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Chen Y, Wu J, Chen M, Zhu Y, Wang H, Cui T, Zhang S, Wang D. Association between metabolic syndrome and outcomes of large-artery atherosclerosis stroke treated with reperfusion therapy. J Stroke Cerebrovasc Dis 2024; 33:107927. [PMID: 39142610 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/16/2024] Open
Abstract
AIM We aimed to investigate the impact of metabolic syndrome (MetS) on the outcomes of stroke patients with large-artery atherosclerosis who underwent reperfusion therapy. METHODS A retrospective analysis was carried out on patients receiving reperfusion therapy for atherothrombotic stroke between January 2019 and May 2021. MetS was diagnosed according to the AHA/NHLBI criteria. The primary outcome was the composite outcome of disability (modified Rankin Scale [mRS] score 3-5), death or stroke recurrence within 3 months of stroke onset. Secondary outcomes included disability and death within 3 months as well as hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) within 24 hours after reperfusion treatment. The independent association of MetS with the above outcomes and the highly correlated components of MetS was examined using binary logistic regression analysis. RESULTS A total of 174 patients were enrolled. MetS patients had a higher proportion of the composite outcome (p = 0.012), disability (p = 0.029) and HT (p = 0.049) than those without MetS, except for death (p = 0.375) and sICH (p = 0.306). Following adjustments, MetS remained independently associated with the composite outcome (adjusted OR, 3.011 [95 %CI 1.372-6.604]; p = 0.006) and disability (adjusted OR, 2.727 [95 %CI 1.220-6.098]; p = 0.015), but not HT (adjusted OR, 1.872 [95 %CI 0.854-4.104]; p = 0.117). Hypertriglyceridemia was remarkedly associated with the composite outcome (adjusted OR, 9.746 [95 % CI 2.402-39.536]; p = 0.001) and disability (adjusted OR, 6.966 [95 % CI 1.889-25.692]; p = 0.004). CONCLUSION MetS is independently associated with an increased risk of composite outcome and disability in patients with large-artery atherosclerosis stroke receiving reperfusion therapy, and hypertriglyceridemia is the main component that drives the effect of MetS on outcomes.
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Affiliation(s)
- Yaqi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Jiongxing Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Mingxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Yuyi Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Huan Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Ting Cui
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Shihong Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Deren Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
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Zhang F, Liu L, Zhang C, Ji S, Mei Z, Li T. Association of Metabolic Syndrome and Its Components With Risk of Stroke Recurrence and Mortality: A Meta-analysis. Neurology 2021; 97:e695-e705. [PMID: 34321360 DOI: 10.1212/wnl.0000000000012415] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Because metabolic syndrome is a significant risk factor for cardio-cerebrovascular diseases and the relationship between metabolic syndrome (including its components) and the prognosis of stroke is controversial, this study was conducted to evaluate whether metabolic syndrome is associated with a high recurrence and mortality of stroke. METHODS This study was registered in the PROSPERO database (CRD42020177118). We searched for relevant observational cohort studies published from inception to April 23, 2020, using PubMed, Embase, and the Cochrane Library. Effect estimates with 95% confidence intervals (CIs) were pooled using the random-effects model. The primary and secondary outcomes were stroke recurrence and all-cause mortality, respectively. Leave-one-out sensitivity analyses and nonparametric trim-and-fill method were used to identify the stability of the results. RESULTS Thirteen cohort studies comprising 59,919 participants >60 years of age were included for analysis. Overall, metabolic syndrome was significantly associated with stroke recurrence (relative risk [RR] 1.46, 95% CI 1.07-1.97, p = 0.02). Among the metabolic syndrome components, low levels of high-density lipoprotein cholesterol (HDL-C) (RR 1.32, 95% CI 1.11-1.57, p = 0.002) and ≥2 metabolic syndrome components (RR 1.68, 95% CI 1.44-1.94, p < 0.001) significantly predicted stroke recurrence, whereas elevated triglycerides, elevated waist circumference, hyperglycemia, and hypertension failed to account for risk factors for stroke recurrence. Moreover, metabolic syndrome, not its components, was significantly associated with all-cause mortality (RR 1.27, 95% CI 1.18-1.36, p < 0.001). The stability of these results was further confirmed by the leave-one-out sensitivity analyses and nonparametric trim-and-fill method. CONCLUSIONS The present study indicates that metabolic syndrome and some of its components (low HDL-C and number of metabolic syndrome components) seem to be risk factors for stroke recurrence. Although metabolic syndrome is also associated with all-cause mortality, the role of its components in predicting all-cause mortality deserves further study.
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Affiliation(s)
- Fangfang Zhang
- From the Second Department of Neurology (F.F.), Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University; National Clinical Research Center for Metabolic Diseases (L.L.), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha; Department of Gastrointestinal Surgery (C.Z.), The Fourth Affiliated Hospital of China Medical University, Shenyang; Department of Pharmacy (S.J.), The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou; Department of Anorectal Surgery (Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (Z.M.), Shanghai, China, and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
| | - Lili Liu
- From the Second Department of Neurology (F.F.), Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University; National Clinical Research Center for Metabolic Diseases (L.L.), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha; Department of Gastrointestinal Surgery (C.Z.), The Fourth Affiliated Hospital of China Medical University, Shenyang; Department of Pharmacy (S.J.), The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou; Department of Anorectal Surgery (Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (Z.M.), Shanghai, China, and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
| | - Chundong Zhang
- From the Second Department of Neurology (F.F.), Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University; National Clinical Research Center for Metabolic Diseases (L.L.), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha; Department of Gastrointestinal Surgery (C.Z.), The Fourth Affiliated Hospital of China Medical University, Shenyang; Department of Pharmacy (S.J.), The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou; Department of Anorectal Surgery (Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (Z.M.), Shanghai, China, and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
| | - Shiliang Ji
- From the Second Department of Neurology (F.F.), Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University; National Clinical Research Center for Metabolic Diseases (L.L.), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha; Department of Gastrointestinal Surgery (C.Z.), The Fourth Affiliated Hospital of China Medical University, Shenyang; Department of Pharmacy (S.J.), The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou; Department of Anorectal Surgery (Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (Z.M.), Shanghai, China, and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
| | - Zubing Mei
- From the Second Department of Neurology (F.F.), Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University; National Clinical Research Center for Metabolic Diseases (L.L.), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha; Department of Gastrointestinal Surgery (C.Z.), The Fourth Affiliated Hospital of China Medical University, Shenyang; Department of Pharmacy (S.J.), The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou; Department of Anorectal Surgery (Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (Z.M.), Shanghai, China, and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China.
| | - Tian Li
- From the Second Department of Neurology (F.F.), Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University; National Clinical Research Center for Metabolic Diseases (L.L.), Metabolic Syndrome Research Center, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha; Department of Gastrointestinal Surgery (C.Z.), The Fourth Affiliated Hospital of China Medical University, Shenyang; Department of Pharmacy (S.J.), The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou; Department of Anorectal Surgery (Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (Z.M.), Shanghai, China, and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
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Li X, Zhai Y, Zhao J, He H, Li Y, Liu Y, Feng A, Li L, Huang T, Xu A, Lyu J. Impact of Metabolic Syndrome and It's Components on Prognosis in Patients With Cardiovascular Diseases: A Meta-Analysis. Front Cardiovasc Med 2021; 8:704145. [PMID: 34336959 PMCID: PMC8319572 DOI: 10.3389/fcvm.2021.704145] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with metabolic syndrome (MetS) have a higher risk of developing cardiovascular diseases (CVD). However, controversy exists about the impact of MetS on the prognosis of patients with CVD. Methods: Pubmed, Cochrane library, and EMBASE databases were searched. Cohort Studies and randomized controlled trials post hoc analyses that evaluated the impact of MetS on prognosis in patients (≥18 years) with CVD were included. Relative risk (RR), hazard rate (HR) and 95% confidence intervals (CIs) were calculated for each individual study by random-effect model. Subgroup analysis and meta-regression analysis was performed to explore the heterogeneity. Results: 55 studies with 16,2450 patients were included. Compared to patients without MetS, the MetS was associated with higher all-cause death [RR, 1.220, 95% CI (1.103 to 1.349), P, 0.000], CV death [RR, 1.360, 95% CI (1.152 to 1.606), P, 0.000], Myocardial Infarction [RR, 1.460, 95% CI (1.242 to 1.716), P, 0.000], stroke [RR, 1.435, 95% CI (1.131 to 1.820), P, 0.000]. Lower high-density lipoproteins (40/50) significantly increased the risk of all-cause death and CV death. Elevated fasting plasma glucose (FPG) (>100 mg/dl) was associated with an increased risk of all-cause death, while a higher body mass index (BMI>25 kg/m2) was related to a reduced risk of all-cause death. Conclusions: MetS increased the risk of cardiovascular-related adverse events among patients with CVD. For MetS components, there was an increased risk in people with low HDL-C and FPG>100 mg/dl. Positive measures should be implemented timely for patients with CVD after the diagnosis of MetS, strengthen the prevention and treatment of hyperglycemia and hyperlipidemia.
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Affiliation(s)
- Xiao Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Clinical Medicine, Qinghai Institute of Health Sciences, Xining, China
| | - Yajing Zhai
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Jiaguo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuanjie Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yue Liu
- Xiyuan Hospital of China Academy of Chinese Medicinal Sciences, Beijing, China
| | - Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Anding Xu
- Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Mi D, Wang Y, Wang Y, Liu L. Insulin resistance is an independent risk factor for early neurological deterioration in non-diabetic patients with acute ischemic stroke. Neurol Sci 2020; 41:1467-1473. [DOI: 10.1007/s10072-019-04221-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
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Metabolic Syndrome and the Risk of Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:286-294. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/20/2016] [Accepted: 09/13/2016] [Indexed: 01/24/2023] Open
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Wang GS, Tong DM, Chen XD, Yang TH, Zhou YT, Ma XB. Metabolic Syndrome Is a Strong Risk Factor for Minor Ischemic Stroke and Subsequent Vascular Events. PLoS One 2016; 11:e0156243. [PMID: 27536865 PMCID: PMC4990187 DOI: 10.1371/journal.pone.0156243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
Background Minor ischemic stroke (MIS) represents a major global public health problem worldwide due to high incidence. The aim of this study was to investigate whether metabolic syndrome (MetS) is a strong risk for MIS and subsequent vascular events (SVE). Methods A retrospective cohort study was performed examining symptomatic MIS in a Chinese neurologic outpatient population aged over 25 years without history of stroke. MetS was defined using the International Diabetes Federation criteria. MIS was diagnosed by magnetic resonance imaging-diffusion weighted images or fluid-attenuated inversion recovery. Results Of 1361 outpatients, a total of 753 (55.3%) patients were diagnosed with MIS; of them, 80% had a score of 0 using the MIS had a 0 score on the National Institutes of Health Stroke Scale. Among these, 303 (40.2%) individuals with MIS were diagnosed with MetS. Diagnosed of MIS with MetS significantly correlated with abdominal obesity (30.7% v.s 18.0%), hypertension (91.1% v.s 81.6%), increased blood glucose (6.9±2.4 v.s 5.0±0.4), dyslipidemia (78.2% v.s 48.2%), and SVE (50.5% v.s 11.3%) when compared with the controls group. On adjusted analysis, the risk of SVE was also significantly associated with three additional MetS criterion (RR,9.0; 95% CI, 5.677–14.46). Using Cox proportional analysis, risk of SVE in patient with MIS was significantly associated with MetS (RR, 3.3; 95% CI, 1.799–6.210), older age (RR, 1.0; 95% CI, 1.001–1.048), and high blood glucose (RR,1.1; 95%CI, 1.007–1.187). Conclusions The MetS is a strong risk factor for MIS, and patients presenting with MIS and MetS are at a high risk of SVE. Further studies are required to determine the improvement of Mets prevention in the reduction of MIS and SVE.
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Affiliation(s)
- Guang-Sheng Wang
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
| | - Dao-Ming Tong
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
- * E-mail:
| | - Xiao-Dong Chen
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
| | - Tong-Hui Yang
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
| | - Ye-Ting Zhou
- Department of Clinical Research, Affiliated Shu Yang People's Hospital, XuZhou Medical University, XuZhou, China
| | - Xiao-Bo Ma
- Department of science and education, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
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Park HJ, Kim TU, Hyun JK, Kim JY. Family History and Functional Outcome in Korean Stroke Patients: A Preliminary Study. Ann Rehabil Med 2016; 39:980-5. [PMID: 26798613 PMCID: PMC4720775 DOI: 10.5535/arm.2015.39.6.980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/18/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the association of family history of stroke with functional outcomes in stroke patients in Korea. METHODS A case-control study was conducted. A total of 170 patients who were admitted to a rehabilitation unit were included. Risk factors for stroke such as age, sex, diabetes mellitus, hypertension, atrial fibrillation, smoking, high blood cholesterol and homocysteine level, obesity, and family history of stroke were taken into account. Stroke subtypes were the following: large vessel infarct, small vessel infarct, embolic infarct, subarachnoid hemorrhage, and intracranial hemorrhage. Stroke severity as assessed with the National Institutes of Health Stroke Scale (NIHSS), functional outcomes using the Korean version of the Modified Barthel index (K-MBI), Functional Independence Measurement (FIM), and cognitive function using the Korean version of Mini-Mental State Examination (K-MMSE) were assessed at admission and discharge. RESULTS Subjects with a family history of stroke were more likely to have an ischemic stroke (90.7%) than were those without a family history (70.9%). The K-MBI, FIM, NIHSS, and K-MMSE scores did not show significant differences between patients with or without family history. CONCLUSION Family history of stroke was significantly associated with ischemic stroke, but not with functional outcomes. Other prognostic factors of stroke were not distributed differently between patients included in this study with or without a family history of stroke.
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Affiliation(s)
- Hee Jung Park
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Tae Uk Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea.; Department of Nanobiomedical Science & WCU Research Center, Dankook University, Cheonan, Korea.; Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Korea
| | - Jung Yoon Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea.; Ewha Brain Institute, Ewha Womans University, Seoul, Korea
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Liu L, Zhan L, Wang Y, Bai C, Guo J, Lin Q, Liang D, Xu E. Metabolic syndrome and the short-term prognosis of acute ischemic stroke: a hospital-based retrospective study. Lipids Health Dis 2015. [PMID: 26199022 PMCID: PMC4511539 DOI: 10.1186/s12944-015-0080-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is an important risk factor for cerebral ischemic stroke, yet previous studies on the relationship between MetS or its components and acute cerebral infarction have been inconsistent. This study aims to evaluate the effects of MetS and its components on the short-term prognosis of patients with acute ischemic stroke. METHODS Subjects with ischemic stroke of <7-day duration (530 cases) were enrolled. MetS was defined based on the modified criteria of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Demographic data, vascular risk factors, National Institutes of Health Stroke Scale score, the results of physical, laboratory and imaging examinations and clinical outcomes at 30 and 90 days were recorded. Using univariate analysis, we compared different baseline characteristics between patients with MetS and those without MetS. Further, we assessed MetS and its 5 components on the contribution to short-term prognosis of ischemic stroke with multiple logistic regression models after adjusting for age and sex. RESULTS The prevalence of MetS among the patients with acute ischemic stroke in the study is 58.3%, with more in females (70.3%) than in males (49.7%, p < 0.001). As expected, among the MetS components, elevated waist circumference, elevated triglyceride, high fasting blood glucose and low high density lipoprotein cholesterol (HDL-C) were significantly more prevalent in patients with MetS than those without MetS (all p < 0.001). There was no correlation between MetS itself and the short-term prognosis of acute ischemic stroke. Only hyperglycemia in the serum was shown to have impact on poor functional outcomes in 30 and 90 days after the onset of stroke. CONCLUSIONS The occurrence of MetS among patients with acute ischemic stroke in our study is 58.3%. MetS itself may not be predictive for the short-term prognosis of patients, while hyperglycemia is a significant predictor for poor functional outcomes in our study.
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Affiliation(s)
- Liu Liu
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Lixuan Zhan
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Yisheng Wang
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Chengping Bai
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Jianjun Guo
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Qingyuan Lin
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Donghai Liang
- Department of Environmental Health Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, 2040K, Atlanta, GA, 30322, USA
| | - En Xu
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China.
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Zhang Y, Zhan RX, Chen JQ, Gao Y, Chen L, Kong Y, Zhong XJ, Liu MQ, Chu JJ, Yan GQ, Li T, He M, Huang QR. Pharmacological activation of PPAR gamma ameliorates vascular endothelial insulin resistance via a non-canonical PPAR gamma-dependent nuclear factor-kappa B trans-repression pathway. Eur J Pharmacol 2015; 754:41-51. [PMID: 25687252 DOI: 10.1016/j.ejphar.2015.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 12/16/2022]
Abstract
Vascular endothelial insulin resistance (IR) is a critically initial factor in cardiocerebrovascular events resulted from diabetes and is becoming a worldwide public health issue. Thiazolidinediones (TZDs) are clinical insulin-sensitizers acting through a canonical peroxisome proliferator-activated receptor gamma (PPARγ)-dependent insulin trans-activation pathway. However, it remains elusive whether there are other mechanisms. In current study, we investigated whether TZDs improve endothelial IR induced by high glucose concentration or hyperglycemia via a non-canonical PPARγ-dependent nuclear factor-kappa B (NF-κB) trans-repression pathway. Our results showed that pre-treatment with TZDs dramatically decrease the susceptibility of endothelial cell to IR, while post-treatment notably improve the endothelial IR both in vitro and in vivo. Moreover, TZDs substantially increase the levels of endothelial nitric oxide synthase (eNOS) and inhibitory κB alpha (IκBα), whereas decrease those of the phosphorylated inhibitory κB kinase alpha/beta (phosphor-IKKα/β) and the cytokines including tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cellular adhesion molecule-1 (sVCAM-1), suggesting that TZDs act indeed through a PPARγ-dependent NF-κB trans-repression pathway. These findings highlighted a non-canonical mechanism for TZDs to ameliorate endothelial IR which might provide a potential strategy to prevent and treat the diabetic vascular complications clinically.
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Affiliation(s)
- Ying Zhang
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Ri-Xin Zhan
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Jun-Qun Chen
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Yan Gao
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Li Chen
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Ying Kong
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Xiao-Juan Zhong
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Mei-Qi Liu
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Jia-Jia Chu
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Guo-Qiang Yan
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Teng Li
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Ming He
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China
| | - Qi-Ren Huang
- Jiangxi Provincial Key Laboratory of Basic Pharmacology, Nanchang University, Nanchang 330006, PR China; Department of Pharmacology, Pharmaceutical Science College, Nanchang University, Nanchang 330006, PR China.
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Wang A, Li Z, Luo Y, Liu X, Guo X, Wu S, Zhao X, Jonas JB. Asymptomatic intracranial arterial stenosis and metabolic syndrome: the APAC study. PLoS One 2014; 9:e113205. [PMID: 25463628 PMCID: PMC4251973 DOI: 10.1371/journal.pone.0113205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/05/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose The metabolic syndrome (MetS) is a major risk factor for cardiovascular diseases. We investigated potential associations between MetS and asymptomatic intracranial arterial stenosis (ICAS) in a general population. Methods The community-based “Asymptomatic Polyvascular Abnormalities in Community Study” examined asymptomatic polyvascular abnormalities in a Chinese population aged 40+ years without history of stroke and coronary heart disease. MetS was defined by the International Diabetes Federation criteria. Asymptomatic ICAS was diagnosed by transcranial color-coded Doppler sonography. Results Out of 5393 study participants, asymptomatic ICAS was detected in 713 (13.2%) participants, and MetS in 1323 (24.5%) individuals. Prevalence of asymptomatic ICAS increased significantly from 7.5% to 24.2% with increasing number of MetS components. After adjusting for age, gender, physical activity, body mass index, low-density lipoprotein cholesterol and high-sensitivity C-reactive protein, MetS was significantly associated with asymptomatic ICAS (OR: 1.50; 95%CI: 1.23,1.83). Compared with the subgroup without MetS, the ORs for asymptomatic ICAS increased (P<0.0001) for each of 5 components of MetS from 1.71 (95%CI: 1.27,2.30), to 2.20 (95%CI: 1.63,2.98), 2.79 (95CI: 2.01,3.88), 3.08 (95%CI: 2.11,4.51) and 4.27 (95%CI: 2.22,8.20). Conclusions In multivariate analysis, MetS was an independent and additional factor associated with asymptomatic ICAS. Study participants with 5 MetS components had a 4 times higher risk of asymptomatic ICAS than participants with no MetS component.
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Affiliation(s)
- Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Zhaoxia Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiaoxue Liu
- Department of Cardiology, Tangshan People's Hospital, Tangshan, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- * E-mail: (XG); (SW); (XZ)
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
- * E-mail: (XG); (SW); (XZ)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail: (XG); (SW); (XZ)
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Seegartenklinik Heidelberg, Germany
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Noncardiogenic stroke patients with metabolic syndrome have more border-zone infarction and intracranial artery stenosis. J Stroke Cerebrovasc Dis 2014; 24:629-34. [PMID: 25561314 DOI: 10.1016/j.jstrokecerebrovasdis.2014.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/22/2014] [Accepted: 10/23/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little is known about the clinical character of stroke patients with metabolic syndrome (MetS) in Chinese population. In this hospital-based cross-sectional study, we elucidated the prevalence of MetS among patients with acute noncardiogenic cerebral infarction from south China, the topographic infarction patterns in magnetic resonance imaging, and vascular angiography findings of stroke patients with MetS. METHODS The patients with acute noncardiogenic stroke were clinically evaluated including waistline circumference, blood pressure, glycemia, serum triglyceride, high-density lipoprotein cholesterol level, magnetic resonance imaging, and angiography evaluation, including magnetic resonance angiography, computed tomography angiography, or digital subtraction angiography for intracranial (IC) and extracranial arteries. According to the National Cholesterol Education Program Adult Treatment Panel III criterion, the patients were classified into the MetS and non-MetS groups. RESULTS Among 222 patients studied, the prevalence of MetS was 54.5%, and there were more women in the MetS group than in the non-MetS group (P < .05). Frequency of all the individual factors of MetS was higher in the MetS group than in the non-MetS group (P < .05). The lesion pattern of border-zone (BZ) infarction was more prevalent in MetS patients (P < .05). The frequency of IC artery stenosis was higher in the MetS group than in the non-MetS group (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.0). After adjustment for age and gender, IC stenosis was significantly associated with large waistline circumference (OR, .95; 95% CI, .91-.99). CONCLUSIONS According to our findings, MetS was of high prevalence in noncardiogenic stroke patients in China, and female patients were more likely to have MetS. The MetS patients tended to have more BZ infarctions and more IC artery stenosis than the non-MetS stroke patients.
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