Paradoxical effect of obesity on hemorrhagic transformation after acute ischemic stroke

Chi Kyung Kim, Wi Sun Ryu, Beom Joon Kim, Seung Hoon Lee

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Background: Among the patients with established coronary artery diseases, obese patients tend to have a more favorable prognosis, which is called as obesity paradox. Interestingly, mildly obese patients who underwent coronary revascularization had a lower risk of bleeding. In this context, we have investigated the association between obesity and hemorrhagic transformation (HTf) after acute ischemic stroke. Methods: A total of 365 patients with first-ever acute ischemic stroke were included in this study. Demographic, clinical and radiological information was collected and HTf was evaluated through follow-up T2*-weighted gradient-recalled echo MRI performed usually within 1 week after occurrence of stroke. Body mass index was calculated, and obesity was defined using the World Health Organization Western Pacific Regional Office criteria. Results: The HTf was identified in 59 patients (16.2%). As the severity of obesity increased, the occurrence of HTf decreased. Compared with the normal weight group and after controlling possible confounders including acute and previous treatment, stroke severity and subtype, the risk of HTf decreased significantly in the obese group (odds ratio, 0.39; 95% confidence interval, 0.17-0.87). Conclusions: The better outcome for HTf seen in obese patients suggests the existence of a " bleeding-obesity paradox" in acute ischemic stroke.

Original languageEnglish
Article number123
JournalBMC Neurology
Publication statusPublished - 2013 Sept 23

Bibliographical note

Funding Information:
This work was supported by grants of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A111014). The analyses and interpretations of the data and the final content of the article were produced independently of the financial sponsors.


  • Bleeding-obesity paradox
  • Body mass index
  • Hemorrhagic transformation
  • Ischemic stroke
  • Obesity

ASJC Scopus subject areas

  • Clinical Neurology


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