DÄ internationalArchive12/2010Association With Increased Risk of Stroke
LNSLNS The authors have presented an interesting overview of morbidity and mortality in overweight. They come to the conclusion that the generally accepted assumption that overweight is associated with increased risk of morbidity and mortality is no longer tenable and that it must be specified more precisely. Unfortunately, when the authors selected their search terms, they missed some important articles on the association between overweight and cardiovascular or cerebrovascular diseases which have a decisive effect on morbidity and mortality. Hu et al. (1) reported a population-based study with about 50 000 participants. They demonstrated an association between body mass index (BMI) of 25–29 kg/m2 and an increased risk of stroke. Our research group has recently reported the result of a case-control study with 1137 participants, which demonstrated an association between abdominal overweight and increased risk of stroke (2).

It follows that the statement in the article that there is “no association with stroke risk” is untenable. This is based on a study in the Asia-Pacific area and cannot be directly transferred to the European population. We refer you to Yusuf et al. (3) for the association between overweight and myocardial infarction.

We agree with the authors that the morbidity associated with overweight must be specified more precisely. Nevertheless, the important role of overweight in cerebrovascular and cardiovascular diseases should not be neglected, as, taken together, these are the most important causes of mortality and handicap in adults.
DOI: 10.3238/arztebl.2010.0214b

Dr. med. Yaroslav Winter
Klinik für Neurologie, Universitätsklinikum Gießen und Marburg,
Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany

Prof. Dr. med. habil. Tobias Back
Neurologische Klinik
Sächsisches Krankenhaus Arnsdorf
Hufelandstr. 15, 01477 Arnsdorf, Germany

Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Hu G, Tuomilehto J, Silventoinen K, et al.: Body Mass Index, Waist Circumference, and Waist-Hip Ratio on the Risk of Total and Type-Specific Stroke. Archives of internal medicine 2007; 167: 1420–7. MEDLINE
2.
Winter Y, Rohrmann S, Linseisen J, et al.: Contribution of obesity and abdominal fat mass to risk of stroke and transient ischemic attacks. Stroke 2008; 39: 3145–51. MEDLINE
3.
Yusuf S, Hawken S, Ôunpuu S, et al.: Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640–49. MEDLINE
4.
Lenz M, Richter T, Mühlhauser I: The morbidity and mortality associated with overweight and obesity in adulthood [Morbidität und Mortalität bei Übergewicht und Adipositas im Erwachsenenalter]. Dtsch Arztebl Int 2009; 106(40): 641–8. VOLLTEXT
1. Hu G, Tuomilehto J, Silventoinen K, et al.: Body Mass Index, Waist Circumference, and Waist-Hip Ratio on the Risk of Total and Type-Specific Stroke. Archives of internal medicine 2007; 167: 1420–7. MEDLINE
2. Winter Y, Rohrmann S, Linseisen J, et al.: Contribution of obesity and abdominal fat mass to risk of stroke and transient ischemic attacks. Stroke 2008; 39: 3145–51. MEDLINE
3. Yusuf S, Hawken S, Ôunpuu S, et al.: Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640–49. MEDLINE
4. Lenz M, Richter T, Mühlhauser I: The morbidity and mortality associated with overweight and obesity in adulthood [Morbidität und Mortalität bei Übergewicht und Adipositas im Erwachsenenalter]. Dtsch Arztebl Int 2009; 106(40): 641–8. VOLLTEXT