Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

Mi, Donghua; Jia, Qi; Zheng, Huaguang; Hoff, Kolin; Wang, Wenjuan; Wang, Chunxue; Liu, Gaifen; Wang, Yilong; Liu, Liping; Wang, Xianwei; Wang, Yongjun

doi:10.1371/journal.pone.0051406

Cited by 27 publications

(18 citation statements)

References 38 publications

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“…In this study, MetSyn prevalence in the ischaemic stroke subjects defined by IDF and HMS criteria are higher than in previous studies conducted among Chinese acute stroke subjects (51.35%), ischaemic stroke subjects in India (60%) and Iran (62%) [6] [10] [27]. The discrepancies could be due to the differences in proportions of co-morbidities among study subjects.…”

Section: Discussioncontrasting

confidence: 73%

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

Yeboah¹,

Nkum²,

Amankwaa³

et al. 2017

OALib

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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.

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Section: Discussioncontrasting

confidence: 73%

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

Yeboah¹,

Nkum²,

Amankwaa³

et al. 2017

OALib

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“…The risk of first stroke doubles with the presence of the metabolic syndrome, but recurrent stroke is not affected. [77][78][79][80][81][82] Diabetes mellitus worsens the outcomes from stroke, as it does in coronary artery disease. A study of nearly 12 000 community-dwelling men in western Australia found that diabetes mellitus significantly increased the risk of death in patients with stroke.…”

Section: Strokementioning

confidence: 99%

Vascular Complications of Diabetes

Beckman

Creager

2016

Circulation Research

302

218

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Over the last several decades, the global incidence and prevalence of diabetes mellitus has increased significantly. The raised incidence rate is projected to continue as greater numbers of persons adopt a Western lifestyle and diet. Patients with diabetes mellitus are at heightened risk of both adverse microvascular and cardiovascular events. Moreover, once cardiovascular disease develops, diabetes mellitus exacerbates progression and worsens outcomes. The medical management of patients with diabetes mellitus mandates comprehensive risk factor modification and antiplatelet therapy. Recent clinical trials of new medical therapies continue to inform the care of patients with diabetes mellitus to reduce both cardiovascular morbidity and mortality.

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“…There are limited data, however, on the relationship between METS and the risk of stroke recurrence. Previous studies found that METS may not be predictive for stroke recurrence in patients with general ischemic stroke,8, 9 whereas another study demonstrated that METS was associated with higher risk of stroke recurrence in patients with ischemic stroke 10. The relationship between METS and recurrence of stroke after a stroke or TIA remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…Factors associated with a high risk of recurrence in patients with TIA or minor stroke were different from those of general stroke16; however, data from previous studies were derived from trials or cohorts in which patients were recruited weeks or months after their initial event and underestimated early recurrence, especially for minor stroke or TIA 8, 9, 17. Consequently, the risks of recurrent stroke caused by METS and DM in patients with a minor stroke or TIA should be further examined.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

Chen

Pan

Jing

et al. 2017

JAHA

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BackgroundWe aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.Methods and ResultsIn total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (P=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.ConclusionsConcurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

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Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

Cited by 27 publications

References 38 publications

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

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

Vascular Complications of Diabetes

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

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