on February 9, 2006
Published online before print February 9, 2006, doi: 10.1161/01.STR.0000204354.06965.44
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Submitted on April 28, 2005
From the Research Institute of Public Health (S.K., J.A.L., K.N., J.T.S.), University of Kuopio, Finland; the Research Institute of Public Health and Department of Internal Medicine (J.A.L., L.N., D.L.), University Hospital of Kuopio, Finland; Department of Neurology (J.S.), University Hospital of Kuopio and Brain Research and Rehabilitation Centre Neuron, Kuopio, Finland; and Department of Public Health and General Practice (J.T.S.), University of Kuopio, and the Jurilab Ltd, Kuopio, Finland. * To whom correspondence should be addressed. E-mail: sudhir.kurl{at}uku.fi.
Background and Purpose--The metabolic syndrome, a clustering of disturbed glucose and insulin metabolism, obesity and abdominal fat distribution, dyslipidemia, and hypertension is associated with cardiovascular diseases. The aim of this study was to examine the relationship of metabolic syndrome, as defined by National Cholesterol Education Program (NCEP) and World Health Organization (WHO) criteria, with the risk for stroke. Methods--Population-based cohort study with an average follow-up of 14.3 years from eastern Finland. A total of 1131 men with no history of cardiovascular disease and diabetes at baseline participated. Sixty-five strokes occurred, of which 47 were ischemic strokes. Results--Men with the metabolic syndrome as defined by the NCEP criteria had a 2.05-fold (95% CI, 1.03 to 4.11; P=0.042) risk for all strokes and 2.41-fold (95% CI, 1.12 to 5.32; P=0.025) risk for ischemic stroke, after adjusting for socioeconomic status, smoking, alcohol, and family history of coronary heart disease. Additional adjustment for ischemic changes during exercise test, serum low-density lipoprotein cholesterol, plasma fibrinogen, energy intake for saturated fats, energy expenditure of leisure time physical activity, and white blood cell count, the results remained significant. The risk ratios among men with metabolic syndrome as defined by the WHO criteria were 1.82 (95% CI, 1.01 to 3.26; P=0.046) for all strokes and 2.16 (95% CI, 1.11 to 4.19; P=0.022) for ischemic stroke. After further adjustment, the respective risks were 2.08 (95% CI, 1.12 to 3.87; P=0.020) and 2.47 (95% CI, 1.21 to 5.07; P=0.013). Conclusion--The risk of any stroke is increased in men with metabolic syndrome, in the absence of stroke, diabetes and cardiovascular disease at baseline. Prevention of the metabolic syndrome presents a great challenge for clinicians with respect to stroke.
Accepted on December 28, 2005
Metabolic Syndrome and the Risk of Stroke in Middle-Aged Men
Sudhir Kurl MD*;
Key words: diabetes mellitus • ischemic stroke • metabolic syndrome • prospective studies • risk factors • stroke
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