Published online before print June 2, 2005, doi: 10.1161/01.STR.0000169945.75911.33
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(Stroke. 2005;36:1366.)
© 2005 American Heart Association, Inc.
Original Contributions |
Relation Between the Metabolic Syndrome and Ischemic Stroke or Transient Ischemic Attack
A Prospective Cohort Study in Patients With Atherosclerotic Cardiovascular Disease
From the Division of Epidemiology, Sackler Medical Faculty, Tel Aviv University, Israel and the Stroke Unit, Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.
Correspondence to Uri Goldbourt, PhD, Professor of Epidemiology, Sackler Medical Faculty, Tel Aviv University campus, Tel Aviv 69978, Israel. E-mail goldbu1{at}post.tau.ac.il
Background and Purpose— The combination of risk factors known as the metabolic syndrome is receiving increased attention, but prospective data on the syndrome’s association with ischemic cerebrovascular events are scarce. We explored the relation of metabolic syndrome versus frank diabetes with first-ever ischemic stroke or transient ischemic attack (TIA) in a large cohort of patients with atherosclerotic cardiovascular disease.
Methods— Patients with coronary heart disease, screened for a clinical trial, underwent an extensive medical evaluation and follow-up for cerebrovascular disease over 4.8 to 8.1 years. National Cholesterol Education Program Adult Treatment Panel III criteria were used to define the metabolic syndrome, with body mass index substituted for waist circumference. Patients with previously diagnosed diabetes or with a fasting plasma glucose level >125 mg/dL (
7.0 mmol/L) were considered diabetic.
Results— The study sample comprised 14 284 patients, of which 3703 (26%) fulfilled the criteria for the metabolic syndrome without diabetes and 3500 others (25%) the criteria for diabetes. Adjusting for stroke risk factors, patients with the metabolic syndrome without diabetes exhibited a 1.49-fold increased odds for ischemic stroke or TIA (95% confidence interval [CI], 1.20 to 1.84), whereas those with frank diabetes had a 2.29-fold increased odds (95% CI, 1.88 to 2.78). The relative odds for ischemic stroke or TIA, associated with presence of the metabolic syndrome per se, were 1.39 (95% CI, 1.10 to 1.77) in men but 2.10 (95% CI, 1.26 to 3.51) in women. Although all components of the metabolic syndrome were associated with increased risk for ischemic stroke or TIA, impaired fasting glucose and hypertension were the strongest predictors of risk.
Conclusions— The presence of the metabolic syndrome, even without diabetes, in patients with pre-existing atherosclerotic vascular disease identifies patients at increased risk for ischemic stroke or TIA. The suggestion of more pronounced risk associated with the metabolic syndrome in women deserves further assessment in other cohorts.
Key Words: metabolism • prospective studies • stroke, ischemic
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