Link Between Metabolic Syndrome and Atherothrombotic Stroke
We conducted a retrospective study through an analysis of medical charts (from 2003 to 2006) of patients who were admitted to our hospital with defined intracranial atherothrombotic stroke. The included patients were limited to those with a diagnosis of the first-ever symptomatic stroke. The diagnosis of atherothrombotic stroke was made according to the diagnostic criteria of the National Institute of Neurological Disorders and Stroke by neurological specialists. That is, it was diagnosed in cases with infarcts greater than 1.5 cm in diameter of a major brain and/or branch cortical artery on imaging (a computed tomography and/or magnetic resonance imaging) as possible origins under clinical symptoms of neurological deficits. Strokes in patients with a source of embolus, such as atrial fibrillation, moderate-to-severe valvular heart disease or intra-carotid/cardiac thrombus, were excluded as having a definite or possible cardioembolic stroke. Strokes in patients with an undetermined etiology despite an extensive evaluation were also excluded. The study was approved by the Ethics Committee of Kyoto Medical Center.
A total of 202 patients (137 men and 65 women) were enrolled in the study. The clinical data on the components of MetS and stroke multiplicity in the patients was collected based on the description of the medical records. Like the National Cholesterol Education Program Adult Treatment Panel III (the criterion level for obesity and low HDL-C was modified for Japanese people), the patients were diagnosed as having MetS when the patients had at least three components of MetS. The components were obesity (a body mass index ≥25 kg/m ), high BP (systolic BP ≥130 mmHg, diastolic BP ≥85 mmHg and/or the use of antihypertensive drugs), hyperglycemia (fasting plasma glucose ≥110 mg/dL and/or the use of glucose-lowering drugs), high TG (fasting serum triglyceride ≥150 mg/dL and/or the use of triglyceride-lowering drugs) and low HDL-C (fasting serum HDL-C <40 mg/dL). The components of MetS were according to the laboratory data and/or the description in medical records (e.g., if glucose intolerance was clearly described in the charts, it was treated as being within the hyperglycemic criteria).
The differences between the groups were examined by an independent t test or the Chi square test. For the outcome variable (having multiple lesions of stroke), odds ratio [OR: 95 % confidence interval (CI)] of the explanatory variables (MetS and its components) was calculated using crude and adjusted logistic regression model analyses. In the logistic regression models, high TG and low HDL-C were treated as a dyslipidemic component because few patients had low HDL-C (this is often seen in Japanese people) and the potential collinearity of low HDL-C with high TG (which mirrors the biological nature). The statistical analyses were also performed according to gender. A P value < 0.05 was considered to be statistically significant.
Methods
We conducted a retrospective study through an analysis of medical charts (from 2003 to 2006) of patients who were admitted to our hospital with defined intracranial atherothrombotic stroke. The included patients were limited to those with a diagnosis of the first-ever symptomatic stroke. The diagnosis of atherothrombotic stroke was made according to the diagnostic criteria of the National Institute of Neurological Disorders and Stroke by neurological specialists. That is, it was diagnosed in cases with infarcts greater than 1.5 cm in diameter of a major brain and/or branch cortical artery on imaging (a computed tomography and/or magnetic resonance imaging) as possible origins under clinical symptoms of neurological deficits. Strokes in patients with a source of embolus, such as atrial fibrillation, moderate-to-severe valvular heart disease or intra-carotid/cardiac thrombus, were excluded as having a definite or possible cardioembolic stroke. Strokes in patients with an undetermined etiology despite an extensive evaluation were also excluded. The study was approved by the Ethics Committee of Kyoto Medical Center.
A total of 202 patients (137 men and 65 women) were enrolled in the study. The clinical data on the components of MetS and stroke multiplicity in the patients was collected based on the description of the medical records. Like the National Cholesterol Education Program Adult Treatment Panel III (the criterion level for obesity and low HDL-C was modified for Japanese people), the patients were diagnosed as having MetS when the patients had at least three components of MetS. The components were obesity (a body mass index ≥25 kg/m ), high BP (systolic BP ≥130 mmHg, diastolic BP ≥85 mmHg and/or the use of antihypertensive drugs), hyperglycemia (fasting plasma glucose ≥110 mg/dL and/or the use of glucose-lowering drugs), high TG (fasting serum triglyceride ≥150 mg/dL and/or the use of triglyceride-lowering drugs) and low HDL-C (fasting serum HDL-C <40 mg/dL). The components of MetS were according to the laboratory data and/or the description in medical records (e.g., if glucose intolerance was clearly described in the charts, it was treated as being within the hyperglycemic criteria).
The differences between the groups were examined by an independent t test or the Chi square test. For the outcome variable (having multiple lesions of stroke), odds ratio [OR: 95 % confidence interval (CI)] of the explanatory variables (MetS and its components) was calculated using crude and adjusted logistic regression model analyses. In the logistic regression models, high TG and low HDL-C were treated as a dyslipidemic component because few patients had low HDL-C (this is often seen in Japanese people) and the potential collinearity of low HDL-C with high TG (which mirrors the biological nature). The statistical analyses were also performed according to gender. A P value < 0.05 was considered to be statistically significant.
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