Metabolic Syndrome among Ischaemic Stroke Patients in Ghana: The Possible Role of Renin and Aldosterone

Abstract

Background: Both metabolic syndrome (MetSyn) and the Renin Angiotensin Aldosterone System (RAAS) are predictors of adverse outcomes in stroke patients. This study aimed at evaluating the association between RAAS and MetSyn among ischaemic stroke subjects in a tertiary hospital of Ghana from September 2015 to June 2016. Methodology: The study purposively recruited 252 Ghanaians comprising 132 ischaemic stroke patients and 120 apparently healthy control subjects. The participants were subjected to measurements of plasma renin, serum aldosterone, lipid profile, anthropometries and blood pressure. Results: MetSyn prevalence among the stroke subjects compared to the controls were 50.0% vs 8.3% (NCEP/ATP III), 71.2% vs 9.2 (IDF) and 71.2% vs 6.7% (H_MS). Both renin and aldosterone were significantly (p < 0.05) higher in the ischaemic stroke subjects [(1.8 ± 0.1 vs 1.4 ± 0.1) pg/ml and (2.9 ± 0.2 vs 2.3 ± 0.2) pg/ml respectively]. Adjusting for age, gender, diabetes status and hypertension, third tertile (T 3 ) aldosterone (aOR = 2.7, p = 0.008), obesity (aOR = 11.7, p = 0.004) and high triglyceride (aOR = 5.3, p < 0.001) but not renin (aOR = 6.1, p = 0.742) were independently associated with increasing odds of metabolic syndrome. Moreover, there was a significant (p < 0.050) correlation between plasma renin and waist circumference How to cite this paper: Yeboah, F.A., Nkum, B., Amankwaa, B., Eghan Jr., B.A., Acheampong, E., Nsiah, P., Okyere, P., Owusu, L., Nsenba, E.B. and Anto, E.O. (WC) (r = 0.493) and high density lipoprotein (HDL) (r = −0.319). Significant (p < 0.050) correlations also existed between serum aldosterone and WC (r = 0.588), waist-to-height ratio (WHR) (r = 0.503), body mass index (BMI) (r = 0.691), HDL (r = −0.317), total cholesterol (r = 0.678) and triglyceride (r = 0.439). Conclusion: Aldosterone and not renin could play significant role in the pathophysiology of metabolic syndrome in ischaemic stroke. These findings underpin the observations that aldosterone is associated with several cardiovascular risk factors and may exacerbate metabolic defects in people with ischaemic stroke. Adequate aldosterone blockade could therefore mitigate the development and progression of metabolic syndrome in ischaemic stroke subjects.