Division of Pediatric Endocrinology, University of Virginia, Charlottesville (M.D.D.).
Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville (S.L.F., M.L.G.).
Stroke. 2020 Aug;51(8):2548-2552. doi: 10.1161/STROKEAHA.120.028944. Epub 2020 Jun 19.
Ischemic stroke is associated with the metabolic syndrome (MetS) as diagnosed using dichotomous criteria; however, these criteria exhibit racial/ethnic discrepancies. Our goal was to assess whether ischemic stroke risk extended over the spectrum of worsening MetS severity using a sex- and race/ethnicity-specific MetS-severity score.
We used Cox-proportional hazards models to assess the relationship between baseline MetS- score and incident ischemic stroke among participants of the Atherosclerosis Risk in Communities study and Jackson Heart Study who were free from diabetes, coronary heart disease or stroke at baseline, evaluating 13 141 white and black individuals with mean follow-up of 18.6 years.
We found that risk of ischemic stroke increased consistently with MetS severity, with a hazard ratio of 1.75 (95% CI, 1.35-2.27) for those >75th percentile compared to those <25th percentile. This risk was highest for white females (hazard ratio, 2.63 [CI, 1.70-4.07]) though without significant interaction by sex and race. Relationships between stroke and all the individual components of MetS were only noted for white females, though again without sex-race interactions. Hazard ratio's for systolic blood pressure and stroke were significant among all sex/racial subgroups.
Ischemic stroke risk increased over the spectrum of MetS severity in the absence of baseline diabetes mellitus, further implicating potential etiologic risks from processes underlying MetS. Individuals with elevated MetS severity should be counselled toward lifestyle modification to lower ischemic stroke risk.
缺血性卒中与代谢综合征（MetS）相关，其诊断标准为二分类标准；然而，这些标准存在种族/民族差异。我们的目标是使用性别和种族/民族特异性 MetS 严重程度评分评估缺血性卒中风险是否随着 MetS 严重程度的恶化而扩大。
我们使用 Cox 比例风险模型评估了 Atherosclerosis Risk in Communities 研究和 Jackson Heart 研究中基线 MetS 评分与首发缺血性卒中之间的关系，这些研究参与者在基线时无糖尿病、冠心病或卒中，共纳入 13141 名白人和黑人，平均随访时间为 18.6 年。
我们发现，随着 MetS 严重程度的增加，缺血性卒中的风险也持续增加，与第 25 百分位以下的患者相比，第 75 百分位以上的患者发生缺血性卒中的风险比为 1.75（95%CI，1.35-2.27）。这种风险在白人女性中最高（风险比，2.63 [CI，1.70-4.07]），尽管没有按性别和种族进行显著的交互作用。尽管没有性别-种族交互作用，但仅在白人女性中观察到卒中与 MetS 所有个体成分之间的关系。在所有性别/种族亚组中，收缩压和卒中的风险比均具有统计学意义。
在无基线糖尿病的情况下，缺血性卒中风险随着 MetS 严重程度的增加而增加，这进一步提示了 MetS 潜在病因风险。应向 MetS 严重程度升高的个体提供生活方式改变以降低缺血性卒中风险的咨询。
