Influence of Metabolic Syndrome and General Obesity on the Risk of Ischemic Stroke

Institute of Biomedical Sciences, Academia Sinica, Taiwan.
Stroke (Impact Factor: 5.72). 04/2006; 37(4):1060-4. DOI: 10.1161/01.STR.0000206458.58142.f3
Source: PubMed


In 2005, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guideline lowered the fasting glucose cut point used to define metabolic syndrome (MS). This study investigated the influence of MS on ischemic stroke (IS) risk using both the original and revised definitions. In addition, because abdominal obesity is the measure of obesity used in the guideline to define MS, we also investigated whether general obesity (GOB) should be considered in the definition of MS.
Baseline data from 3453 adults (> or =20 years of age) in the Cardiovascular Diseases Risk Factor Two-Township Study were linked to insurance claim and death certificate records. The 2001 and 2005 NCEP-ATP III definitions were used with Asian and Taiwanese specific cut-off values for waist circumference and body mass index. Hazard ratios of MS and GOB on IS were calculated using Cox models, and the Kaplan-Meier method was used to derive free-of-IS survival curves.
During 10.4 years of follow-up, 132 persons developed IS. Hazard ratios of subjects with 1 to 2 and > or =3 MS component disorders were 2.69 and 4.30, respectively, under the 2001 definition, and 3.16 and 5.15, respectively, under the 2005 definition (all P values <0.05). MS subjects with GOB had reduced survival at a borderline significance level. Adding GOB in the MS definition did not significantly alter the number of subjects with MS nor the ability to predict stroke risk. Replacing abdominal obesity with GOB in MS definition reduced the number slightly and increased the hazard ratio.
MS predicted IS and the 2005 NCEP definition showed a stronger dose-response relationship with IS. Adding GOB to the existing MS definition had limited benefit.

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    • "Please cite this article as: Kang MK, et al, Interplay between polymorphisms in the endothelial nitric oxide synthase (eNOS) gene and metabolic syndrome in determining the risk of ischemic stroke in Koreans, J Neurol Sci (2014), in 2001, this syndrome has received increasing levels of attention [12]. Studies report positive associations between MetS and IS, indicating that the former is an important risk factor for the latter [13] [14] [15] [16]. "
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    ABSTRACT: Background Endothelial nitric oxide synthase (eNOS) gene variants are known to play a role in atherosclerotic development. However, whether interplay between eNOS polymorphisms and metabolic syndrome (MetS) affects ischemic stroke (IS) risk has yet to be discovered. We investigated whether the combined effects of eNOS polymorphisms and MetS influence ischemic stroke risk in Koreans. Methods We genotyped the eNOS -922A > G, -786T > C, 4a4b, and + 894G > T polymorphisms in 531 IS cases and 502 controls using polymerase chain reaction-amplified DNA. We then investigated whether the presence of MetS and the number of MetS risk factors worked with eNOS polymorphisms to influence IS risk. Results IS patients had a significantly higher prevalence of MetS than controls [adjusted odds ratio (AOR) = 2.943, 95% confidence interval (CI), 2.256–3.840, P < 0.0001], and MetS prevalence did not differ between stroke subtypes. The 894GT + TT genotypes were positively associated with IS (AOR = 1.670, 95% CI, 1.208–2.308, P = 0.002), and the -786TC + CC genotypes showed co-morbidity with MetS (AOR = 1.448, 95% CI, 1.401–2.015, P = 0.028). Among subjects with three or more MetS risk factors, the highest AOR value (28.490, 95% CI, 3.162–256.688) was observed for the eNOS -786 TC + CC genotypes. Conclusions The eNOS 894T allele and interplay between the eNOS -786C allele and MetS may predispose Koreans to IS.
    Journal of the Neurological Sciences 09/2014; 344(1-2). DOI:10.1016/j.jns.2014.06.020 · 2.47 Impact Factor
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    • "According to a nationwide population-based survey conducted in Taiwan, obesity prevalence (BMI≥27) in 2002 was 19.2% in men and 13.4% in women.25 Comparing the Taiwanese data with other countries, obesity prevalence was greater in Taiwan than in the other Asian countries, but less than in the western countries.26 Data from the Cardiovascular Diseases Risk Factor Two-Township Study showed that the prevalence of obesity in ischemic stroke patients was 25% in males and 35% in females.27 The authors also found that metabolic syndrome subjects with general obesity exhibited a greater risk of ischemic stroke. "
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    ABSTRACT: Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke, it was successful to increased annual smoke cessation rate through the 2009 Tobacco Hazards Prevention Act and decreased obesity rate through a nationwide weight-loss program conducted by Health Promotion Administration from 2011 to 2013 in Taiwan.
    05/2014; 16(2):59-64. DOI:10.5853/jos.2014.16.2.59
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    • "Several studies have shown that the risk of cardiovascular morbidity and mortality associated with MetS is greater than the risk associated with the individual components, which is linked to a greater metabolic load and inability to maintain physiological functions [8] [9]. MetS has also been found to be a risk factor for dementia [including vascular dementia and Alzheimer's disease (AD)] [10] [11] [12], mild cognitive impairment (MCI), and its associated states (e.g., Age Related Cognitive Decline) [13]. "
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    ABSTRACT: Background: Metabolic syndrome (MetS) is associated with an increased risk of coronary heart diseases and stroke. Results on the association of MetS with dementia and cognitive decline have been inconsistent. Objective: The aim of this study was to examine the association between MetS and longitudinal changes in cognitive function. Methods: Medline, EMBASE, and Scopus databases were searched from inception to June 2013. Longitudinal cohort studies that reported on the association between MetS and change in cognitive function (over two or more time points), were included. Results: Random-effects models were used to assess the pooled effect sizes of longitudinal changes in cognitive function associated with MetS. Thirteen studies were included. The total sample size was 19,522 subjects. Follow up duration ranged from 1 to 16 years. In the total sample, a small association of MetS with cognitive decline was observed (SDM 0.06, 95%CI: -0.001, 0.12; p = 0.05). When age-stratified, a marginal significant association between MetS and cognitive decline was observed in the younger old group (≤70 years; SDM = 0.09, 95%CI: -0.003, 0.19; p = 0.05) but not in the older group (>70 years; SDM = 0.03, 95%CI: -0.05, 0.11; p = 0.48). The meta-regression showed that duration of follow up was not associated with changes in cognitive estimates (β = 0.005; p = 0.30). Conclusions: Age appears to modify the association between MetS and cognitive decline. These results emphasize the importance of age-stratified risk prediction models of dementia in subjects with chronic metabolic disorders.
    Journal of Alzheimer's disease: JAD 02/2014; 41(1). DOI:10.3233/JAD-132279 · 4.15 Impact Factor
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