Research Paper Volume 12, Issue 12 pp 12175—12186

Combined impact of body mass index and glycemic control on the efficacy of clopidogrel-aspirin therapy in patients with minor stroke or transient ischemic attack

Zimo Chen1,2,3,4, *, , Jinglin Mo1,2,3,4, *, , Jie Xu1,2,3,4, *, , Anxin Wang1,2,3,4, , Haiqiang Qin1,2,3,4, , Huaguang Zheng1,2,3,4, , Liping Liu1,2,3,4, , Xia Meng1,2,3,4, , Hao Li1,2,3,4, , Yongjun Wang1,2,3,4, , on behalf of the CHANCE investigators,

  • 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  • 2 China National Clinical Research Center for Neurological Diseases, Beijing, China
  • 3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
  • 4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
* Equal contribution

Received: December 24, 2019       Accepted: May 25, 2020       Published: June 16, 2020
How to Cite

Copyright © 2020 Chen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: A single index of body mass index (BMI) may not fully address its impact on anti-platelet therapy. We aimed to elucidate the combined impact of BMI and dysglycemia expressed by glycated albumin (GA) on efficacy of clopidogrel-aspirin therapy among minor stroke (MS) or transient ischemic attack (TIA) patients.

Results: Patients with overweight/obesity and low GA levels still benefited from clopidogrel-aspirin therapy for stroke recurrence (Hazard ratio [HR]: 0.48, 95 % confidence interval [CI]: 0.28–0.82), so did those with high GA levels but low/normal weight (HR: 0.67, 95 % CI: 0.45–0.99). However, patients with both overweight/obesity and high GA levels did not benefit from clopidogrel-aspirin therapy (HR: 0.89, 95 % CI: 0.59–1.33).

Conclusions: Compared with aspirin alone, efficacy of clopidogrel-aspirin therapy for stroke still exists in overweight/obesity patients with normal glycemic control.

Methods: In Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial, 3044 patients with available baseline GA were recruited. Low/normal weight and overweight/obesity were defined as BMI < 25 kg/m2 and ≥ 25 kg/m2, respectively. Elevated and low GA levels were defined as GA levels > 15.5 % and ≤ 15.5 %, respectively. The primary outcome was stroke recurrence during the 90-day follow-up.


BMI: body mass index; GA: glycated albumin; MS: minor stroke; TIA: transient ischemic attack patients; CHANCE: Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events; HR: hazard ratio; CI: confidence interval; NIHSS score: National Institute Health Stroke Scale score; SBP: systolic blood pressure.