LAUSR

Stroke is a leading cause of premature death and disability, and one of its major risk factors— obesity—is worrisomely increasing in prevalence across the world. The study results reported by Pillay et al 1 provide a fresh perspective on the differential risks for the main pathological stroke types associated with different measures of adiposity and body fat distribution. Using data from the UK Biobank, a prospective study of 500000 adults recruited between 2006 and 2010 who were followed up for a median of 12 years, they show that after mutual adjustment of body mass index (BMI) and waist circumference together with recognized confounders, BMI was not associated with ischemic stroke (hazard ratio [HR], 1.04; 95% CI, 0.97-1.11 per 5-unit higher BMI) but was inversely associated with intracerebral hemorrhage (HR, 0.85; 95% CI, 0.74-0.96) and subarachnoid hemorrhage (HR, 0.82; 95% CI, 0.69-0.96). Conversely, waist circumference, which is a better measure of body fat and particularly of internal fat deposits, was positively correlated with both ischemic stroke (HR, 1.19; 95% CI, 1.13-1.25 per 10 cm higher waist circumference) and intracerebral hemorrhage (HR, 1.17; 95% CI, 1.05-1.30) but not associated with subarachnoid hemorrhage (HR, 1.07; 95% CI, 0.93-1.22). A BMI