This association, however, was not independent of diabetes mellitus, smoking, and hypertension.272 Mounting evidence shows a graded positive relationship between stroke and obesity independent of age, lifestyle, or other cardiovascular risk factors. Prospective studies of the relationship between weight (or measures of adiposity) and incident stroke indicate that in the BMI range of 25 to 50 kg/ there was a 40% increased stroke mortality with each 5-kg/ increase in BMI. However, in the BMI range of 15 to 24 kg/ , there was no relationship between BMI and mortality.273 A meta-analysis of data from 25 studies involving >2.2 million people and >30000 events found an RR for ischemic stroke of 1.22 (95% CI, 1.05 1.41) for overweight people and For hemor- rhagic stroke, the RR was 1.01 (95% CI, 0.88 1.17) for over- weight people and 1.24 (95% CI, 0.99 1.54) for obese people. This meta-analysis showed an increased risk of ischemic stroke compared with normal-weight individuals of 22% in overweight individuals and 64% in obese individuals. When diabetes mellitus, hypertension, dyslipidemia, and other con- founders were taken into account, there was no significant increase in the incidence of hemorrhagic stroke. These find- ings have been subsequently borne out in a Chinese study of In Japan, a meta-analysis of 44000 patients found a positive correlation in both sexes of elevated BMI with both ischemic and hemorrhagic events.276 ARIC exam- ined a population of 13000 black and white participants and found that obesity was a risk factor for ischemic stroke inde- pendently of race.277 Adjustments for covariates in all these studies significantly reduced these associations. The effects of stroke risk and weight reduction have not been studied extensively. 