In fact, data from NHANES in 2007 to 2008 revealed that among adults 20 years old, age-adjusted prevalence of abdominal obesity was 61.8% in women compared with 43.7% in men.293 In addi- tion, premenopausal women are increasingly likely to have abdominal obesity; a recent study of women aged 35 to 54 years in the United States revealed that from 1988 1994 until 1999 2004, the prevalence of abdominal obesity increased The escalating obesity epidemic may counter the tremendous advances that have been made Bushnell et al Guidelines for Prevention of Stroke in Women 1565 in smoking cessation and hypertension and dyslipidemia awareness and control in the United States. Understanding the effects of obesity and abdominal adiposity on stroke risk, and the potentially differential impact of these conditions on women compared with men, may elucidate avenues for reduc- ing the incidence and morbidity of stroke. Association Between Obesity and Abdominal Adiposity and Stroke Risk and Outcomes Obesity is an independent risk factor for stroke. Studies have revealed a graded association between BMI and stroke risk; the risk of total stroke or IS rises linearly with increasing BMI and in a stepwise fashion for higher BMI categories.297 299 Obesity affects stroke risk in both men and women, even after adjustment for factors such as age, physical activity, smok- ing, alcohol consumption, and comorbid conditions such as hypertension and diabetes mellitus297 307 (Table 10). There is no clear evidence that obesity has a stronger impact on stroke risk in women than in men (Table 10). Numerous epidemiological and metabolic studies have shown that abdominal obesity has a stronger correlation with insulin resistance, atherogenic dyslipidemia, diabetes mellitus, and CVD than other distributions of body fat.309 Abdominal obesity can be measured by use of waist circum- ference, waist-to-hip ratio, and waist-to-stature ratio. 