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(Stroke. 2005;36:1372.)
© 2005 American Heart Association, Inc.

Original Contributions

Components of the Metabolic Syndrome and Risk for First-Ever Acute Ischemic Nonembolic Stroke in Elderly Subjects

Haralampos J. Milionis, MD; Evangelos Rizos, MD; John Goudevenos, MD; Konstantinos Seferiadis, PhD; Dimitri P. Mikhailidis, MD, FRCPath Moses S. Elisaf, MD, FRSH

From the Department of Internal Medicine (H.J.M., E.R., J.G., M.S.E.), School of Medicine, University of Ioannina, Ioannina, Greece; the Laboratory of Biochemistry (K.S.), University Hospital of Ioannina, Ioannina, Greece; and the Department of Clinical Biochemistry (D.P.M.), Royal Free Hospital, London, UK.

Correspondence to Haralampos J. Milionis, MD, Lecturer in Internal Medicine, Department of Internal Medicine, Medical School, University of Ioannina, 451 10 Ioannina, Greece. E-mail hmilioni{at}cc.uoi.gr

Background and Purpose— Metabolic syndrome (MetSyn) represents a constellation of lipid and nonlipid risk factors for cardiovascular disease and is a recognized target for increased behavioral therapy.

Objective— The association between acute ischemic/nonembolic stroke and the MetSyn in elderly individuals was assessed in a population-based case-control study in the prefecture of Ioannina, Greece.

Study Population— A total of 163 patients aged older than 70 years admitted with first-ever-in-a-lifetime acute ischemic/nonembolic stroke and 166 controls were included.

Results— The prevalence of MetSyn (defined according to NCEP/ATP III criteria) was high in stroke patients (46.0% versus 15.7%, P<0.001). Compared with controls as a group (with and without MetSyn), stroke patients with the MetSyn showed higher concentrations of triglycerides, lipoprotein(a), uric acid, and fibrinogen, and lower high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I levels. In logistic regression analysis, crude and adjusted odd ratios (ORs) for MetSyn were 5.33 (95% confidence interval [CI], 2.91 to 9.79; P<0.0001) and 2.59 (95% CI, 1.24 to 5.42; P=0.012), respectively. The analysis of interaction between MetSyn and its individual components revealed significant associations with abdominal obesity (adjusted OR, 2.74; 95% CI, 1.15 to 6.50; P=0.02), hypertension (OR, 2.03; 95% CI, 0.91 to 4.49; P=0.08), high fasting glucose levels (OR, 2.95; 95% CI, 1.19 to 7.35; P=0.02), high triglyceride (OR, 5.55; 95% CI, 2.71 to 11.37; P<0.0001]), and low HDL cholesterol (OR, 5.42; 95% CI, 2.85 to 10.30; P<0.0001). Notably, in stroke patients with the MetSyn the inverse relationship between HDL cholesterol levels and ischemic stroke was negated (OR, 1.04; 95% CI, 1.02 to 1.05; P<0.0001).

Conclusions— MetSyn is associated with an increased risk for acute ischemic/nonembolic stroke in elderly subjects with significant contributions from its individual components. In the presence of MetSyn, HDL cholesterol loses its protective role against ischemic stroke.

Key Words: elderly • lipids • ischemic stroke • metabolic syndrome

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