whether obesity is related to burden of cerebral small vessel disease (CSVD). We explored burden of CSVD, stroke recurrence and mortality in obese and non-obese patients with lacunar infarcts. Method: Data was from the SPS3 (Secondary Prevention of Small Subcortical Strokes) trial. Participants were according to BMI categories: normal /underweight (<24.9), overweight (25.0-29.9), and obese (>30.0). Baseline MRI findings were explored with multivariable logistic regression and outcomes using multivariable Cox proportional hazards. Results: Compared with participants who were normal/underweight (n=691, 23%) overweight (n=1256, 42%) and obese (n=1072, 36%) participants tended to be younger, male and with a higher prevalence of vascular risk factors. Compared to obese participants, normal/underweight had a higher burden of SVD on MRI: odds were 1.40 ( 95% CI 1.15 - 1.69) for severe burden of white matter disease, 1.23 (1.01 - 1.52) for 1+ old lacunes, and, in those 1278 participants with baseline T2*-weighted gradient echo MRI, 1.64 (1.35-2.00) times as likely to have 1+ microbleeds. During a mean follow-up of 3.3 years, overweight and obese subjects also had a lower risk of stroke recurrence (HR 0.74, 95% CI 0.5-1.0 and HR 0.71, 95% CI 0.5-1.0, respectively) and death (HR 0.71 95% CI 0.5-1.0 and HR 0.61, 95% CI 0.4-0.9, respectively). Conclusion: In this cohort, unexpectedly, being overweight or obese was associated with less CSVD, stroke recurrence and mortality. Further research is required to elucidate the mechanisms for this relationship.