Stroke and stroke risk factors in women of reproductive age with a history of metabolic or bariatric surgery



      To determine the odds of stroke in women of reproductive age who have had metabolic or bariatric surgery (MBS).


      We used the National Inpatient Sample (NIS), a publicly available dataset that samples 20% of hospital discharges. The study population includes women between the ages of 20 and 44 without a maternal admission code. Weighted logistic regression analyses were conducted to assess the odds of stroke in women with history of MBS compared to other women of reproductive age. Adjustment of odds was done for the following covariates: age, race, primary payer, severity of illness, depression, and obesity.


      Women with a history of MBS had 52% lower adjusted odds of having a stroke than women who did not have MBS (OR = 0.48, 95%CI = 0.42-0.55). Additionally, women who had MBS had lower odds of risk factors for stroke, including diabetes (OR = 0.61, 95%CI = 0.59-0.63), hypertension (OR = 0.82, 95%CI = 0.81-0.84), hypercholesterolemia (OR=0.72, 95%CI =0.68-0.77), and migraine with aura (OR = 0.86, 95%CI = 0.74-0.99).


      Among women of reproductive age with a history of MBS, there were lower odds of having a stroke and stroke risk factors when compared to women who did not have MBS. Additionally, this study showed a modest decrease in the odds of stroke among women with obesity when adjusted for other risk factors. Future research should focus on examining this finding further, with a focus on the moderation of the impact of having obesity on stroke risk independent of other stroke risk factors.



      MBS (metabolic or bariatric surgery), NIS (National Inpatient Sample), AHRQ (Agency for Healthcare Research and Quality)
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        • Ahmad FB
        • Anderson RN.
        The Leading Causes of Death in the US for 2020.
        JAMA. 2021; 325: 1829-1830
        • Virani SS
        • Alonso A
        • Benjamin EJ
        • et al.
        Heart disease and stroke statistics-2020 update: a report from the American Heart Association.
        Circulation. 2020; 141: e139-e596
        • Leppert MH
        • Ho PM
        • Burke J
        • et al.
        Young women had more strokes than young men in a large, United States Claims Sample.
        Stroke. 2020; 51: 3352-3355
        • Feigin VL
        • Roth GA
        • Naghavi M
        • et al.
        Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet Neurol. 2016; 15: 913-924
        • Salisbury M
        • Pfeffer G
        • Yip S.
        Stroke in young women.
        Can J Neurol Sci. 2011; 38: 404-410
        • Altamura C
        • Cascio Rizzo A
        • Viticchi G
        • et al.
        Shorter visual aura characterizes young and middle-aged stroke patients with migraine with aura.
        J Neurol. 2022; 269: 897-906
        • Gollion C
        • Guidolin B
        • Lerebours F
        • Rousseau V
        • Barbieux-Guillot M
        • Larrue V.
        Migraine and large artery atherosclerosis in young adults with ischemic stroke.
        Headache. 2022; 62: 191-197
        • Aly S HK
        • Pernar LIM
        Gender disparities in weight loss surgery.
        Mini-invasive Surg. 2020; 4
        • Arterburn DE
        • Telem DA
        • Kushner RF
        • Courcoulas AP.
        Benefits and risks of bariatric surgery in adults: a review.
        JAMA. 2020; 324: 879-887
        • American Society for Metabolic and Bariatric Surgery
        Estimate of Bariatric Surgery Numbers, 2011-2019.
        • Alatishe A
        • Ammori BJ
        • New JP
        • Syed AA.
        Bariatric surgery in women of childbearing age.
        QJM. 2013; 106: 717-720
      1. Quality AfHRa. HCUP National Inpatient Sample (NIS). In: (HCUP) HCaUP, Rockville, MD, 2012-2017.

        • Buchwald H
        • Estok R
        • Fahrbach K
        • et al.
        Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.
        Am J Med. 2009; 122 (e5): 248-256
        • Bray GA.
        Risks of obesity.
        Endocrinol Metabol Clin North Am. 2003; 32 (viii): 787-804
        • Korakas E
        • Kountouri A
        • Raptis A
        • Kokkinos A
        • Lambadiari V.
        Bariatric surgery and type 1 diabetes: unanswered questions.
        Front Endocrinol. 2020; 11525909
        • Chow A
        • Switzer NJ
        • Dang J
        • et al.
        A systematic review and meta-analysis of outcomes for type 1 diabetes after bariatric surgery.
        Journal of obesity. 2016; 20166170719
        • Ashrafian H
        • Harling L
        • Toma T
        • et al.
        Type 1 diabetes mellitus and bariatric surgery: a systematic review and meta-analysis.
        Obesity surgery. 2016; 26: 1697-1704
        • Schiavon CA
        • Bhatt DL
        • Ikeoka D
        • et al.
        Three-year outcomes of bariatric surgery in patients with obesity and hypertension : a randomized clinical trial.
        Ann Intern Med. 2020; 173: 685-693
        • Courcoulas AP
        • Christian NJ
        • Belle SH
        • et al.
        Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity.
        JAMA. 2013; 310: 2416-2425
        • Stenberg E
        • Cao Y
        • Marsk R
        • Sundbom M
        • Jernberg T
        • Naslund E.
        Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study.
        PLoS Med. 2020; 17e1003307
        • Razeghi Jahromi S
        • Abolhasani M
        • Ghorbani Z
        • et al.
        Bariatric surgery promising in migraine control: a controlled trial on weight loss and its effect on migraine headache.
        Obesity Surg. 2018; 28: 87-96
        • Bond DS
        • Vithiananthan S
        • Nash JM
        • Thomas JG
        • Wing RR.
        Improvement of migraine headaches in severely obese patients after bariatric surgery.
        Neurology. 2011; 76: 1135-1138
        • Novack V
        • Fuchs L
        • Lantsberg L
        • et al.
        Changes in headache frequency in premenopausal obese women with migraine after bariatric surgery: a case series.
        Cephalalgia. 2011; 31: 1336-1342
        • Dang JT
        • Lee JKH
        • Kung JY
        • Switzer NJ
        • Karmali S
        • Birch DW.
        The effect of bariatric surgery on migraines: a systematic review and meta-analysis.
        Obesity Surg. 2020; 30: 1061-1067
        • Di Vincenzo A
        • Beghetto M
        • Vettor R
        • et al.
        Effects of surgical and non-surgical weight loss on migraine headache: a systematic review and meta-analysis.
        Obesity Surg. 2020; 30: 2173-2185
        • Williams MD
        • Kim S
        • Sarran M
        • et al.
        The effect of bariatric surgery on ischemic stroke risk.
        Surg Obes Related Dis. 2021; 17: 1949-1955
        • Towfighi A
        • Zheng L
        • Ovbiagele B.
        Weight of the obesity epidemic: rising stroke rates among middle-aged women in the United States.
        Stroke. 2010; 41: 1371-1375
        • Kurth T
        • Gaziano JM
        • Rexrode KM
        • et al.
        Prospective study of body mass index and risk of stroke in apparently healthy women.
        Circulation. 2005; 111: 1992-1998
        • Jaakonmaki N
        • Zedde M
        • Sarkanen T
        • et al.
        Obesity and the risk of cryptogenic ischemic stroke in young adults.
        J Stroke Cerebrovasc Dis. 2022; 31106380
        • Hales CM
        • Carroll MD
        • Fryar CD
        • Ogden CL.
        Prevalence of obesity and severe obesity among adults: United States, 2017-2018.
        NCHS data brief. 2020; : 1-8