Metabolic Syndrome and the Risk of Stroke in Middle-Aged Men

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.

[1]  D. Tanné,et al.  Relation Between the Metabolic Syndrome and Ischemic Stroke or Transient Ischemic Attack: A Prospective Cohort Study in Patients With Atherosclerotic Cardiovascular Disease , 2005, Stroke.

[2]  D. Mikhailidis,et al.  Components of the Metabolic Syndrome and Risk for First-Ever Acute Ischemic Nonembolic Stroke in Elderly Subjects , 2005, Stroke.

[3]  Tomi-Pekka Tuomainen,et al.  The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: a prospective cohort study. , 2005, The Journal of clinical endocrinology and metabolism.

[4]  A. Manley.  Physical Activity And Health: A Report Of The Surgeon General , 2004 .

[5]  A. Algra,et al.  The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. , 2004, European heart journal.

[6]  Anthony Gamst,et al.  Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey , 2004, Circulation.

[7]  P. Ridker,et al.  C-reactive protein and the risk of developing hypertension. , 2003, JAMA.

[8]  S. Grundy,et al.  Elevated plasma high-sensitivity C-reactive protein concentrations in Asian Indians living in the United States. , 2003, The Journal of clinical endocrinology and metabolism.

[9]  T. Lakka,et al.  Cardiorespiratory fitness and the risk for stroke in men. , 2003, Archives of internal medicine.

[10]  T. Lakka,et al.  Association of Exercise-Induced, Silent ST-Segment Depression With the Risk of Stroke and Cardiovascular Diseases in Men , 2003, Stroke.

[11]  Jukka T Salonen,et al.  The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. , 2002, JAMA.

[12]  T. Lakka,et al.  Plasma Vitamin C Modifies the Association Between Hypertension and Risk of Stroke , 2002, Stroke.

[13]  S. Fowler,et al.  Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. , 2002 .

[14]  W. Dietz,et al.  Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. , 2002, JAMA.

[15]  Ose,et al.  Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events* , 2002 .

[16]  Cynthia A. Carnes,et al.  C-Reactive Protein Elevation in Patients With Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation , 2001, Circulation.

[17]  T. Valle,et al.  Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. , 2001, The New England journal of medicine.

[18]  P. Jousilahti,et al.  Secular trends in body mass index by birth cohort in eastern Finland from 1972 to 1997 , 2001, International Journal of Obesity.

[19]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.

[20]  U. Smith,et al.  Dietary fibre, lente carbohydrates and the insulin-resistant diseases , 2000, British Journal of Nutrition.

[21]  T. Lakka,et al.  Hyperinsulinemia and the risk of cardiovascular death and acute coronary and cerebrovascular events in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. , 2000, Archives of internal medicine.

[22]  Who Consultation on Obesity.  Obesity: preventing and managing the global epidemic. Report of a WHO consultation. , 2000, World Health Organization technical report series.

[23]  B. Balkau,et al.  Comment on the provisional report from the WHO consultation , 1999, Diabetic medicine : a journal of the British Diabetic Association.

[24]  T. Miller,et al.  Prognostic significance of exercise-induced systemic hypertension in healthy subjects. , 1999, The American journal of cardiology.

[25]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[26]  Detection.  The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) , 1997 .

[27]  R. Weinshilboum,et al.  The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. , 1997, Archives of internal medicine.

[28]  T. Lakka,et al.  Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men. , 1996, Archives of internal medicine.

[29]  G. Kajiyama,et al.  Abnormal systolic blood pressure response during exercise recovery in patients with angina pectoris. , 1993, Journal of the American College of Cardiology.

[30]  Heikki Korpela,et al.  High Stored Iron Levels Are Associated With Excess Risk of Myocardial Infarction in Eastern Finnish Men , 1992, Circulation.

[31]  V. Salomaa,et al.  The FINMONICA Stroke Register. Community-based stroke registration and analysis of stroke incidence in Finland, 1983-1985. , 1992, American journal of epidemiology.

[32]  G. Reaven.  Role of Insulin Resistance in Human Disease , 1988, Diabetes.

[33]  G. Reaven.  Banting lecture 1988. Role of insulin resistance in human disease. , 1988, Diabetes.