Skip to main content

Advertisement

SpringerLink
Log in

Metabolic syndrome increases the risk of stroke: a 5-year follow-up study in a Chinese population

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Limited information is available on the relationship between metabolic syndrome and stroke in the Chinese population. The aim of this study was to establish the prevalence of metabolic syndrome in the Chinese population and the relationship between stroke and metabolic syndrome in that population. 2,173 subjects aged 45 years and above without a history of stroke were recruited from six communities in Chongqing city, China. The participants were followed for incident stroke events (ischemic stroke and hemorrhagic stroke) for 5 years. Incidence rates and hazard ratios (HRs) for both subtypes of stroke were stratified by the presence or absence of metabolic syndrome and by each component. Among the subjects, women had a higher prevalence rate of metabolic syndrome than men (26 vs. 19%). As the number of metabolic syndrome components increased, HRs increased significantly, up to 5.1 (95% CI, 1.9–7.4) for ischemic stroke and 3.3 (95% CI, 1.7–5.7) for hemorrhagic stroke. We found that abdominal obesity had the highest HR (2.12, P < 0.001) for ischemic stroke, followed by metabolic syndrome (HR 1.65, P < 0.001). For hemorrhagic stroke, high blood pressure had the highest HR (2.17, P < 0.001), followed by abdominal obesity (HR 1.83, P < 0.001). After 5-year follow-up, the survival rates of stroke events were 94.2% among those with metabolic syndrome and 96.9% among those without. As the number of metabolic syndrome components increased, survival rates decreased progressively, from 99.6% for individuals with none of the components to 90.1% for those with four to five components. The results showed that metabolic syndrome is highly prevalent among the Chinese adult population and is associated with an increased risk for both ischemic stroke and hemorrhagic stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alberti KG, Zimmet P, Shaw J (2005) The metabolic syndrome—a new worldwide definition. Lancet 366:1059–1062

    Article  PubMed  Google Scholar 

  2. Arenillas JF, Moro MA, Davalos A (2007) The metabolic syndrome and stroke: potential treatment approaches. Stroke 38:2196–2203

    Article  PubMed  Google Scholar 

  3. Chen HJ, Bai CH, Yeh WT, Chiu HC, Pan WH (2006) Influence of metabolic syndrome and general obesity on the risk of ischemic stroke. Stroke 37:1060–1064

    Article  PubMed  Google Scholar 

  4. Chien KL, Hsu HC, Sung FC, Su TC, Chen MF, Lee YT (2007) Metabolic syndrome as a risk factor for coronary heart disease and stroke: an 11-year prospective cohort in Taiwan community. Atherosclerosis 194:214–221

    Article  PubMed  CAS  Google Scholar 

  5. Dey DK, Rothenberg E, Sundh V, Bosaeus I, Steen B (2002) Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70-year-olds. J Am Geriatr Soc 50:1510–1518

    Article  PubMed  Google Scholar 

  6. Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet 365:1415–1428

    Article  PubMed  CAS  Google Scholar 

  7. Ford ES, Giles WH, Dietz WH (2002) Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 287:356–359

    Article  PubMed  Google Scholar 

  8. Ford ES (2004) The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study. Atherosclerosis 173:309–314

    Article  PubMed  CAS  Google Scholar 

  9. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O (2003) Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348:383–393

    Article  PubMed  Google Scholar 

  10. Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, Culebras A, Degraba TJ, Gorelick PB, Guyton JR, Hart RG, Howard G, Kelly-Hayes M, Nixon JV, Sacco RL (2006) Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke 37:1583–1633

    PubMed  Google Scholar 

  11. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C (2004) Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 109:433–438

    Article  PubMed  Google Scholar 

  12. Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, Whelton PK, He J (2005) Prevalence of the metabolic syndrome and overweight among adults in China. Lancet 365:1398–1405

    Article  PubMed  Google Scholar 

  13. He J, Gu D, Wu X, Reynolds K, Duan X, Yao C, Wang J, Chen CS, Chen J, Wildman RP, Klag MJ, Whelton PK (2005) Major causes of death among men and women in China. N Engl J Med 353:1124–1134

    Article  PubMed  CAS  Google Scholar 

  14. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K (2004) Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med 164:1066–1076

    Article  PubMed  Google Scholar 

  15. Huang Y, Cheng Y, Wu J, Li Y, Xu E, Hong Z, Li Z, Zhang W, Ding M, Gao X, Fan D, Zeng J, Wong K, Lu C, Xiao J, Yao C (2008) Cilostazol as an alternative to aspirin after ischaemic stroke: a randomised, double-blind, pilot study. Lancet Neurol 7:494–499

    Article  PubMed  CAS  Google Scholar 

  16. Iso H, Imano H, Kitamura A, Sato S, Naito Y, Tanigawa T, Ohira T, Yamagishi K, Iida M, Shimamoto T (2004) Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women. Diabetologia 47:2137–2144

    Article  PubMed  CAS  Google Scholar 

  17. Iso H, Sato S, Kitamura A, Imano H, Kiyama M, Yamagishi K, Cui R, Tanigawa T, Shimamoto T (2007) Metabolic syndrome and the risk of ischemic heart disease and stroke among Japanese men and women. Stroke 38:1744–1751

    Article  PubMed  Google Scholar 

  18. Kahn R, Buse J, Ferrannini E, Stern M (2005) The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28:2289–2304

    Article  PubMed  Google Scholar 

  19. Koren-Morag N, Goldbourt U, Tanne D (2005) Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease. Stroke 36:1366–1371

    Article  PubMed  CAS  Google Scholar 

  20. Kurl S, Laukkanen JA, Niskanen L, Laaksonen D, Sivenius J, Nyyssonen K, Salonen JT (2005) Metabolic syndrome and the risk of stroke in middle-aged men. Stroke 37:806–811

    Article  Google Scholar 

  21. Kurth T, Gaziano JM, Berger K, Kase CS, Rexrode KM, Cook NR, Buring JE, Manson JE (2002) Body mass index and the risk of stroke in men. Arch Intern Med 162:1557–1562

    Article  Google Scholar 

  22. Liu J, Grundy SM, Wang W, Smith SC Jr, Vega GL, Wu Z, Zeng Z, Wang W, Zhao D (2006) Ethnic-specific criteria for the metabolic syndrome: evidence from China. Diabetes Care 29:1414–1416

    Article  PubMed  Google Scholar 

  23. Liu J, Grundy SM, Wang W, Smith SC Jr, Vega GL, Wu Z, Zeng Z, Wang W, Zhao D (2007) Ten-year risk of cardiovascular incidence related to diabetes, prediabetes, and the metabolic syndrome. Am Heart J 153:552–558

    Article  PubMed  Google Scholar 

  24. Malik S, Wong ND, Franklin SS, Kamath TV, L’Italien GJ, Pio JR, Williams GR (2004) Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 110:1245–1250

    Article  PubMed  Google Scholar 

  25. Marroquin OC, Kip KE, Kelley DE, Johnson BD, Shaw LJ, Bairey Merz CN, Sharaf BL, Pepine CJ, Sopko G, Reis SE (2004) Metabolic syndrome modifies the cardiovascular risk associated with angiographic coronary artery disease in women: a report from the Women’s Ischemia Syndrome Evaluation. Circulation 109:714–721

    Article  PubMed  CAS  Google Scholar 

  26. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, Ballantyne CM, Heiss G (2005) The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 28:385–390

    Article  PubMed  Google Scholar 

  27. Milionis HJ, Rizos E, Goudevenos J, Seferiadis K, Mikhailidis DP, Elisaf MS (2005) Components of the metabolic syndrome and risk for first-ever acute ischemic nonembolic stroke in elderly subjects. Stroke 36:1372–1376

    Article  PubMed  Google Scholar 

  28. Najarian RM, Sullivan LM, Kannel WB, Wilson PW, D’Agostino RB, Wolf PA (2006) Metabolic syndrome compared with type 2 diabetes mellitus as a risk factor for stroke: the Framingham Offspring Study. Arch Intern Med 166:106–111

    Article  PubMed  Google Scholar 

  29. Olijhoek JK, van der Graaf Y, Banga JD, Algra A, Rabelink TJ, Visseren FL (2004) The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. Eur Heart J 25(4):342–348

    Article  PubMed  Google Scholar 

  30. Scott CL (2003) Diagnosis, prevention, and intervention for the metabolic syndrome. Am J Cardiol 92(1A):35i–342i

    Article  PubMed  Google Scholar 

  31. Thomas GN, Ho SY, Janus ED, Lam KS, Hedley AJ, Lam TH (2005) The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population. Diabetes Res Clin Pract 67(3):251–257

    Article  PubMed  Google Scholar 

  32. UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853

    Article  Google Scholar 

  33. Wang W, Zhao D, Liu J, Sun JY, Wu GX, Zeng ZC, Liu J, Qin LP, Wu ZS (2004) A prospective study of relationship between blood pressure and 10-year cardiovascular risk in a Chinese cohort aged 35–64 years. Zhonghua Nei Ke Za Zhi 43(10):730–734

    PubMed  Google Scholar 

  34. Wang Y, Mi J, Shan XY, Wang QJ, Ge KY (2007) Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes (Lond) 31(1):177–188

    Article  CAS  Google Scholar 

  35. Wildman RP, Gu D, Reynolds K, Duan X, Wu X, He J (2005) Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults? Am J Clin Nutr 82(6):1195–1202

    PubMed  CAS  Google Scholar 

  36. Zhang Y, Lee ET, Devereux RB, Yeh J, Best LG, Fabsitz RR, Howard BV (2006) Prehypertension, diabetes, and cardiovascular disease risk in a population-based sample: the Strong Heart Study. Hypertension 47(3):410–414

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The study was funded by a grant (No. 2001-54-23) from the Science and Technology Committee of Chongqing, China.

Conflict of interest statement

The authors report no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, Daping Hospital, The Third Military Medical University, Chang Jiang Branch Road 10, Da Ping, YuZhong District, 400042, Chongqing, China

    Wei-Wei Zhang, Chun-Yu Liu, Yan-Jiang Wang, Zhi-Qiang Xu, Yang Chen & Hua-Dong Zhou

Authors
  1. Wei-Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chun-Yu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yan-Jiang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhi-Qiang Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hua-Dong Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hua-Dong Zhou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, WW., Liu, CY., Wang, YJ. et al. Metabolic syndrome increases the risk of stroke: a 5-year follow-up study in a Chinese population. J Neurol 256, 1493–1499 (2009). https://doi.org/10.1007/s00415-009-5150-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-009-5150-2

Keywords

Search

Navigation