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Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease.
Stroke 2005; 36(7):1366-71S

Abstract

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 (> or =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.

Authors+Show Affiliations

Division of Epidemiology, Sackler Medical Faculty, Tel Aviv University, Israel.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15933253

Citation

Koren-Morag, N, et al. "Relation Between the Metabolic Syndrome and Ischemic Stroke or Transient Ischemic Attack: a Prospective Cohort Study in Patients With Atherosclerotic Cardiovascular Disease." Stroke, vol. 36, no. 7, 2005, pp. 1366-71.
Koren-Morag N, Goldbourt U, Tanne D. Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease. Stroke. 2005;36(7):1366-71.
Koren-Morag, N., Goldbourt, U., & Tanne, D. (2005). Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease. Stroke, 36(7), pp. 1366-71.
Koren-Morag N, Goldbourt U, Tanne D. Relation Between the Metabolic Syndrome and Ischemic Stroke or Transient Ischemic Attack: a Prospective Cohort Study in Patients With Atherosclerotic Cardiovascular Disease. Stroke. 2005;36(7):1366-71. PubMed PMID: 15933253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease. AU - Koren-Morag,N, AU - Goldbourt,U, AU - Tanne,D, Y1 - 2005/06/02/ PY - 2005/6/4/pubmed PY - 2005/12/13/medline PY - 2005/6/4/entrez SP - 1366 EP - 71 JF - Stroke JO - Stroke VL - 36 IS - 7 N2 - 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 (> or =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. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/15933253/Relation_between_the_metabolic_syndrome_and_ischemic_stroke_or_transient_ischemic_attack:_a_prospective_cohort_study_in_patients_with_atherosclerotic_cardiovascular_disease_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.STR.0000169945.75911.33?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -