The Relationship Between Metabolic Syndrome And Ischemic And Hemorrhagic Stroke

Objective: The metabolic Syndrome (MetSyn) is a multi-factorial disorder that represents a constellation of lipid and nonlipid risk factors, including insulin resistance, abdominal obesity or overweight, hypertension, dyslipdemia. MetSyn have been become common and prevalent in elderly and middle-aged person with the development of society and the change of life style, and the onset age of MetSyn become much younger. Therefore, it is important to prevent MetSyn due to all components of MetSyn are high risk factors of AS and its final clinical events are diabetes mellitus (DM), stroke and cardiovascular disease. Many studies had showed that most ischemic stroke patients were related with atherosclerotic stenosis or occlusive disease. While cerebral hemorrhage may be associated with vessel wall effusion and pseudoaneurysm rupture, which are caused by consistent hypertension with small artery disease. The pathogenesis of ischemic stroke is different from that of hemorrhage stroke, and the risk factors are not the same as the latter. Therefore it is important to study the relationship between MetSyn and various subtypes of strokesIt is well known that DM was one of the most important risk factors of AS, In addition, impaired fasting glucose (IFG) as the transition phases of the normal glucose tolerance (NGT) and DM, it has had the same metabolic characters as DM, and its morbidity and mortality of vascular events was were much higher than that of NGT. Based on all above, we estimate the prevalence of MetSyn in stroke patients and study the relationship between MetSyn and stroke.Methods: Between January 2005 and January 2007, all acute infarction and cerebral hemorrhage patients in hospital, who were 3 weeks after onset, were enrolled in this study. And age, gender and demographic matched subjects without stroke were included as controls. Clinical and laboratory data of all patients, including age, sex, height tall, fat weight, blood pressure, fasting plasma glucose (FPG), serum lipids level (including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) were recorded. Then the patients with 5.6mmol/l≤FPG <7.1 mmol/l were prescribed to have a standard 75-g oral glucose tolerance test (OGTT) after overnight fast.The MetSyn was defined by the International Diabetes Federation (IDF) definition. And in our study, all subjects with≥5.6mmol/l were admitted to have OGTT. We diagnosed MetSyn as the results of OGTT and IDF definition.According to history, fasting glucose and the result of OGTT, the MetSyn subjects in ischemic infarction group and control group were classified into three groups, which were the MetSyn with DM, MetSyn with IFG, MetSyn with NGT. And the diagnosis standard of above three kinds of MetSyn respectively were FBG≥7.0mmol/l and/or OGTT2h glucose level≥11.1mmol/l and/or history of DM, 5.6mmol/l≤FBG<7.0mmol/l, and FBG<5.6mmol/l and OGTT 2h glucose level<7.8mmol/l.According to the results of TCD and MRA, all the patients with infarction were divided into atherosclerotic occlusive disease group (stenostic group) and small artery disease group (nonstenostic group).Results: 576 cerebral infarction patients and 76 cerebral hemorrhage patients were enrolled in our study. Among of these infarction patients, there were 369 patients accompanied with the atherosclerostic occlusive disease and 207 patients were small artery disease. And 500 subjects without stroke as controls. (Table 1)1 The relationships between MetSyn and ischemic and hemorrhagic stroke1.1 The prevalence of MetSyn in stroke patientsThe prevalence of MetSyn defined by IDF criteria is significantly higher in patients with infarction and cerebral hemorrhage than that of control subjects (all P values<0.001). Furthermore, It was more prevalent in infarction patients than cerebral hemorrhage patients (P<0.001).1.2 The prevalence of components of the MetSyn in stroke patients Hypertension was most common in ischemic and hemorrhagic stroke patients. The prevalences of all components were higher in stroke patients than that in control groups (all P values<0.05). In these factors, the prevalence of hyperglycemia and low HDL-cholesterol in infarction patients were higher than that in cerebral hemorrhage patients (P<0.05) and the prevalence of hypertension in cerebral hemorrhage patients was significantly higher than that in infarction patients (P value <0.01). (Table 2)1.3 The relationship between MetSyn/its components and strokesBy Logistic regression analysis, adjusting for sex, age and smoking history, MetSyn increased the risk of infarction and cerebral hemorrhage, the ORs of infarction and cerebral hemorrhage respectively were 5.73 and 3.01 (all P values<0.001).Adjusting for sex, age, smoking, and the components of MetSyn, MetSyn was associated with infarction and the adjusted OR was 2.24(p<0.001). The components significantly associated with infarction were hypertension (OR=3.56, P<0.001), hyperglycemia (OR=1.94, P<0.001), high triglyceride (OR=1.44, P=0.04), low HDL-C (OR=1.72, P<0.001). And only hypertension was significantly associated with cerebral hemorrhage (OR=13.41, P<0.001).2 The relationship between MetSyn with and without DM and ischemic stroke 2.1 The prevalences of MetSyn with DM/IFG in cerebral infarction patientsThe prevalence of MetSyn with DM, IFG, NGT in infarction patients were respectively higher than these in control subjects (all P values<0.01).2.2 MetSyn with and without DM and the risk of ischemic strokeIn Logistic regression analysis, adjusting for sex, age, smoking, all MetSyn with DM, IFG, NGT significantly associated with infarction (OR values and P values:11.24,P<0.001; 4.60,P<0.001; 4.15,P<0.001).Adjusting for sex, age, smoking, and all metabolic parameters, the adjusted OR for the MetSyn with DM, IFG, NGT was respectively 5.70 (p<0.001),2.24 (P<0.001) and 2.19 (P=0.006).3 The relationship between MetSyn and atherosclerotic occlusive diseases3.1 The prevalence of MetSyn in atherosclerotic occlusive diseasesAccording to the results of TCD and/or MRA, there were 369 patients with atherosclerotic occlusive disease (stenosis group) and 207 patients with small artery disease (nonstenosis group). The prevalence of MetSyn in stenosis group was higher than that in nonstenosis group (P<0.01).The prevalence of MetSyn with DM in stenosis group was higher than that in nonstenosis group (P<0.05). But the prevalences of MetSyn with IFG and NGT respectively were not statistically significant (P>0.05).3.2 MetSyn and the risk of atherosclerotic occlusive diseasesBy Logistic regression analysis, adjusting for sex, age, smoking, MetSyn was associated with atherosclerotic occlusive disease (OR=1.57, P=0.011).Adjusting for sex, age, smoking, and all metabolic parameters, MetSyn was not associated with atherosclerotic occlusive disease (OR=1.08, P=0.732). The factors significantly associated with infarction were DM (OR=1.63, P=0.028), hypertension (OR=1.59, P=0.025), Low HDL-C (OR=1.57, P=0.024).3.3 MetSyn with DM/IFG and the risk of atherosclerotic occlusive diseasesBy Logistic regression analysis, adjusting for sex, age, smoking, MetSyn with DM was associated with atherosclerotic occlusive disease (OR=1.74, P=0.014). But MetSyn with IFG, NGT was not associated with atherosclerotic occlusive disease (OR and P values respectively were 1.81, 0.082; 1.33, 0.198).Conclusion:1 MetSyn was significantly associated with cerebral infarction. Among of all vascular risk factors attributing to MetSyn, hyperglycemia, high triglyceride, low HDL-cholesterol were significantly associated with cerebral infarction. And hypertension and hyperglycemia were stronger predictors of cerebral infarction. While hypertension was the only risk factor associated with cerebral hemorrhage.2 The MetSyn with and without DM were associated with cerebral infarction and the patients for MetSyn with DM have the highest risk for ischemic stroke.3 About 60% atherosclerotic stroke patients associated with MetSyn and the MetSyn with DM have a higher risk for late atherosclerosis. The MetSyn may not provide additional ability to predict outcomes beyond the individual factors for patients with atherosclerotic occlusive disease.