What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic stroke. Intervention: Obesity and diabetes vs. Underweight/normal-weight without diabetes. Primary outcome: All-cause mortality and cardiovascular-related mortality.

What question did this study set out to answer?

This research aims to assess how obesity and diabetes together influence mortality events after ischemic strokes.

March 21, 2026Open Access

Determining the Joint Effect of Obesity and Diabetes on All-Cause Mortality and Cardiovascular-Related Mortality Following an Ischemic Stroke

Key Result

Obese subjects with diabetes had an increased hazard of cardiovascular-related mortality following an ischemic stroke compared with underweight/normal-weight subjects without diabetes.

Key Points

This research aims to assess how obesity and diabetes together influence mortality events after ischemic strokes.
Analyzed data from the multicenter PRoFESS trial
Utilized Cox proportional hazards regression models to estimate joint effects
Compared mortality rates between obese subjects with diabetes and underweight/normal-weight subjects without diabetes
No difference in all-cause mortality risk was found between the groups
Obese subjects with diabetes exhibited a higher risk of cardiovascular-related mortality
Significant interaction effects were observed, indicating a synergistic risk due to obesity and diabetes

Study Design

Type

Cohort

Multicenter

Yes

Structured PICO

Does the joint presence of obesity and diabetes increase all-cause and cardiovascular-related mortality in patients following an ischemic stroke?

Population

Subjects with a recent ischemic stroke (data from the multicenter PRoFESS trial)

Intervention

Obesity and diabetes mellitus (joint exposure)

Comparator

Underweight/normal-weight subjects without diabetes

Outcome

All-cause mortality and cardiovascular-related mortalityhard clinical

Obesity and diabetes synergistically interact to increase the hazard of cardiovascular-related mortality in ischemic stroke survivors.

Abstract

Although obesity and diabetes mellitus, or diabetes, are independently associated with mortality-related events (e.g., all-cause mortality and cardiovascular-related mortality) following an ischemic stroke, little is known about the joint effect of obesity and diabetes on mortality-related events following an ischemic stroke. The aim of this study is to evaluate the joint effect of obesity and diabetes on mortality-related events in subjects with a recent ischemic stroke. Data from the multicenter Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial was analyzed for this study. The joint effect of obesity and diabetes on mortality-related events was estimated via Cox proportional hazards regression models. No difference in the hazard of all-cause mortality following an ischemic stroke was observed between obese subjects with diabetes and underweight/normal-weight subjects without diabetes. In contrast, obese subjects with diabetes had an increased hazard of cardiovascular-related mortality following an ischemic stroke compared with underweight/normal-weight subjects without diabetes. Additionally, there was evidence of an attributable proportion due to interaction as well as evidence of a highly statistically significant interaction on the multiplicative scale for cardiovascular-related mortality. In this clinical trial cohort of ischemic stroke survivors, obesity and diabetes synergistically interacted to increase the hazard of cardiovascular-related mortality.