Koren-Morag N, Goldbourt U, Tanne D
Division of Epidemiology, Sackler Medical Faculty, Tel Aviv University, Israel.
Stroke. 2005 Jul;36(7):1366-71. doi: 10.1161/01.STR.0000169945.75911.33. Epub 2005 Jun 2.
The combination of risk factors known as the metabolic syndrome is receiving increased attention, but prospective data on the syndrome's association with ischemic cerebrovascular events are scarce. We explored the relation of metabolic syndrome versus frank diabetes with first-ever ischemic stroke or transient ischemic attack (TIA) in a large cohort of patients with atherosclerotic cardiovascular disease.
Patients with coronary heart disease, screened for a clinical trial, underwent an extensive medical evaluation and follow-up for cerebrovascular disease over 4.8 to 8.1 years. National Cholesterol Education Program Adult Treatment Panel III criteria were used to define the metabolic syndrome, with body mass index substituted for waist circumference. Patients with previously diagnosed diabetes or with a fasting plasma glucose level >125 mg/dL (> or =7.0 mmol/L) were considered diabetic.
The study sample comprised 14,284 patients, of which 3703 (26%) fulfilled the criteria for the metabolic syndrome without diabetes and 3500 others (25%) the criteria for diabetes. Adjusting for stroke risk factors, patients with the metabolic syndrome without diabetes exhibited a 1.49-fold increased odds for ischemic stroke or TIA (95% confidence interval [CI], 1.20 to 1.84), whereas those with frank diabetes had a 2.29-fold increased odds (95% CI, 1.88 to 2.78). The relative odds for ischemic stroke or TIA, associated with presence of the metabolic syndrome per se, were 1.39 (95% CI, 1.10 to 1.77) in men but 2.10 (95% CI, 1.26 to 3.51) in women. Although all components of the metabolic syndrome were associated with increased risk for ischemic stroke or TIA, impaired fasting glucose and hypertension were the strongest predictors of risk.
The presence of the metabolic syndrome, even without diabetes, in patients with pre-existing atherosclerotic vascular disease identifies patients at increased risk for ischemic stroke or TIA. The suggestion of more pronounced risk associated with the metabolic syndrome in women deserves further assessment in other cohorts.
被称为代谢综合征的多种危险因素组合正受到越来越多的关注，但关于该综合征与缺血性脑血管事件关联的前瞻性数据却很匮乏。我们在一大群患有动脉粥样硬化性心血管疾病的患者中，探讨了代谢综合征与显性糖尿病和首次缺血性卒中或短暂性脑缺血发作（TIA）之间的关系。
入选一项临床试验的冠心病患者，接受了全面的医学评估，并在4.8至8.1年期间对脑血管疾病进行随访。采用美国国家胆固醇教育计划成人治疗专家组第三次报告的标准来定义代谢综合征，用体重指数替代腰围。既往诊断为糖尿病或空腹血糖水平>125mg/dL（≥7.0mmol/L）的患者被视为糖尿病患者。
研究样本包括14284例患者，其中3703例（26%）符合无糖尿病的代谢综合征标准，另外3500例（25%）符合糖尿病标准。在对卒中危险因素进行校正后，无糖尿病的代谢综合征患者发生缺血性卒中或TIA的几率增加了1.49倍（95%置信区间[CI]，1.20至1.84）；而显性糖尿病患者的几率增加了2.29倍（95%CI，1.88至2.78）。代谢综合征本身与缺血性卒中或TIA相关的相对几率，男性为1.39（95%CI，1.10至1.77），女性为2.10（95%CI，1.26至3.51）。虽然代谢综合征的所有组分均与缺血性卒中或TIA风险增加相关，但空腹血糖受损和高血压是最强的风险预测因素。
在已有动脉粥样硬化性血管疾病的患者中，即使没有糖尿病，代谢综合征的存在也表明患者发生缺血性卒中或TIA的风险增加。代谢综合征在女性中与更显著风险相关的这一提示值得在其他队列中进一步评估。
