Metabolic Syndrome and Fatal Outcomes in the Post-Stroke Event: A 5-Year Cohort Study in Cameroon

Abstract

Background and PurposeDeterminants of post-acute stroke outcomes in Africa have been less investigated. We assessed the association of metabolic syndrome (MetS) and insulin resistance with post-stroke mortality in patients with first-ever-in-lifetime stroke in the capital city of Cameroon (sub-Saharan Africa).MethodsPatients with an acute first-stroke event (n = 57) were recruited between May and October 2006, and followed for 5 years for mortality outcome. MetS definition was based on the Joint Interim Statement 2009, insulin sensitivity/resistance assessed via glucose-to-insulin ratio, quantitative insulin sensitivity check index and homeostatic model assessment.ResultsOverall, 24 (42%) patients deceased during follow-up. The prevalence of MetS was higher in patients who died after 28 days, 1 year and 5 years from any cause or cardiovascular-related causes (all p≤0.040). MetS was associated with an increased overall mortality both after 1 year (39% vs. 9%) and 5 years of follow-up (55% vs. 26%, p = 0.022). Similarly, fatal events due to cardiovascular-related conditions were more frequent in the presence of MetS both 1 year (37% vs. 9%) and 5 years after the first-ever-in-lifetime stroke (43% vs. 13%, p = 0.017). Unlike biochemical measures of insulin sensitivity and resistance (non-significant), in age- and sex-adjusted Cox models, MetS was associated with hazard ratio (95% CI) of 2.63 (1.03–6.73) and 3.54 (1.00–12.56) respectively for all-cause and cardiovascular mortality 5 years after stroke onset.ConclusionThe Joint Interim Statement 2009 definition of MetS may aid the identification of a subgroup of black African stroke patients who may benefit from intensification of risk factor management.

Acute high-fat feeding leads to disruptions in glucose homeostasis and worsens stroke outcome

“…Obesity as a result of prolonged high-fat feeding is often associated with liver steatosis, hyperlipidemia, low-grade inflammation and hypertension, conditions associated with the metabolic syndrome that can lead to increased risk and impact on outcome for stroke. [33][34][35] Here in naı¨ve mice, a chronic high-fat diet increased body weight and adiposity, induced liver steatosis and inflammation, and altered fat metabolism, changes not seen in mice fed an acute high-fat diet. An acute high-fat diet also had no effect on blood pressure or production of inflammatory markers from the adipose tissue or liver.…”

Metabolic Syndrome Augments the Risk of Early Neurological Deterioration in Acute Ischemic Stroke Patients Independent of Inflammatory Mediators: A Hospital-Based Prospective Study

“…Over the past two decades, the number of patients with MetS has enlarged strikingly in China [ 9 ]. There are a few studies reporting a positive relationship between MetS and unfavorable outcome after ischemic stroke [ 10 , 11 ]. Nevertheless, whether MetS is a novel risk factor for acute stroke complication, such as END, has not been well addressed.…”

Improving access to HbA1c in sub-Saharan Africa (IA3) cohort: cohort profile

“…Although difficult to anticipate, this latter limitation has however been accounted for and our current sample size at baseline largely exceeds the adequate size to obtain robust estimates from statistical analysis. Although adequate for the main study purpose the study sample may actually be rather small to investigate major outcomes such as diabetes-associated complications or mortality [ 9 – 11 ]. For such outcomes, much longer duration of follow-up would be needed to accumulate a reasonable number of events.…”