Diabetes Research Center, Faculty of Medicine and Pharmacy, Brussels Free University, Brussels, Belgium.
PLoS One. 2013;8(4):e60117. doi: 10.1371/journal.pone.0060117. Epub 2013 Apr 2.
Determinants of post-acute stroke outcomes in Africa have been less investigated. We assessed the association of metabolic syndrome (MetS) and insulin resistance with post-stroke mortality in patients with first-ever-in-lifetime stroke in the capital city of Cameroon (sub-Saharan Africa).
Patients with an acute first-stroke event (n = 57) were recruited between May and October 2006, and followed for 5 years for mortality outcome. MetS definition was based on the Joint Interim Statement 2009, insulin sensitivity/resistance assessed via glucose-to-insulin ratio, quantitative insulin sensitivity check index and homeostatic model assessment.
Overall, 24 (42%) patients deceased during follow-up. The prevalence of MetS was higher in patients who died after 28 days, 1 year and 5 years from any cause or cardiovascular-related causes (all p≤0.040). MetS was associated with an increased overall mortality both after 1 year (39% vs. 9%) and 5 years of follow-up (55% vs. 26%, p = 0.022). Similarly, fatal events due to cardiovascular-related conditions were more frequent in the presence of MetS both 1 year (37% vs. 9%) and 5 years after the first-ever-in-lifetime stroke (43% vs. 13%, p = 0.017). Unlike biochemical measures of insulin sensitivity and resistance (non-significant), in age- and sex-adjusted Cox models, MetS was associated with hazard ratio (95% CI) of 2.63 (1.03-6.73) and 3.54 (1.00-12.56) respectively for all-cause and cardiovascular mortality 5 years after stroke onset.
The Joint Interim Statement 2009 definition of MetS may aid the identification of a subgroup of black African stroke patients who may benefit from intensification of risk factor management.
在非洲，人们对急性后期卒中结局的影响因素研究较少。我们评估了在喀麦隆首都（撒哈拉以南非洲）首次发生卒中的患者中，代谢综合征（MetS）和胰岛素抵抗与卒中后死亡率的相关性。
2006 年 5 月至 10 月间，我们招募了 57 例急性首发卒中患者，并对其进行了 5 年的死亡率随访。MetS 的定义基于 2009 年联合临时声明，通过血糖与胰岛素比值、定量胰岛素敏感性检查指数和稳态模型评估来评估胰岛素敏感性/抵抗。
总体而言，有 24 例（42%）患者在随访期间死亡。28 天、1 年和 5 年时，无论任何原因或心血管相关原因导致死亡的患者中，MetS 的患病率均较高（均 p≤0.040）。MetS 与 1 年后（39%比 9%）和 5 年后（55%比 26%，p=0.022）的总死亡率增加相关。同样，在首次发生卒中后 1 年（37%比 9%）和 5 年（43%比 13%，p=0.017）时，心血管相关疾病的致死事件也更常见于 MetS 患者。与生化指标评估的胰岛素敏感性和抵抗（无统计学意义）不同，在年龄和性别校正的 Cox 模型中，MetS 与卒中后 5 年的全因死亡率和心血管死亡率的风险比（95%CI）分别为 2.63（1.03-6.73）和 3.54（1.00-12.56）。
2009 年联合临时声明中 MetS 的定义可能有助于确定可能从危险因素管理强化中获益的黑非洲卒中患者亚组。
