Metabolic Syndrome and Ischemic Stroke Risk

Abstract

Background and Purpose-More than 47 million individuals in the United States meet the criteria for the metabolic syndrome. The relation between the metabolic syndrome and stroke risk in multiethnic populations has not been well characterized. Methods-As part of the Northern Manhattan Study, 3298 stroke-free community residents were prospectively followed up for a mean of 6.4 years. The metabolic syndrome was defined according to guidelines established by the National Cholesterol Education Program Adult Treatment Panel III. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and 95% CIs for ischemic stroke and vascular events (ischemic stroke, myocardial infarction, or vascular death). The etiologic fraction estimates the proportion of events attributable to the metabolic syndrome. Results-More than 44% of the cohort had the metabolic syndrome (48% of women vs 38% of men, PϽ0.0001), which was more prevalent among Hispanics (50%) than whites (39%) or blacks (37%). The metabolic syndrome was associated with increased risk of stroke (HRϭ1.5; 95% CI, 1.1 to 2.2) and vascular events (HRϭ1.6; 95% CI, 1.3 to 2.0) after adjustment for sociodemographic and risk factors. The effect of the metabolic syndrome on stroke risk was greater among women (HRϭ2.0; 95% CI, 1.3 to 3.1) than men (HRϭ1.1; 95% CI, 0.6 to 1.9) and among Hispanics (HRϭ2.0; 95% CI, 1.2 to 3.4) compared with blacks and whites. The etiologic fraction estimates suggest that elimination of the metabolic syndrome would result in a 19% reduction in overall stroke, a 30% reduction of stroke in women; and a 35% reduction of stroke among Hispanics. Conclusions-The metabolic syndrome is an important risk factor for ischemic stroke, with differential effects by sex and race/ethnicity. (Stroke. 2008;39:30-35.)

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

“…Furthermore, among nondiabetic subjects in NOMASS, those with elevated measurements of insulin resistance were significantly more likely to have a first ischemic stroke, even after adjusting for other risk factors and the metabolic syndrome [30]. The metabolic syndrome, a constellation of glucose dysmetabolism, obesity, hypertension, and dyslipidemia has been shown to independently confer greater risk of first and recurrent stroke [31,32]. It is unclear if metabolic syndrome confers a greater risk of first stroke than what one would expect for its components [33].…”

Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study

“…However, recent studies suggested that diet soft drink consumption may also be associated with health consequences, particularly type 2 diabetes and the metabolic syndrome, [4][5][6] risk factors for cardiovascular disease (CVD), ischemic stroke, and all-cause mortality. [7][8][9][10][11] A report from the Nurses' Health Study (NHS), which includes only women, showed an increased risk of coronary heart disease (CHD) with greater consumption of sugarsweetened beverages, and particularly soft drinks. 12 In that study, an increased risk of CHD was associated with diet soft drink consumption after adjustment for age only, but the association was no longer significant after adjusting for other cardiac risk factors.…”

Association of genetic variants with atherothrombotic cerebral infarction in Japanese individuals with metabolic syndrome

“…Although metabolic syndrome has been recognized as a risk factor for atherosclerotic diseases such as coronary heart disease (2,3) and ischemic stroke (4)(5)(6)(7)(8), genetic risk for ischemic stroke in individuals with metabolic syndrome has remained uncharacterized. Given that stroke is the leading cause of severe disability and the third leading cause of death, after heart disease and cancer, in western countries and Japan (9), the identification of biomarkers for stroke risk is important both for risk prediction and for intervention to avert future events.…”