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Jeong S, Davis CK, Chokkalla AK, Kim B, Park S, Vemuganti R. Fecal microbiota transplantation fails to impart the benefits of circadian-dependent intermittent fasting following ischemic stroke. J Cereb Blood Flow Metab 2025; 45:779-789. [PMID: 39917846 PMCID: PMC11806450 DOI: 10.1177/0271678x251319636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 10/28/2024] [Accepted: 01/21/2025] [Indexed: 02/11/2025]
Abstract
Intermittent fasting (IF) is known to induce significant ischemic tolerance. Diet is a major proponent of gut microbiota, and gut microbial dysbiosis plays a role in post-stroke brain damage. Hence, we currently evaluated whether IF-mediated ischemic tolerance is mediated by gut microbiota. Additionally, circadian cycle is known to modulate post-ischemic outcomes, and thus we further evaluated if gut microbiota would be influenced by prophylactic IF during the inactive phase (fasting during daytime; IIF) or active phase (fasting during nighttime; AIF). The AIF, but not IIF, cohort showed a significantly decreased fecal Firmicutes/Bacteroidetes ratio compared with the ad libitum (AL) cohort. Moreover, the levels of gut microbiota-derived metabolites butyrate and propionate decreased in AL cohort following focal ischemia, whereas they increased in AIF cohort. However, fecal microbiota transplantation (FMT) from IIF or AIF cohort had no significant effects on post-ischemic motor and cognitive function recovery, anxiety-, and depression-like behaviors compared with FMT from AL cohort. Furthermore, FMT from IIF or AIF cohort did not influence the post-ischemic infarct volume, atrophy volume or white matter damage. Overall, the current findings indicate that the beneficial effects of IF after focal ischemia are not mediated by the gut microbiota.
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Affiliation(s)
- Soomin Jeong
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
- Neuroscience Training Program, University of Wisconsin, Madison, WI, USA
| | - Charles K Davis
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Anil K Chokkalla
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Bori Kim
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Sena Park
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
- Neuroscience Training Program, University of Wisconsin, Madison, WI, USA
- William S. Middleton Veterans Hospital, Madison, WI, USA
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2
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Zhang YN, Wu Q, Cui Y, Zhang NN, Chen HS. Metabolic Syndrome and Efficacy of Remote Ischemic Postconditioning in Acute Moderate Ischemic Stroke: A Post Hoc Analysis of the RICAMIS Trial. J Am Heart Assoc 2025; 14:e037859. [PMID: 40079308 DOI: 10.1161/jaha.124.037859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 02/11/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND Metabolic syndrome (METS) is associated with poor outcomes after acute ischemic stroke. This study aimed to investigate the relationship between METS and efficacy of remote ischemic postconditioning (RIPostC) in acute moderate ischemic stroke using the database of the RICAMIS (Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) trial. METHODS AND RESULTS In the RICAMIS trial, eligible participants were patients with acute moderate ischemic stroke within 48 hours of onset who did not receive reperfusion treatment. A total of 1482 patients were enrolled in this secondary analysis, including the METS (602) and non-METS (880) group according to the METS definitions of the Chinese Diabetes Society, which was further subdivided into RIPostC and control subgroups. The primary outcome was excellent functional outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days. The differences in clinical outcomes between the RIPostC subgroup and control subgroup were compared in patients with METS or non-METS, respectively, and the interaction effects of RIPostC treatment assignment with METS status were evaluated. The baseline characteristics between RIPostC and control subgroups across patients with METS and non-METS were well balanced, except the difference in Trial of Org 10 172 in Acute Stroke Treatment stroke mechanism in the METS group. Compared with control, RIPostC was associated with high probability of excellent functional outcome in patients with METS (68.8% versus 56.1%; odds ratio [OR], 1.751 [95% CI, 1.248-2.456]; P=0.001), but not in patients without METS (66.6% versus 64.6%; OR, 1.103 [95% CI, 0.833-1.461]; P=0.494). Notably, a significant interaction effect between treatments (RIPostC or control) by different METS status on excellent functional outcome was observed (P=0.039). CONCLUSIONS The secondary analysis suggests for the first time that RIPostC may provide greater benefit in patients with acute ischemic stroke with METS versus non-METS.
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Affiliation(s)
- Yi-Na Zhang
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Qiong Wu
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Yu Cui
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Nan-Nan Zhang
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Hui-Sheng Chen
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
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3
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Meshkat S, F Duffy S, K Tassone V, Lin Q, Ym Pang H, Jung H, Lou W, Bhat V. Increased odds of metabolic syndrome among adults with depressive symptoms or antidepressant use. Transl Psychiatry 2025; 15:68. [PMID: 40016233 PMCID: PMC11868621 DOI: 10.1038/s41398-025-03289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/14/2025] [Accepted: 02/13/2025] [Indexed: 03/01/2025] Open
Abstract
Metabolic syndrome (MetS) is a condition that includes a cluster of risk factors for cardiovascular disease. In this paper, we aimed to evaluate the association between depressive symptoms, antidepressant use, duration of antidepressant use, antidepressant type and MetS. Data from the 2005-2018 National Health and Nutrition Examination Surveys were used in this study. Adults were included if they responded to the depressive symptoms and prescription medications questionnaires and had measures of blood pressure, waist circumference, triglycerides, high-density lipoprotein, and fasting plasma glucose. Participants were categorized by their antidepressant use (yes/no), type, and duration. This study included 14,875 participants (50.45% females), with 3616 (23.45%) meeting the criteria for MetS. Participants with higher depressive symptom scores (aOR = 1.04, 95% CI: 1.02, 1.05, p < 0.001) or those with depressive symptoms (aOR = 1.42, 95% CI: 1.17, 1.73, p = 0.001) had higher odds of MetS. A similar associations was seen among those who were on antidepressants compared to those who were not on antidepressants (aOR = 1.24, 95% CI: 1.03, 1.50, p = 0.025). Duration of antidepressant use was not significantly associated with MetS. Participants on tricyclic antidepressants had greater odds of MetS compared to those not taking any antidepressants (aOR = 2.27, 95% CI: 1.31, 3.93, p = 0.004). Our study provides evidence of the association between depressive symptoms, antidepressant use, and MetS, highlighting the importance of monitoring metabolic and cardiovascular alterations in individuals of depression.
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Affiliation(s)
- Shakila Meshkat
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sophie F Duffy
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Qiaowei Lin
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hilary Ym Pang
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hyejung Jung
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Mental Health and Addictions Services, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
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4
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Pawluk H, Tafelska-Kaczmarek A, Sopońska M, Porzych M, Modrzejewska M, Pawluk M, Kurhaluk N, Tkaczenko H, Kołodziejska R. The Influence of Oxidative Stress Markers in Patients with Ischemic Stroke. Biomolecules 2024; 14:1130. [PMID: 39334896 PMCID: PMC11430825 DOI: 10.3390/biom14091130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/27/2024] [Accepted: 09/02/2024] [Indexed: 09/30/2024] Open
Abstract
Stroke is the second leading cause of death worldwide, and its incidence is rising rapidly. Acute ischemic stroke is a subtype of stroke that accounts for the majority of stroke cases and has a high mortality rate. An effective treatment for stroke is to minimize damage to the brain's neural tissue by restoring blood flow to decreased perfusion areas of the brain. Many reports have concluded that both oxidative stress and excitotoxicity are the main pathological processes associated with ischemic stroke. Current measures to protect the brain against serious damage caused by stroke are insufficient. For this reason, it is important to investigate oxidative and antioxidant strategies to reduce oxidative damage. This review focuses on studies assessing the concentration of oxidative stress biomarkers and the level of antioxidants (enzymatic and non-enzymatic) and their impact on the clinical prognosis of patients after stroke. Mechanisms related to the production of ROS/RNS and the role of oxidative stress in the pathogenesis of ischemic stroke are presented, as well as new therapeutic strategies aimed at reducing the effects of ischemia and reperfusion.
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Affiliation(s)
- Hanna Pawluk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza 24, 85-092 Bydgoszcz, Poland
| | - Agnieszka Tafelska-Kaczmarek
- Department of Organic Chemistry, Faculty of Chemistry, Nicolaus Copernicus University, Gagarina 7, 87-100 Torun, Poland
| | - Małgorzata Sopońska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza 24, 85-092 Bydgoszcz, Poland
| | - Marta Porzych
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza 24, 85-092 Bydgoszcz, Poland
| | - Martyna Modrzejewska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza 24, 85-092 Bydgoszcz, Poland
| | - Mateusz Pawluk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza 24, 85-092 Bydgoszcz, Poland
| | - Natalia Kurhaluk
- Institute of Biology, Pomeranian University in Slupsk, Arciszewski 22B, 76-200 Slupsk, Poland
| | - Halina Tkaczenko
- Institute of Biology, Pomeranian University in Slupsk, Arciszewski 22B, 76-200 Slupsk, Poland
| | - Renata Kołodziejska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karlowicza 24, 85-092 Bydgoszcz, Poland
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Savaliya R, Chavda V, Patel B, Brahmbhatt R, Figueiredo EG, Chaurasia B. Post-ischemic scars and 'The micro-metabolic-glia-cerebral changes": do we know everything? Neurosurg Rev 2024; 47:455. [PMID: 39168927 DOI: 10.1007/s10143-024-02721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/05/2024] [Accepted: 08/18/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Rutvik Savaliya
- Department of Medicine, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India
| | - Vishal Chavda
- Department of Medicine, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India
- Department of Critical Care, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India
| | - Bipin Patel
- Department of Medicine, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India
- Department of Critical Care, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India
| | - Raxit Brahmbhatt
- Department of Medicine, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India
- Department of Critical Care, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India
| | - Eberval G Figueiredo
- Neurology and Neurosurgery Department, Hospital Das Clinicas FMUSP, University of Sao Paulo, Sao Paulo, Brazil
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
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Dong H, Guo W, Yue R, Sun X, Zhou Z. Nuclear Nicotinamide Adenine Dinucleotide Deficiency by Nmnat1 Deletion Impaired Hepatic Insulin Signaling, Mitochondrial Function, and Hepatokine Expression in Mice Fed a High-Fat Diet. J Transl Med 2024; 104:100329. [PMID: 38237740 PMCID: PMC10957298 DOI: 10.1016/j.labinv.2024.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024] Open
Abstract
Metabolic syndrome (MetS) is a worldwide challenge that is closely associated with obesity, nonalcoholic liver disease, insulin resistance, and type 2 diabetes. Boosting nicotinamide adenine dinucleotide (NAD+) presents great potential in preventing MetS. However, the function of nuclear NAD+ in the development of MetS remains poorly understood. In this study, hepatocyte-specific Nmnat1 knockout mice were used to determine a possible link between nuclear NAD+ and high-fat diet (HFD)-induced MetS. We found that Nmnat1 knockout significantly reduced hepatic nuclear NAD+ levels but did not exacerbate HFD-induced obesity and hepatic triglycerides accumulation. Interestingly, loss of Nmnat1 caused insulin resistance. Further analysis revealed that Nmnat1 deletion promoted gluconeogenesis but inhibited glycogen synthesis in the liver. Moreover, Nmnat1 deficiency induced mitochondrial dysfunction by decreasing mitochondrial DNA (mtDNA)-encoded complexes Ⅰ and Ⅳ, suppressing mtDNA replication and mtRNA transcription and reducing mtDNA copy number. In addition, Nmnat1 depletion affected the expression of hepatokines in the liver, particularly downregulating the expression of follistatin. These findings highlight the importance of nuclear NAD+ in maintaining insulin sensitivity and provide insights into the mechanisms underlying HFD-induced insulin resistance.
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Affiliation(s)
- Haibo Dong
- Center for Translational Biomedical Research, University of North Carolina at Greensboro, North Carolina Research Campus, Kannapolis, North Carolina
| | - Wei Guo
- Center for Translational Biomedical Research, University of North Carolina at Greensboro, North Carolina Research Campus, Kannapolis, North Carolina
| | - Ruichao Yue
- Center for Translational Biomedical Research, University of North Carolina at Greensboro, North Carolina Research Campus, Kannapolis, North Carolina
| | - Xinguo Sun
- Center for Translational Biomedical Research, University of North Carolina at Greensboro, North Carolina Research Campus, Kannapolis, North Carolina
| | - Zhanxiang Zhou
- Center for Translational Biomedical Research, University of North Carolina at Greensboro, North Carolina Research Campus, Kannapolis, North Carolina; Department of Nutrition, University of North Carolina at Greensboro, Greensboro, North Carolina.
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7
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He Q, Wang W, Li H, Xiong Y, Tao C, Ma L, You C. Genetic insights into the risk of metabolic syndrome and its components on stroke and its subtypes: Bidirectional Mendelian randomization. J Cereb Blood Flow Metab 2023; 43:126-137. [PMID: 37198928 PMCID: PMC10638990 DOI: 10.1177/0271678x231169838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 05/19/2023]
Abstract
The role of metabolic syndrome (MetS) on stroke has been explored only in many observational studies. We conducted Mendelian randomization (MR) to clarify whether or not the genetically predicted MetS and its components are causally associated with stroke and its subtypes. Genetic instruments of MetS and its components and outcome data sets for stroke and its subtypes came from the gene-wide association study in the UK Biobank and MEGASTROKE consortium, respectively. Inverse variance weighting was utilized as the main method. Genetically predicted MetS, waist circumference (WC), and hypertension increase the risk of stroke. WC and hypertension are related to increased risk of ischemic stroke. MetS, WC, hypertension, and triglycerides (TG) are causally associated with the increasing of large artery stroke. Hypertension increased the risk of cardioembolic stroke. Hypertension and TG lead to 77.43- and 1.19-fold increases, respectively, in small vessel stroke (SVS) risk. The protective role of high-density lipoprotein cholesterol on SVS is identified. Results of the reverse MR analyses show that stroke is related to hypertension risk. From the genetical variants perspective, our study provides novel evidence that early management of MetS and its components are effective strategies to decrease the risk of stroke and its subtypes.
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Affiliation(s)
- Qiang He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjing Wang
- Department of Pharmacy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Li
- State Key Laboratory of Proteomics, National Center for Protein Sciences at Beijing, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yang Xiong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Potenza A, Gorla G, Carrozzini T, Bersano A, Gatti L, Pollaci G. Lipidomic Approaches in Common and Rare Cerebrovascular Diseases: The Discovery of Unconventional Lipids as Novel Biomarkers. Int J Mol Sci 2023; 24:12744. [PMID: 37628924 PMCID: PMC10454673 DOI: 10.3390/ijms241612744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Stroke remains a major cause of death and disability worldwide. Identifying new circulating biomarkers able to distinguish and monitor common and rare cerebrovascular diseases that lead to stroke is of great importance. Biomarkers provide complementary information that may improve diagnosis, prognosis and prediction of progression as well. Furthermore, biomarkers can contribute to filling the gap in knowledge concerning the underlying disease mechanisms by pointing out novel potential therapeutic targets for personalized medicine. If many "conventional" lipid biomarkers are already known to exert a relevant role in cerebrovascular diseases, the aim of our study is to review novel "unconventional" lipid biomarkers that have been recently identified in common and rare cerebrovascular disorders using novel, cutting-edge lipidomic approaches.
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Affiliation(s)
- Antonella Potenza
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.P.); (G.G.); (T.C.); (G.P.)
| | - Gemma Gorla
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.P.); (G.G.); (T.C.); (G.P.)
| | - Tatiana Carrozzini
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.P.); (G.G.); (T.C.); (G.P.)
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Laura Gatti
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.P.); (G.G.); (T.C.); (G.P.)
| | - Giuliana Pollaci
- Laboratory of Neurobiology and UCV, Neurology IX Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.P.); (G.G.); (T.C.); (G.P.)
- Department of Pharmacological and Biomolecular Sciences, Università di Milano, 20122 Milan, Italy
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Otieno P, Agyemang C, Wao H, Wambiya E, Ng'oda M, Mwanga D, Oguta J, Kibe P, Asiki G. Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2023; 13:e073652. [PMID: 37369405 PMCID: PMC10410889 DOI: 10.1136/bmjopen-2023-073652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence. DESIGN Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES We systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner's chronic care model. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search and screen included studies. Publication bias was assessed using the Doi plot and Luis Furuya Kanamori Index. Meta-analysis was conducted using random effects models. RESULTS In all, we included 10 randomised controlled trials from 11 publications with 4864 participants from six SSA countries (South Africa, Kenya, Nigeria, Eswatini, Ghana and Uganda). The overall quality of evidence based on GRADE criteria was moderate. A random-effects meta-analysis of six studies involving 1754 participants shows that integrated compared with standard care conferred a moderately lower mean SBP (mean difference=-4.85 mm Hg, 95% CI -7.37 to -2.34) for people with cardiometabolic multimorbidity; Hedges' g effect size (g=-0.25, (-0.39 to -0.11). However, integrated care compared with usual care showed mixed results for glycated haemoglobin, depression, medication adherence and quality of life. CONCLUSION Integrated care improved SBP among patients living with cardiometabolic multimorbidity in SSA. More studies on integrated care are required to improve the evidence pool on chronic care models for multimorbidity in SSA. These include implementation studies and cost-effectiveness studies. PROSPERO REGISTRATION NUMBER CRD42020187756.
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Affiliation(s)
- Peter Otieno
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Hesborn Wao
- Research and Related Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Elvis Wambiya
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- African Network of Research Scientists, Nairobi, Kenya
| | - Maurine Ng'oda
- Emerging and Re-emerging infectious Diseases Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Mwanga
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - James Oguta
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- African Network of Research Scientists, Nairobi, Kenya
| | - Peter Kibe
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- African Network of Research Scientists, Nairobi, Kenya
| | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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10
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Otieno P, Asiki G, Wekesah F, Wilunda C, Sanya RE, Wami W, Agyemang C. Multimorbidity of cardiometabolic diseases: a cross-sectional study of patterns, clusters and associated risk factors in sub-Saharan Africa. BMJ Open 2023; 13:e064275. [PMID: 36759029 PMCID: PMC9923299 DOI: 10.1136/bmjopen-2022-064275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To determine the patterns of cardiometabolic multimorbidity and associated risk factors in sub-Saharan Africa (SSA). DESIGN We used data from the WHO STEPwise approach to non-communicable disease risk factor surveillance cross-sectional surveys conducted between 2014 and 2017. PARTICIPANTS The participants comprised 39, 658 respondents aged 15-69 years randomly selected from nine SSA countries using a multistage stratified sampling design. PRIMARY OUTCOME MEASURE Using latent class analysis and agglomerative hierarchical clustering algorithms, we analysed the clustering of cardiometabolic diseases (CMDs) including high blood sugar, hypercholesterolaemia, hypertension and cardiovascular diseases (CVDs) such as heart attack, angina and stroke. Clusters of lifestyle risk factors: harmful salt intake, physical inactivity, obesity, tobacco and alcohol use were also computed. Prevalence ratios (PR) from modified Poisson regression were used to assess the association of cardiometabolic multimorbidity with sociodemographic and lifestyle risk factors. RESULTS Two distinct classes of CMDs were identified: relatively healthy group with minimal CMDs (95.2%) and cardiometabolic multimorbidity class comprising participants with high blood sugar, hypercholesterolaemia, hypertension and CVDs (4.8%). The clusters of lifestyle risk factors included alcohol, tobacco and harmful salt consumption (27.0%), and physical inactivity and obesity (5.8%). The cardiometabolic multimorbidity cluster exhibited unique sociodemographic and lifestyle risk profiles. Being female (PR=1.7, 95% CI (1.5 to 2.0), middle-aged (35-54 years) (3.9 (95% CI 3.2 to 4.8)), compared with age 15-34 years, employed (1.2 (95% CI 1.1 to 1.4)), having tertiary education (2.5 (95% CI 2.0 to 3.3)), vs no formal education and clustering of physical inactivity and obesity (2.4 (95% CI 2.0 to 2.8)) were associated with a higher likelihood of cardiometabolic multimorbidity. CONCLUSION Our findings show that cardiometabolic multimorbidity and lifestyle risk factors cluster in distinct patterns with a disproportionate burden among women, middle-aged, persons in high socioeconomic positions, and those with sedentary lifestyles and obesity. These results provide insights for health systems response in SSA to focus on these clusters as potential targets for integrated care.
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Affiliation(s)
- Peter Otieno
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Gershim Asiki
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Frederick Wekesah
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Lown Scholars Program, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Calistus Wilunda
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Richard E Sanya
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Welcome Wami
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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11
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Cardiometabolic Multimorbidity Associated with Moderate and Severe Disabilities: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana and South Africa. Glob Heart 2023; 18:9. [PMID: 36874442 PMCID: PMC9983501 DOI: 10.5334/gh.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/23/2023] [Indexed: 03/05/2023] Open
Abstract
Background Integrated management of cardiometabolic diseases is crucial in improving the quality of life of older persons. The objective of the study was to identify clusters of cardiometabolic multimorbidity associated with moderate and severe disabilities in Ghana and South Africa. Methods Data were from the World Health Organization (WHO) study on global AGEing and adult health (SAGE) Wave-2 (2015) conducted in Ghana and South Africa. We analysed the clustering of cardiometabolic diseases including angina, stroke, diabetes, obesity, and hypertension with unrelated conditions such as asthma, chronic lung disease, arthritis, cataracts, and depression. The WHO Disability Assessment Instrument version 2.0 was used to assess functional disability. We used latent class analysis to calculate the multimorbidity classes and disability severity levels. Ordinal logistic regression was used to identify the clusters of multimorbidity associated with moderate and severe disabilities. Results Data from 4,190 adults aged over 50 years were analysed. The prevalence of moderate and severe disabilities was 27.0% and 8.9% respectively. Four latent classes of multimorbidity were identified. These included a relatively healthy group with minimal cardiometabolic multimorbidity (63.5%), general and abdominal obesity (20.5%), hypertension, abdominal obesity, diabetes, cataracts, and arthritis (10.0%), and angina, chronic lung disease, asthma, and depression (6.0%). Compared to the participants with minimal cardiometabolic multimorbidity, the odds of moderate and severe disabilities were higher among participants with multimorbidity comprising hypertension, abdominal obesity, diabetes, cataract and arthritis [aOR = 3.0; 95% CI 1.6 to 5.6], and those with angina, chronic lung disease, asthma and depression [aOR = 2.7; 95% CI 1.6 to 4.5]. Conclusions Cardiometabolic diseases among older persons in Ghana and South Africa cluster in distinct multimorbidity patterns that are significant predictors of functional disabilities. This evidence may be useful for defining disability prevention strategies and long-term care for older persons living with or at risk of cardiometabolic multimorbidity in sub-Saharan Africa.
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12
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Park SK, Jung JY, Kim MH, Oh CM, Ha E, Shin SS, Lee HC, Hwang WY, Ryoo JH. The association between changes in proteinuria and the risk of cerebral infarction in the Korean population. Diabetes Res Clin Pract 2022; 192:110090. [PMID: 36122864 DOI: 10.1016/j.diabres.2022.110090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Proteinuria is a risk factor for cerebral infarction. It is known that proteinuria can change over time. However, published data is scarce for the association between changes in proteinuria and the risk of cerebral infarction. METHOD Study participants were 276,861 Koreans who were assessed for urine dipstick proteinuria both in 2003-2004 and 2007-2008. They were categorized into four groups by changes in proteinuria over 4 years (negative: negative → negative, resolved: proteinuria ≥ 1+ → negative, incident: negative → proteinuria ≥ 1+, persistent: proteinuria ≥ 1+ → proteinuria ≥ 1 + ). We used multivariate adjusted Cox-proportional hazard model in calculating the adjusted hazard ratios (HR) and 95% confidence interval (CI) for cerebral infarction until 2013 according to changes in proteinuria. RESULT Adjusted HR and 95% CI for cerebral infarction significantly increased in order of persistent, incident, and resolved proteinuria, compared with negative proteinuria (negative: reference, resolved: 1.166 [1.009-1.347], incident: 1.345 [1.188-1.522], and persistent: 1.443 [1.089-1.912]). In gender subgroup analysis, men showed the more clear association between changes in proteinuria and the risk of cerebral infarction (negative: reference, resolved: 1.284 [1.057-1.560], incident: 1.351 [1.149-1.589], and persistent: 1.428 [1.014-2.012]). CONCLUSION All types of proteinuria changes were associated with the increased risk of cerebral infarction, even in participants with once manifested but vanishing proteinuria.
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Affiliation(s)
- Sung Keun Park
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Min-Ho Kim
- Department of Preventive Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea; Informatization Department, Ewha Womans University Seoul Hospital, Seoul, Korea..
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Eunhee Ha
- Department of Occupational and Environment Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Soon Su Shin
- Department of Occupational & Environmental Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
| | - Hyo Choon Lee
- Department of Occupational & Environmental Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
| | - Woo Yeon Hwang
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital, Seoul, Republic of Korea.
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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13
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Narasimhan M, Schwartz R, Halliday G. Parkinsonism and cerebrovascular disease. J Neurol Sci 2021; 433:120011. [PMID: 34686356 DOI: 10.1016/j.jns.2021.120011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
The relationship between cerebrovascular disease and parkinsonism is commonly seen in everyday clinical practice but remains ill-defined and under-recognised with little guidance for the practising neurologist. We attempt to define this association and to illustrate key clinical, radiological and pathological features of the syndrome of Vascular Parkinsonism (VaP). VaP is a major cause of morbidity in the elderly associated with falls, hip fractures and cognitive impairment. Although acute parkinsonism is reported in the context of an acute cerebrovascular event, the vast majority of VaP presents as an insidious syndrome usually in the context of vascular risk factors and radiological evidence of small vessel disease. There may be an anatomic impact on basal ganglia neuronal networks, however the effect of small vessel disease (SVD) on these pathways is not clear. There are now established reporting standards for radiological features of SVD on MRI. White matter hyperintensities and lacunes have been thought to be the representative radiological features of SVD but other features such as the perivascular space are gaining more importance, especially in context of the glymphatic system. It is important to consider VaP in the differential diagnosis of Parkinson disease (PD) and in these situations, neuroimaging may offer diagnostic benefit especially in those patients with atypical presentations or refractoriness to levodopa. Proactive management of vascular risk factors, monitoring of bone density and an exercise program may offer easily attainable therapeutic targets in PD and VaP. Levodopa therapy should be considered in patients with VaP, however the dose and effect may be different from use in PD. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Manisha Narasimhan
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
| | - Raymond Schwartz
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Glenda Halliday
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
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14
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Perkins JD, Akhtar N, Singh R, Kamran A, Ilyas S. Partitioning risk factors for embolic stroke of undetermined source using exploratory factor analysis. Int J Stroke 2021; 17:407-414. [PMID: 33787396 PMCID: PMC8969073 DOI: 10.1177/17474930211009847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Embolic stroke of undetermined source (ESUS) accounts for up to 25% of strokes. Understanding risk factors associated with ESUS is important in reducing stroke burden worldwide. However, ESUS patients are younger and present with fewer traditional risk factors. Significant global variation in ESUS populations also exists making the clinical picture of this type of stroke unclear. Methods and results ESUS patients were pair matched for age, sex, and ethnicity with a group of all other strokes (both n = 331). Exploratory factor analysis was applied in both groups to 14 risk and clinical factors to identify latent factors. In ESUS patients, two latent factors emerged consisting primarily of heart-related variables such as left ventricular wall motion abnormalities, reduced ejection fraction, and increased left atrial volume index, as well as aortic arch atherosclerosis. This is in comparison to the all other strokes group, which was dominated by traditional stroke risk factors. Conclusions Our findings support the existence of a unique pattern of risk factors specific to ESUS. We show that LVWMA and corresponding changes in left heart function are a potential source of emboli in these patients. In addition, the clustering of aortic arch atherosclerosis with left heart factors suggests a causal link. Through the application of exploratory factor analysis, this work contributes to a further understanding of stroke mechanisms in ESUS.
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Affiliation(s)
- Jon D Perkins
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar.,PMARC, University of Edinburgh, Edinburgh, UK
| | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
| | - Rajvir Singh
- Heart Hospital, 36977Hamad Medical Corporation, Doha, Qatar
| | - Asad Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Saadat Ilyas
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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15
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Cortese F, Scicchitano P, Cortese AM, Meliota G, Andriani A, Truncellito L, Calculli G, Giordano P, Ciccone MM. Uric Acid in Metabolic and Cerebrovascular Disorders: A Review. Curr Vasc Pharmacol 2020; 18:610-618. [PMID: 31845632 DOI: 10.2174/1570161118666191217123930] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/09/2019] [Accepted: 11/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies showed a close link between metabolic syndrome (MetS), type 2 diabetes (T2DM) and cerebrovascular diseases. There is considerable debate regarding the role of uric acid (UA) as a risk factor in these conditions. OBJECTIVE The aim of this narrative review is to discuss the links between UA, MetS, T2DM and cerebrovascular disease. METHODS An extensive review has been conducted based on the scientific literature published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and Google Scholar from January to May 2019. Additional relevant studies published after the initial review were also considered during the period of June 2019-October 2019, during which, this manuscript was written. The Mesh Terms considered were: uric acid, antioxidant, oxidant, metabolic syndrome, diabetes, cerebrovascular diseases, stroke, haemorrhagic stroke, neurocognitive disorders, and their combinations. RESULTS The literature review shows a dose-dependent inflammatory action of UA, which occurs with serum concentrations >4 mg/dl (>0.24 mmol/l), representing one of the contributors to the chronic inflammatory process that underlies metabolic and cerebrovascular diseases. CONCLUSION UA, which is associated with arterial hypertension and cardiovascular diseases, represents one of the indicators of oxidative homeostasis. Increasing concentrations represent a status of active inflammation which is observed with metabolic and cerebrovascular diseases.
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Affiliation(s)
| | | | | | - Giovanni Meliota
- Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Andriani
- Cardiology Unit, Giovanni Paolo II Hospital, Policoro (MT), Italy
| | | | | | - Paola Giordano
- Department of Biomedical Science and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Marco M Ciccone
- Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Bari, Italy
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16
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Saeed S, Waje-Andreassen U, Nilsson PM. The association of the metabolic syndrome with target organ damage: focus on the heart, brain, and central arteries. Expert Rev Cardiovasc Ther 2020; 18:601-614. [PMID: 32757786 DOI: 10.1080/14779072.2020.1807327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The metabolic syndrome (MetS) is an adverse metabolic state composed of obesity, hyperglycemia/pre-diabetes, hypertension, and dyslipidemia. It substantially increases the risk of type 2 diabetes, cardiovascular disease (CVD) and mortality, and has a huge impact on public health. AREA COVERED The present review gives an update on the definition and prevalence of MetS, and its impact on cardiac structure and function as well as on the brain and central arteries. The association with CVD and mortality risk is discussed. Focus is mainly directed toward the subclinical target organ damage related to MetS. Data is also critically reviewed to provide evidence on the incremental prognostic value of overall MetS over its individual components. EXPERT COMMENTARY MetS is a clinical risk condition associated with subclinical and clinical CVD and mortality. Roughly, 30% of the world population suffer from MetS. As all components of the MetS are modifiable, optimal preventive and therapeutic measures should be initiated to improve CV risk control, particularly aggressively treating hypertension and hyperglycemia, and encouraging people to adopt healthy lifestyle as early as possible is of great importance.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital , Bergen, Norway
| | | | - Peter M Nilsson
- Department of Clinical Science, Lund University, Skåne University Hospital , Malmö, Sweden
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17
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The Effect of Whole Blood Lead (Pb-B) Levels on Changes in Peripheral Blood Morphology and Selected Biochemical Parameters, and the Severity of Depression in Peri-Menopausal Women at Risk of Metabolic Syndrome or with Metabolic Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145033. [PMID: 32668760 PMCID: PMC7400500 DOI: 10.3390/ijerph17145033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023]
Abstract
The aim of our study was to assess the impact of whole blood lead (Pb-B) levels on changes in peripheral blood morphology and selected biochemical parameters, and the severity of depression in peri-menopausal women at risk of metabolic syndrome (pre-MetS) or with metabolic syndrome (MetS). The study involved 233 women from the general population of the West Pomeranian Province (Poland) aged 44–65 years. The intensity of menopausal symptoms and the severity of depression was examined using the Blatt–Kupperman Index (KI) and the Beck Depression Inventory (BDI). C-reactive protein (CRP), insulin, glucose, glycated hemoglobin (HbA1C), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglyceride levels (TG), cortisol, morphology of blood cells and homeostasis model assessment for insulin resistance (HOMA-IR) and Pb-B was measured. Women with MetS had higher levels of glucose, HbA1C, HDL, LDL, TG, cortisol, insulin and higher HOMA-IR. No significant differences in Pb-B were observed between pre-MetS and the control group, and between pre-MetS and the MetS group. A significant correlation was noticed between Pb-B vs. the percentage of monocytes in blood, and blood cortisol levels in women with MetS; Pb-B vs. lymphocyte count and HbA1C in the pre-MetS group, as well as in the BDI scores between the MetS and pre-MetS group. We cannot clearly state that exposure to Pb is an environmental factor that can be considered as a risk factor for MetS in this studied group.
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18
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Lan Q, Wu H, Zhou X, Zheng L, Lin F, Meng Q, Xi X, Yue A, Buys N, Sun J, Liu Z, Li J, Fan H. Predictive Value of Uric Acid Regarding Cardiometabolic Disease in a Community-Dwelling Older Population in Shanghai: A Cohort Study. Front Med (Lausanne) 2020; 7:24. [PMID: 32118009 PMCID: PMC7025523 DOI: 10.3389/fmed.2020.00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/16/2020] [Indexed: 11/24/2022] Open
Abstract
Aim: This study aimed to test the predictive power of serum uric acid (UA) levels on new-onset cardiometabolic risk in the Chinese population. Methods: Older people who visited a community health center for a yearly health check (N = 5,000; men: 47%, women: 53%) were enrolled. Participants were followed for 4 years from baseline (median: 48 months), with the endpoints being development of heart failure, atrial fibrillation, diabetes, hypertension, metabolic syndrome, or kidney disease. Results: During follow-up, 342 men (7.4%) and 360 women (8.6%) developed hypertension; 98 men (2.48%) and 135 women (3.06%) developed diabetes; and 175 men (5.04%) and 214 women (4.51%) developed metabolic syndrome. Incident diabetes, hypertension, and metabolic syndrome increased with increased UA levels at baseline (P < 0.001). A multivariate Cox proportional hazards analysis revealed a significant, independent association between the baseline UA level and the onset and future hypertension and/or diabetes in both men and women. However, UA is associated with the development of metabolic syndrome in men, but not in women. Conclusion: UA is an independent predictor of new-onset diabetes and hypertension in both women and men and a predictor of new-onset metabolic syndrome only in men.
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Affiliation(s)
- Qin Lan
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Hong Wu
- Gaohang Community Hospital, Pudong New Area, Shanghai, China
| | - Xiaohui Zhou
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Liang Zheng
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Fang Lin
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Qingshu Meng
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Xiaoling Xi
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Aixue Yue
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Nicholas Buys
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Zhongmin Liu
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Jue Li
- School of Medicine, Tongji University, Shanghai, China
| | - Huimin Fan
- Shanghai East Hospital, Tongji University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
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19
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Chen Z, Su M, Li Z, Du H, Zhang S, Pu M, Zhang Y. Metabolic Syndrome Predicts Poor Outcome in Acute Ischemic Stroke Patients After Endovascular Thrombectomy. Neuropsychiatr Dis Treat 2020; 16:2045-2052. [PMID: 32982243 PMCID: PMC7494389 DOI: 10.2147/ndt.s264300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS The metabolic syndrome (MetS) is believed to contribute to a higher probability of developing cardiovascular diseases. This study aimed to investigate whether MetS could predict the prognosis in ischemic stroke patients after endovascular thrombectomy (EVT). METHODS Between January 2016 and September 2019, patients treated with EVT due to large vessel occlusions in anterior circulation were prospectively recruited. MetS was defined using the International Diabetes Federation criteria after admission. The primary outcome was a 3-month poor outcome (modified Rankin scale score of 3-6). Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 3 months. Multivariable logistic regression models were used to assess the relationship between MetS and clinical outcomes. RESULTS A total of 248 patients were enrolled (mean age, 66.7 years; 37.5% female) and 114 (46.0%) met with the MetS criteria. The median National Institutes of Health Stroke Scale score was 15.0. There were 131 (52.8%) patients achieving the poor outcome at 3 months, among which 26 (10.5%) patients developed sICH. The mortality at 3 months was 19.0% (47/248). In multivariable analysis, MetS was significantly correlated to poor outcome (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.29-4.78, P = 0.014). The risk for poor outcome was positively associated with the increased number of MetS components (OR 1.78; 95% CI 1.39-2.35, P = 0.001). No significant findings were found in the association of MetS with sICH and mortality. CONCLUSION Our data demonstrated that MetS was associated with poor prognosis in acute ischemic patients treated with EVT.
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Affiliation(s)
- Zhonglun Chen
- Department of Neurology, MianYang Central Hospital, Mianyang, Sichuan 621000, People's Republic of China
| | - Mouxiao Su
- Department of Neurology, MianYang Central Hospital, Mianyang, Sichuan 621000, People's Republic of China
| | - Zhaokun Li
- Department of Neurology, MianYang Central Hospital, Mianyang, Sichuan 621000, People's Republic of China
| | - Hongcai Du
- Department of Neurology, MianYang Central Hospital, Mianyang, Sichuan 621000, People's Republic of China
| | - Shanshan Zhang
- Department of Neurology, MianYang Central Hospital, Mianyang, Sichuan 621000, People's Republic of China
| | - Mingjun Pu
- Department of Neurology, MianYang Central Hospital, Mianyang, Sichuan 621000, People's Republic of China
| | - Yun Zhang
- Department of Neurology, MianYang Central Hospital, Mianyang, Sichuan 621000, People's Republic of China
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20
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Metabolic syndrome and its components in premenopausal and postmenopausal women: a comprehensive systematic review and meta-analysis on observational studies. Menopause 2019; 25:1155-1164. [PMID: 29787477 DOI: 10.1097/gme.0000000000001136] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To perform a meta-analysis on the global prevalence of metabolic syndrome (MetS) in postmenopausal women. The meta-analysis also sought to measure the relationship menopause status has with MetS and its components. METHODS The Web of Science, Medline, PubMed, Scopus, Embase, CINAHL, DOAJ, and Google Scholar were all searched using the relevant keywords. Articles published during the period 2004 to 2017 that met our inclusion criteria and reported the prevalence of MetS among premenopausal and postmenopausal women were included. In the presence of heterogeneity, random-effects models were used to pool the prevalence and odds ratios (ORs), as measures of association in cross-sectional and comparative cross-sectional studies, respectively. RESULTS The prevalence of MetS among postmenopausal women (119 studies [n = 95,115]) and the OR comparing the prevalence of MetS among postmenopausal and premenopausal women (23 studies [n = 66,801]) were pooled separately. The pooled prevalence of MetS among postmenopausal women was found to be 37.17% (95% confidence interval [CI] 35.00%-39.31%), but varied from 13.60% (95% CI 13.55%-13.64%) to 46.00% (95% CI 1.90%-90.09%), depending upon the diagnostic criteria used. The overall pooled OR for MetS in postmenopausal women, compared with premenopausal women, was OR 3.54 (95% CI 2.92-4.30), but this ranged from OR 2.74 (95% CI 1.32-5.66) to OR 5.03 (95% CI 2.25-11.22), depending upon the criteria used. Furthermore, the odds of high fasting blood sugar (OR 3.51, 95% CI 2.11-5.83), low high-density lipoprotein cholesterol (OR 1.45, 95% CI 1.03-2.03), high blood pressure (OR 3.95, 95% CI 2.01-7.78), high triglycerides (OR 3.2, 95% CI 2.37-4.31), and high waist circumference (OR 2.75, 95% CI 1.80-4.21) were all found to be higher in postmenopausal women than in premenopausal women. CONCLUSIONS The prevalence of MetS is relatively high in postmenopausal women and was more prevalent among postmenopausal than premenopausal women. Menopausal hormone therapy should be used with caution in patients with MetS, as its safety has not yet been evaluated among MetS patients and meticulous evaluation of each individual patient before starting MHT is needed.
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21
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Mosimah CI, Murray PJ, Simpkins JW. Not all clots are created equal: a review of deficient thrombolysis with tissue plasminogen activator (tPA) in patients with metabolic syndrome. Int J Neurosci 2018; 129:612-618. [PMID: 30465701 DOI: 10.1080/00207454.2018.1550400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Metabolic syndrome is a cluster of cardiovascular risk factors associated with a prothrombotic, proinflammatory and hypofibrinolysis state. Although resistance to tissue plasminogen activator (tPA) in metabolic syndrome patients has been associated with a defective fibrinolytic system, the factors and mechanisms underlining such resistance is unclear. While there is a great debate on proposed mechanisms, fundamental questions regarding resistance to tPA in metabolic syndrome patients with ischemic stroke remain unanswered. This article reviews articles and documents published between 2001 and 2017, and provides an overview of metabolic syndrome, factors associated with tPA resistance in metabolic syndrome, conflicting evidence of insufficient dosing of tPA in overweight/obese patients and future directions for research.
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Affiliation(s)
- Charles I Mosimah
- a Department of Clinical and Translational Sciences , West Virginia University , Morgantown , WV , USA
| | - Pamela J Murray
- b Department of Pediatrics , West Virginia University , Morgantown , WV , USA
| | - James W Simpkins
- c Department of Physiology Pharmacology & Neuroscience , West Virginia University , Morgantown , WV , USA
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22
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González HM, Tarraf W, Vásquez P, Sanderlin AH, Rosenberg NI, Davis S, Rodríguez CJ, Gallo LC, Thyagarajan B, Daviglus M, Khambaty T, Cai J, Schneiderman N. Metabolic Syndrome and Neurocognition Among Diverse Middle-Aged and Older Hispanics/Latinos: HCHS/SOL Results. Diabetes Care 2018; 41:1501-1509. [PMID: 29716895 PMCID: PMC6014545 DOI: 10.2337/dc17-1896] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hispanics/Latinos have the highest risks for metabolic syndrome (MetS) in the U.S. and are also at increased risk for Alzheimer disease. In this study, we examined associations among neurocognitive function, MetS, and inflammation among diverse middle-aged and older Hispanics/Latinos. RESEARCH DESIGN AND METHODS Cross-sectional data (2008-2011) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analyzed to examine associations between neurocognition and MetS among diverse Hispanics/Latinos (N = 9,136; aged 45-74 years). RESULTS MetS status was associated with lower global neurocognition, mental status, verbal learning and memory, verbal fluency, and executive function. Age significantly modified the associations between MetS and learning and memory measures. Significant associations between MetS and neurocognition were observed among middle-aged Hispanics/Latinos, and all associations remained robust to additional covariates adjustment. CONCLUSIONS We found that MetS was associated with lower neurocognitive function, particularly in midlife. Our findings support and extend current hypotheses that midlife may be a particularly vulnerable developmental period for unhealthy neurocognitive aging.
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Affiliation(s)
- Hector M González
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare Sciences, Wayne State University, Detroit, MI
| | - Priscilla Vásquez
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA
| | - Ashley H Sanderlin
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Natalya I Rosenberg
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Sonia Davis
- Collaborative Studies Coordinating Center, Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Carlos J Rodríguez
- Departments of Medicine and Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Linda C Gallo
- Institute for Behavioral and Community Health and Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center Fairview, Minneapolis, MN
| | - Martha Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Tasneem Khambaty
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Muratov FK, Shermukhamedova FK, Batocyrenov BV, Haritonova TV. [Influence of multimodal effect of cytoflavin in the acute brain stroke in patients with metabolic syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:44-47. [PMID: 28139625 DOI: 10.17116/jnevro201611612144-47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present the results of a multicenter study on efficacy of cytoflavin in the treatment of patients with acute ischemic stroke. One hundred and twenty patients (60 of main group and 60 of control group) were enrolled in the study. All patients received basic therapy aimed at to improve systemic hemodynamics. Rheological blood properties and to prevent stroke complications. Patients of main group were treated with cytoflavin as follows: 1-10 days -20 ml (in200 ml of 0.9% NaCl solution) twice a day intravenously in groups: 11-35 days -850 mg twice a day. We assessed dynamics of restoration of lost functions (NIHSS, Rankin scale, Barthel index) and volume of ischemic lesion (KT, diffusion-weighted image). We reveled a trend towards effect of cytoflavin on the preservations of brain mater in acute phase of stroke. Cytoflavin reduced neurological deficit and improved activities of daily living in patients that may be explained by less brain damage.
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Affiliation(s)
| | | | - B V Batocyrenov
- Dzhanelidze St. Petersburg Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - T V Haritonova
- Dzhanelidze St. Petersburg Research Institute of Emergency Medicine, St. Petersburg, Russia
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24
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Farooqui AA, Farooqui T. Effects of Western, Mediterranean, Vegetarian, and Okinawan Diet Patterns on Human Brain. ROLE OF THE MEDITERRANEAN DIET IN THE BRAIN AND NEURODEGENERATIVE DISEASES 2018:317-332. [DOI: 10.1016/b978-0-12-811959-4.00020-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Olaya B, Moneta MV, Caballero FF, Tyrovolas S, Bayes I, Ayuso-Mateos JL, Haro JM. Latent class analysis of multimorbidity patterns and associated outcomes in Spanish older adults: a prospective cohort study. BMC Geriatr 2017; 17:186. [PMID: 28821233 PMCID: PMC5563011 DOI: 10.1186/s12877-017-0586-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/10/2017] [Indexed: 01/08/2023] Open
Abstract
Background This study sought to identify multimorbidity patterns and determine the association between these latent classes with several outcomes, including health, functioning, disability, quality of life and use of services, at baseline and after 3 years of follow-up. Methods We analyzed data from a representative Spanish cohort of 3541 non-institutionalized people aged 50 years old and over. Measures were taken at baseline and after 3 years of follow-up. Latent Class Analysis (LCA) was conducted using eleven common chronic conditions. Generalized linear models were conducted to determine the adjusted association of multimorbidity latent classes with several outcomes. Results 63.8% of participants were assigned to the “healthy” class, with minimum disease, 30% were classified under the “metabolic/stroke” class and 6% were assigned to the “cardiorespiratory/mental/arthritis” class. Significant cross-sectional associations were found between membership of both multimorbidity classes and poorer memory, quality of life, greater burden and more use of services. After 3 years of follow-up, the “metabolic/stroke” class was a significant predictor of lower levels of verbal fluency while the two multimorbidity classes predicted poor quality of life, problems in independent living, higher risk of hospitalization and greater use of health services. Conclusions Common chronic conditions in older people cluster together in broad categories. These broad clusters are qualitatively distinct and are important predictors of several health and functioning outcomes. Future studies are needed to understand underlying mechanisms and common risk factors for patterns of multimorbidity and to propose more effective treatments. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0586-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beatriz Olaya
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain. .,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Maria Victoria Moneta
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Francisco Félix Caballero
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Stefanos Tyrovolas
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ivet Bayes
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - José Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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de Melo LGP, Nunes SOV, Anderson G, Vargas HO, Barbosa DS, Galecki P, Carvalho AF, Maes M. Shared metabolic and immune-inflammatory, oxidative and nitrosative stress pathways in the metabolic syndrome and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78:34-50. [PMID: 28438472 DOI: 10.1016/j.pnpbp.2017.04.027] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/27/2017] [Accepted: 04/08/2017] [Indexed: 02/08/2023]
Abstract
This review examines the shared immune-inflammatory, oxidative and nitrosative stress (IO&NS) and metabolic pathways underpinning metabolic syndrome (MetS), bipolar disorder (BD) and major depressive disorder (MDD). Shared pathways in both MetS and mood disorders are low grade inflammation, including increased levels of pro-inflammatory cytokines and acute phase proteins, increased lipid peroxidation with formation of malondialdehyde and oxidized low density lipoprotein cholesterol (LDL-c), hypernitrosylation, lowered levels of antioxidants, most importantly zinc and paraoxonase (PON1), increased bacterial translocation (leaky gut), increased atherogenic index of plasma and Castelli risk indices; and reduced levels of high-density lipoprotein (HDL-c) cholesterol. Insulin resistance is probably not a major factor associated with mood disorders. Given the high levels of IO&NS and metabolic dysregulation in BD and MDD and the high comorbidity with the atherogenic components of the MetS, mood disorders should be viewed as systemic neuro-IO&NS-metabolic disorders. The IO&NS-metabolic biomarkers may have prognostic value and may contribute to the development of novel treatments targeting neuro-immune, neuro-oxidative and neuro-nitrosative pathways.
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Affiliation(s)
- Luiz Gustavo Piccoli de Melo
- Department of Clinical Medicine, Londrina State University (UEL), Health Sciences Centre, Londrina, Paraná, Brazil; Center of Approach and Treatment for Smokers, University Hospital, Londrina State University, University Campus, Londrina, Paraná, Brazil; Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Sandra Odebrecht Vargas Nunes
- Department of Clinical Medicine, Londrina State University (UEL), Health Sciences Centre, Londrina, Paraná, Brazil; Center of Approach and Treatment for Smokers, University Hospital, Londrina State University, University Campus, Londrina, Paraná, Brazil; Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | | | - Heber Odebrecht Vargas
- Department of Clinical Medicine, Londrina State University (UEL), Health Sciences Centre, Londrina, Paraná, Brazil; Center of Approach and Treatment for Smokers, University Hospital, Londrina State University, University Campus, Londrina, Paraná, Brazil; Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Décio Sabbattini Barbosa
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Department of Clinical and Toxicological Analysis, State University of Londrina, Londrina, Paraná, Brazil
| | - Piotr Galecki
- Department of Adult Psychiatry, University of Lodz, Lodz, Poland
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Plovdiv University, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands; Impact Strategic Research Center, Deakin University, Geelong, Australia.
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Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res 2017; 120:472-495. [PMID: 28154098 PMCID: PMC5321635 DOI: 10.1161/circresaha.116.308398] [Citation(s) in RCA: 943] [Impact Index Per Article: 117.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/18/2022]
Abstract
Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.
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Affiliation(s)
- Amelia K Boehme
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Charles Esenwa
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY.
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Sung JY, Chen CI, Hsieh YC, Chen YR, Wu HC, Chan L, Hu CJ, Hu HH, Chiou HY, Chi NF. Comparison of admission random glucose, fasting glucose, and glycated hemoglobin in predicting the neurological outcome of acute ischemic stroke: a retrospective study. PeerJ 2017; 5:e2948. [PMID: 28168113 PMCID: PMC5292024 DOI: 10.7717/peerj.2948] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/30/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hyperglycemia is a known predictor of negative outcomes in stroke. Several glycemic measures, including admission random glucose, fasting glucose, and glycated hemoglobin (HbA1c), have been associated with bad neurological outcomes in acute ischemic stroke, particularly in nondiabetic patients. However, the predictive power of these glycemic measures is yet to be investigated. Methods This retrospective study enrolled 484 patients with acute ischemic stroke from January 2009 to March 2013, and complete records of initial stroke severity, neurological outcomes at three months, and glycemic measures were evaluated. We examined the predictive power of admission random glucose, fasting glucose, and HbA1c for neurological outcomes in acute ischemic stroke. Furthermore, subgroup analyses of nondiabetic patients and patients with diabetes were performed separately. Results Receiver operating characteristic (ROC) analysis revealed that admission random glucose and fasting glucose were significant predictors of poor neurological outcomes, whereas HbA1c was not (areas under the ROC curve (AUCs): admission random glucose = 0.564, p = 0.026; fasting glucose = 0.598, p = 0.001; HbA1c = 0.510, p = 0.742). Subgroup analyses of nondiabetic patients and those with diabetes revealed that only fasting glucose predicts neurological outcomes in patients with diabetes, and the AUCs of these three glycemic measures did not differ between the two groups. A multivariate logistic regression analysis of the study patients indicated that only age, initial stroke severity, and fasting glucose were independent predictors of poor neurological outcomes, whereas admission random glucose and HbA1c were not (adjusted odds ratio: admission random glucose = 1.002, p = 0.228; fasting glucose = 1.005, p = 0.039; HbA1c = 1.160, p = 0.076). Furthermore, subgroup multivariate logistic regression analyses of nondiabetic patients and those with diabetes indicated that none of the three glycemic measures were associated with poor neurological outcomes. Discussion Fasting glucose is an independent predictor of poor neurological outcomes in patients with acute ischemic stroke and had greater predictive power than that of admission random glucose and HbA1c. The predictive power of glycemic measures for poor neurological outcomes did not differ significantly between the nondiabetic patients and those with diabetes.
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Affiliation(s)
- Jia-Ying Sung
- Department of Neurology, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-I Chen
- Department of Neurology, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chen Hsieh
- The PhD Program of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University , Taipei , Taiwan
| | - Yih-Ru Chen
- School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan
| | - Hsin-Chiao Wu
- School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan
| | - Lung Chan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Han-Hwa Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan
| | - Nai-Fang Chi
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Metabolic Syndrome and the Risk of Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:286-294. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/20/2016] [Accepted: 09/13/2016] [Indexed: 01/24/2023] Open
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Metabolic Syndrome Augments the Risk of Early Neurological Deterioration in Acute Ischemic Stroke Patients Independent of Inflammatory Mediators: A Hospital-Based Prospective Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:8346301. [PMID: 27119010 PMCID: PMC4828543 DOI: 10.1155/2016/8346301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/17/2016] [Indexed: 01/06/2023]
Abstract
Background and Aims. Metabolic syndrome (MetS) has been associated with occurrence and prognosis of ischemic stroke. This study aimed to evaluate whether an association exists between MetS and early neurological deterioration (END) following acute ischemic stroke and the possible role inflammatory biomarkers play. Methods and Results. We conducted a prospective cohort investigation that involved 208 stroke patients within 48 hours from symptom onset. MetS was determined by the modified National Cholesterol Education Program/Adult Treatment Panel III criteria. END was defined as an increase of ⩾1 point in motor power or ⩾2 points in the total National Institutes of Health Stroke Scale (NIHSS) score within 7 days. Univariate logistic regression analysis showed that patients with MetS had a 125% increased risk of END (OR 2.25; 95% CI 1.71–4.86, P = 0.005). After adjustment for fibrinogen and high-sensitivity C-reactive protein, MetS remained significantly correlated to END (OR 2.20; 95% CI 1.10–4.04, P = 0.026) with a 77% elevated risk per additional MetS trait (OR 1.77; 95% CI 1.23–2.58, P = 0.002). Conclusions. This study demonstrated that MetS may be a potential predictor for END after ischemic stroke, which was independent of raised inflammatory mediators.
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Merdzo I, Rutkai I, Tokes T, Sure VNLR, Katakam PVG, Busija DW. The mitochondrial function of the cerebral vasculature in insulin-resistant Zucker obese rats. Am J Physiol Heart Circ Physiol 2016; 310:H830-8. [PMID: 26873973 DOI: 10.1152/ajpheart.00964.2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/03/2016] [Indexed: 12/24/2022]
Abstract
Little is known about mitochondrial functioning in the cerebral vasculature during insulin resistance (IR). We examined mitochondrial respiration in isolated cerebral arteries of male Zucker obese (ZO) rats and phenotypically normal Zucker lean (ZL) rats using the Seahorse XFe24 analyzer. We investigated mitochondrial morphology in cerebral blood vessels as well as mitochondrial and nonmitochondrial protein expression levels in cerebral arteries and microvessels. We also measured reactive oxygen species (ROS) levels in cerebral microvessels. Under basal conditions, the mitochondrial respiration components (nonmitochondrial respiration, basal respiration, ATP production, proton leak, and spare respiratory capacity) showed similar levels among the ZL and ZO groups with the exception of maximal respiration, which was higher in the ZO group. We examined the role of nitric oxide by measuring mitochondrial respiration following inhibition of nitric oxide synthase with N(ω)-nitro-l-arginine methyl ester (l-NAME) and mitochondrial activation after administration of diazoxide (DZ). Both ZL and ZO groups showed similar responses to these stimuli with minor variations.l-NAME significantly increased the proton leak, and DZ decreased nonmitochondrial respiration in the ZL group. Other components were not affected. Mitochondrial morphology and distribution within vascular smooth muscle and endothelium as well as mitochondrial protein levels were similar in the arteries and microvessels of both groups. Endothelial nitric oxide synthase (eNOS) and ROS levels were increased in cerebral microvessels of the ZO. Our study suggests that mitochondrial function is not significantly altered in the cerebral vasculature of young ZO rats, but increased ROS production might be due to increased eNOS in the cerebral microcirculation during IR.
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Affiliation(s)
- Ivan Merdzo
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ibolya Rutkai
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Tunde Tokes
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Venkata N L R Sure
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Prasad V G Katakam
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
| | - David W Busija
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
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Metabolic Syndrome, Its Components, and Diabetes on 5-Year Risk of Recurrent Stroke among Mild-to-Moderate Ischemic Stroke Survivors: A Multiclinic Registry Study. J Stroke Cerebrovasc Dis 2015; 25:626-34. [PMID: 26725129 DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/05/2015] [Accepted: 11/14/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The pieces of evidence regarding whether metabolic syndrome (MetS) is a better predictor than its individual components, especially diabetes, for recurrent stroke are limited. This study aimed to examine these associations. METHODS A total of 1087 ischemic stroke patients were recruited consecutively from 2003 to 2004. They were followed up until the end of 2008. Baseline clinical and laboratory characteristics and new stroke event during follow-up were recorded. MetS was defined by the definition issued by the Chinese Medical Association/Chinese Diabetes Society. RESULTS One hundred forty-three new stroke cases were recorded. After adjusting for baseline age, gender, education, marriage status, subtype stroke, length of index stroke to baseline assessment, history of cardiac diseases, smoking status, drinking status, clinics, aspirin treatment, and fibrinogen by Cox regression models, the risk of recurrent stroke was 43% higher in MetS patients than in non-MetS patients (hazard ratio [HR] = 1.43, 95% confidence interval [CI]: 1.01-2.01). The strength of this association is weaker than MetS individual components such as elevated glycemia (adjusted HR = 1.78, 95% CI: 1.26-2.52), elevated blood pressure (adjusted HR = 1.91, 95% CI: 1.11-3.30), or low high-density lipoprotein cholesterol (adjusted HR = 1.57, 95% CI: 1.08-2.51). Compared with the group with neither MetS nor diabetes, the adjusted risk of recurrent stroke was highest in the group with diabetes (HR = 2.77, 95% CI: 1.66-4.63), followed by those with both MetS and diabetes (HR = 1.91, 95% CI: 1.25-2.94). The risk of recurrent stroke in patients with MetS in the absence of diabetes was similar to those with neither. CONCLUSION MetS is not superior to its individual components in predicting future recurrent stroke in patients who experience mild-to-moderate ischemic stroke.
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Kotani K, Satoh-Asahara N, Nakakuki T, Yamakage H, Shimatsu A, Tsukahara T. Association between metabolic syndrome and multiple lesions of intracranial atherothrombotic stroke: a hospital-based study. Cardiovasc Diabetol 2015; 14:108. [PMID: 26269150 PMCID: PMC4535534 DOI: 10.1186/s12933-015-0272-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/04/2015] [Indexed: 02/01/2023] Open
Abstract
Background With the increasing trend of metabolic syndrome (MetS) and atherothrombotic stroke (which can manifest as stroke lesion multiplicity), studies on the association between MetS and the clinical aspects of atherothrombotic stroke are of great interest. The present study aimed to investigate the association between MetS and multiple atherothrombotic strokes in patients with intracranial atherothrombotic stroke. Methods A retrospective study based on medical charts was conducted among patients (n = 202: 137 men/65 women) who were symptomatically admitted to the hospital with the first-ever atherothrombotic stroke. For the occurrence of multiple lesions of stroke, odds ratio [OR: 95 % confidence interval (CI)] of MetS or its respective components was calculated using logistic regression models. Results Fifty-one percent of the men and 38 % of women with stroke presented multiple regions. MetS was a significant factor that was associated with an increased risk of multiple regions in women [OR 4.3 (95 % CI 1.4–13.5)], but not in men. According to the components of MetS, dyslipidemia was a significant factor that was positively associated with multiple regions in both men [OR 2.0 (95 % CI 1.1–3.7)] and women [OR 3.2 (95 % CI 1.1–9.1)]. Conclusion MetS may be pathophysiologically associated with intracranial atherothrombotic stroke multiplicity in women in particular. Future studies are warranted to confirm the findings.
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Affiliation(s)
- Kazuhiko Kotani
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan. .,Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Japan. .,Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke, Japan.
| | - Noriko Satoh-Asahara
- Division of Diabetic Research, Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan.
| | - Takuya Nakakuki
- Department of Neurosurgery, Hikone Municipal Hospital, Hikone, Japan.
| | - Hajime Yamakage
- Division of Diabetic Research, Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan.
| | - Akira Shimatsu
- Division of Diabetic Research, Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan.
| | - Tetsuya Tsukahara
- Department of Neurosurgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan.
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Liu L, Zhan L, Wang Y, Bai C, Guo J, Lin Q, Liang D, Xu E. Metabolic syndrome and the short-term prognosis of acute ischemic stroke: a hospital-based retrospective study. Lipids Health Dis 2015. [PMID: 26199022 PMCID: PMC4511539 DOI: 10.1186/s12944-015-0080-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is an important risk factor for cerebral ischemic stroke, yet previous studies on the relationship between MetS or its components and acute cerebral infarction have been inconsistent. This study aims to evaluate the effects of MetS and its components on the short-term prognosis of patients with acute ischemic stroke. METHODS Subjects with ischemic stroke of <7-day duration (530 cases) were enrolled. MetS was defined based on the modified criteria of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Demographic data, vascular risk factors, National Institutes of Health Stroke Scale score, the results of physical, laboratory and imaging examinations and clinical outcomes at 30 and 90 days were recorded. Using univariate analysis, we compared different baseline characteristics between patients with MetS and those without MetS. Further, we assessed MetS and its 5 components on the contribution to short-term prognosis of ischemic stroke with multiple logistic regression models after adjusting for age and sex. RESULTS The prevalence of MetS among the patients with acute ischemic stroke in the study is 58.3%, with more in females (70.3%) than in males (49.7%, p < 0.001). As expected, among the MetS components, elevated waist circumference, elevated triglyceride, high fasting blood glucose and low high density lipoprotein cholesterol (HDL-C) were significantly more prevalent in patients with MetS than those without MetS (all p < 0.001). There was no correlation between MetS itself and the short-term prognosis of acute ischemic stroke. Only hyperglycemia in the serum was shown to have impact on poor functional outcomes in 30 and 90 days after the onset of stroke. CONCLUSIONS The occurrence of MetS among patients with acute ischemic stroke in our study is 58.3%. MetS itself may not be predictive for the short-term prognosis of patients, while hyperglycemia is a significant predictor for poor functional outcomes in our study.
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Affiliation(s)
- Liu Liu
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Lixuan Zhan
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Yisheng Wang
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Chengping Bai
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Jianjun Guo
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Qingyuan Lin
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China
| | - Donghai Liang
- Department of Environmental Health Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, 2040K, Atlanta, GA, 30322, USA
| | - En Xu
- Institute of Neurosciences and the Second Affiliated Hospital of Guangzhou Medical University; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, 250 Changgang Dong RD, Guangzhou, 510260, People's Republic of China.
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Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases 2015; 3:418-429. [PMID: 25984516 PMCID: PMC4419105 DOI: 10.12998/wjcc.v3.i5.418] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/14/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.
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Roy-O'Reilly M, McCullough LD. Sex differences in stroke: the contribution of coagulation. Exp Neurol 2014; 259:16-27. [PMID: 24560819 PMCID: PMC4127336 DOI: 10.1016/j.expneurol.2014.02.011] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/09/2014] [Accepted: 02/12/2014] [Indexed: 12/15/2022]
Abstract
Stroke is now the leading cause of adult disability in the United States. Women are disproportionately affected by stroke. Women increasingly outnumber men in the elderly population, the period of highest risk for stroke. However, there is also a growing recognition that fundamental sex differences are present that contribute to differential ischemic sensitivity. In addition, gonadal hormone exposure can impact coagulation and fibrinolysis, key factors in the initiation of thrombosis. In this review we will discuss sex differences in stroke, with a focus on platelets, vascular reactivity and coagulation.
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Affiliation(s)
| | - Louise D McCullough
- University of Connecticut Health Center, School of Medicine, USA; The Stroke Center at Hartford Hospital, USA.
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Ischemia/Reperfusion-induced neovascularization in the cerebral cortex of the ovine fetus. J Neuropathol Exp Neurol 2014; 73:495-506. [PMID: 24806298 DOI: 10.1097/nen.0000000000000071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Information on the effects of injury on neovascularization in the immature brain is limited. We investigated the effects of ischemia on cerebral cortex neovascularization after the exposure of fetuses to 30 minutes of cerebral ischemia followed by 48 hours of reperfusion (I/R-48), 30 minutes of cerebral ischemia followed by 72 hours of reperfusion (I/R-72), or sham control treatment (Non-I/R). Immunohistochemical and morphometric analyses of cerebral cortex sections included immunostaining for glial fibrillary acidic protein and collagen type IV (a molecular component of the vascular basal lamina) to determine the glial vascular network in fetal brains and Ki67 as a proliferation marker. Cerebral cortices from I/R-48 and I/R-72 fetuses exhibited general responses to ischemia, including reactive astrocyte morphology, which was not observed in Non-I/R fetuses. Cell bodies of reactive proliferating astrocytes, along with large end-feet, surrounded the walls of cerebral cortex microvessels in addition to the thick collagen type IV-enriched basal lamina. Morphometric analysis of the Non-I/R group with the I/R-48 and I/R-72 groups revealed increased collagen type IV density in I/R-72 cerebral cortex microvessels (p < 0.01), which also frequently displayed a sprouting appearance characterized by growing tip cells and activated pericytes. Increases in cerebral cortex basic fibroblast growth factor were associated with neovascularization. We conclude that increased neovascularization in fetal cerebral cortices occurs within 72 hours of ischemia.
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Sjöholm A, Skarin M, Churilov L, Nilsson M, Bernhardt J, Lindén T. Sedentary behaviour and physical activity of people with stroke in rehabilitation hospitals. Stroke Res Treat 2014; 2014:591897. [PMID: 24772368 PMCID: PMC3977466 DOI: 10.1155/2014/591897] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/04/2014] [Accepted: 02/06/2014] [Indexed: 12/12/2022] Open
Abstract
Background. Sedentary behaviour is associated with health risks, independent of physical activity. This study aimed to investigate patterns of sedentary behaviour and physical activity among stroke survivors in rehabilitation hospitals. Methods. Stroke survivors admitted to four Swedish hospital-based rehabilitation units were recruited ≥7 days since stroke onset and their activity was measured using behavioural mapping. Sedentary behaviour was defined as lying down or sitting supported. Results. 104 patients were observed (53% men). Participants spent an average of 74% (standard deviation, SD 21%) of the observed day in sedentary activities. Continuous sedentary bouts of ≥1 hour represented 44% (SD 32%) of the observed day. A higher proportion (30%, SD 7%) of participants were physically active between 9:00 AM and 12:30 PM, compared to the rest of the observed day (23%, SD 6%, P < 0.0005). Patients had higher odds of being physically active in the hall (odds ratio, OR 1.7, P = 0.001) than in the therapy area. Conclusions. The time stroke survivors spend in stroke rehabilitation units may not be used in the most efficient way to promote maximal recovery. Interventions to promote reduced sedentary time could help improve outcome and these should be tested in clinical trials.
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Affiliation(s)
- Anna Sjöholm
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Monica Skarin
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Leonid Churilov
- Department of Florey, University of Melbourne, Melbourne, Australia
| | - Michael Nilsson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Hunter Medical Research Institute, Newcastle, Australia
| | - Julie Bernhardt
- Department of Florey, University of Melbourne, Melbourne, Australia
- La Trobe University, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Thomas Lindén
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Florey, University of Melbourne, Melbourne, Australia
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Corona JC, de Souza SC, Duchen MR. PPARγ activation rescues mitochondrial function from inhibition of complex I and loss of PINK1. Exp Neurol 2013; 253:16-27. [PMID: 24374061 DOI: 10.1016/j.expneurol.2013.12.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/05/2013] [Accepted: 12/17/2013] [Indexed: 01/19/2023]
Abstract
Parkinson's disease has long been associated with impaired mitochondrial complex I activity, while several gene defects associated with familial Parkinson's involve defects in mitochondrial function or 'quality control' pathways, causing an imbalance between mitochondrial biogenesis and removal of dysfunctional mitochondria by autophagy. Amongst these are mutations of the gene for PTEN-induced kinase 1 (PINK1) in which mitochondrial function is abnormal. Peroxisome proliferator-activated receptor gamma (PPARγ), a nuclear receptor and ligand-dependent transcription factor, regulates pathways of inflammation, lipid and carbohydrate metabolism, antioxidant defences and mitochondrial biogenesis. We have found that inhibition of complex I in human differentiated SHSY-5Y cells by the complex I inhibitor rotenone irreversibly decrease mitochondrial mass, membrane potential and oxygen consumption, while increasing free radical generation and autophagy. Similar changes are seen in PINK1 knockdown cells, in which potential, oxygen consumption and mitochondrial mass are all decreased. In both models, all these changes were reversed by pre-treatment of the cells with the PPARγ agonist, rosiglitazone, which increased mitochondrial biogenesis, increased oxygen consumption and suppressed free radical generation and autophagy. Thus, rosiglitazone is neuroprotective in two different models of mitochondrial dysfunction associated with Parkinson's disease through a direct impact on mitochondrial function.
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Affiliation(s)
- Juan Carlos Corona
- Department of Cell and Developmental Biology, University College London, London WC1E 6BT, UK
| | - Senio Campos de Souza
- Department of Cell and Developmental Biology, University College London, London WC1E 6BT, UK
| | - Michael R Duchen
- Department of Cell and Developmental Biology, University College London, London WC1E 6BT, UK.
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Uchino K, Lin R, Zaidi SF, Kuwabara H, Sashin D, Bircher N, Chang YF, Hammer MD, Reddy V, Jovin TG, Vora N, Jumaa M, Massaro L, Billigen J, Boada F, Yonas H, Nemoto EM. Increased cerebral oxygen metabolism and ischemic stress in subjects with metabolic syndrome-associated risk factors: preliminary observations. Transl Stroke Res 2013; 1:178-83. [PMID: 22034586 DOI: 10.1007/s12975-010-0028-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypertension, diabetes, obesity, and dyslipidemia are risk factors that characterize metabolic syndrome (MetS), which increases the risk for stroke by 40%. In a preliminary study, our aim was to evaluate cerebrovascular reactivity and oxygen metabolism in subjects free of vascular disease but with one or more of these risk factors. Volunteers (n=15) 59±15 (mean±SD)years of age clear of cerebrovascular disease by magnetic resonance angiography but with one or more risk factors were studied by quantitative positron emission tomography for measure ment of cerebral blood flow, oxygen consumption, oxygen extraction fraction (OEF), and acetazolamide cerebrovascular reactivity. Eight of ten subjects with MetS risk factors had OEF >50%. None of the five without risk factors had OEF >50%. The presence of MetS risk factors was highly correlated with OEF >50% by Fisher's exact test (p<0.007). The increase in OEF was significantly (P<0.001) correlated with cerebral metabolic rate for oxygen. Increased OEF was not associated with compromised acetazolamide cerebrovascular reactivity. Subjects with one or more MetS risk factors are characterized by increased cerebral oxygen consumption and ischemic stress, which may be related to increased risk of cerebrovascular disease and stroke.
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Affiliation(s)
- Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
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Hyperglycemia accelerates apparent diffusion coefficient-defined lesion growth after focal cerebral ischemia in rats with and without features of metabolic syndrome. J Cereb Blood Flow Metab 2013; 33:1556-63. [PMID: 23838826 PMCID: PMC3790923 DOI: 10.1038/jcbfm.2013.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/31/2013] [Accepted: 06/04/2013] [Indexed: 01/04/2023]
Abstract
Poststroke hyperglycemia is associated with a poor outcome yet clinical management is inadequately informed. We sought to determine whether clinically relevant levels of hyperglycemia exert detrimental effects on the early evolution of focal ischemic brain damage, as determined by magnetic resonance imaging, in normal rats and in those modeling the 'metabolic syndrome'. Wistar Kyoto (WKY) or fructose-fed spontaneously hypertensive stroke-prone (ffSHRSP) rats were randomly allocated to groups for glucose or vehicle administration before permanent middle cerebral artery occlusion. Diffusion-weighted imaging was carried out over the first 4 hours after middle cerebral artery occlusion and lesion volume calculated from apparent diffusion coefficient maps. Infarct volume and immunostaining for markers of oxidative stress were measured in the fixed brain sections at 24 hours. Hyperglycemia rapidly exacerbated early ischemic damage in both WKY and ffSHRSP rats but increased infarct volume only in WKY rats. There was only limited evidence of oxidative stress in hyperglycemic animals. Acute hyperglycemia, at clinically relevant levels, exacerbates early ischemic damage in both normal and metabolic syndrome rats. Management of hyperglycemia may have greatest benefit when performed in the acute phase after stroke in the absence or presence of comorbidities.
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Oh MY, Ko SB, Lee SH, Kim C, Ryu WS, Kim CH, Yoon BW. Association between metabolic syndrome and functional outcome in patients with acute ischaemic stroke. Eur J Neurol 2013; 21:177-9. [PMID: 23530656 DOI: 10.1111/ene.12128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/30/2013] [Indexed: 01/04/2023]
Affiliation(s)
- M. Y. Oh
- Department of Neurology; Seoul National University Hospital; Seoul Korea
| | - S. B. Ko
- Department of Neurology; Seoul National University Hospital; Seoul Korea
| | - S. H. Lee
- Department of Neurology; Seoul National University Hospital; Seoul Korea
| | - C. Kim
- Department of Neurology; Seoul National University Hospital; Seoul Korea
| | - W. S. Ryu
- Department of Neurology; Seoul National University Hospital; Seoul Korea
| | - C. H. Kim
- Department of Neurology; Seoul National University Hospital; Seoul Korea
| | - B. W. Yoon
- Department of Neurology; Seoul National University Hospital; Seoul Korea
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Mi D, Zhang L, Wang C, Liu L, Pu Y, Zhao X, Wang Y, Wang Y. Impact of metabolic syndrome on the prognosis of ischemic stroke secondary to symptomatic intracranial atherosclerosis in Chinese patients. PLoS One 2012; 7:e51421. [PMID: 23251528 PMCID: PMC3519650 DOI: 10.1371/journal.pone.0051421] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 11/01/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To analyze the effect of metabolic syndrome (MetS) on prognosis of ischemic stroke secondary to intracranial stenosis in Chinese patients. METHODS A prospective cohort of 701 patients with ischemic stroke, caused by intracranial stenosis, were followed at 3-month intervals for 1 year to monitor development of recurrent stroke or death. Imaging was performed using magnetic resonance angiography. MetS was defined using International Diabetes Federation (IDF) criteria. RESULTS MetS was identified in 26.0% of the cohort of stroke patients. Patients with MetS were more likely to be female, nonsmokers, and more likely to have a prior history of diabetes mellitus, high blood glucose and a family history of stroke than patients without MetS. During 1-year follow-up, patients with MetS had a non-significantly higher rate of stroke recurrence (7.1%) than patients without MetS (3.9%; P = 0.07). There was no difference in mortality (3.3% versus 3.5%, respectively). Multivariate Cox proportional hazards analysis (adjusting for gender, BMI, smoking, diabetes, and LDL-C) identified an association between that 1-year stroke recurrence and the presence of MetS (hazard ratio 2.30; 95% CI: 1.01-5.22) and large waist circumference (hazard ratio: 2.39; 95% CI: 1.05-5.42). However, multivariable analysis adjusting for the individual components of MetS found no significant associations between MetS and stroke recurrence. There were no associations between these parameters and mortality. CONCLUSIONS Chinese patients with symptomatic intracranial atherosclerosis who have MetS, are at higher risk of recurrent stroke than those without MetS. However, MetS was not predictive of stroke recurrence beyond its individual components and one-year mortality.
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Affiliation(s)
- Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
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Abstract
Metabolic syndrome (MetS) is a heterogeneous clinical entity represented by the occurrence of central obesity, hyperlipidaemia, hyperglycaemia and hypertension. The results of previous studies have shown that the probable common underlying pathophysiological factor for MetS is the insulin resistance phenomenon. However, the pathogenesis of the syndrome is still not well known. We present substantial information on MetS and the relationships between stroke and MetS as a compound entity, while individual components of MetS are well known risk factors for both first-in-life and recurrent ischaemic stroke. We also discuss primary and secondary stroke prevention in subjects with MetS.
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Calleja AI, García-Bermejo P, Cortijo E, Bustamante R, Rojo Martínez E, González Sarmiento E, Fernández-Herranz R, Arenillas JF. Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke. Diabetes Care 2011; 34:2413-7. [PMID: 21911778 PMCID: PMC3198275 DOI: 10.2337/dc11-1242] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance (IR) may not only increase stroke risk, but could also contribute to aggravate stroke prognosis. Mainly through a derangement in endogenous fibrinolysis, IR could affect the response to intravenous thrombolysis, currently the only therapy proved to be efficacious for acute ischemic stroke. We hypothesized that high IR is associated with more persistent arterial occlusions and poorer long-term outcome after stroke thrombolysis. RESEARCH DESIGN AND METHODS We performed a prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis. Patients with acute hyperglycemia (≥155 mg/dL) receiving insulin were excluded. IR was determined during admission by the homeostatic model assessment index (HOMA-IR). Poor long-term outcome, as defined by a day 90 modified Rankin scale score ≥ 3, was considered the primary outcome variable. Transcranial Duplex-assessed resistance to MCA recanalization and symptomatic hemorrhagic transformation were considered secondary end points. RESULTS A total of 109 thrombolysed MCA ischemic stroke patients were included (43.1% women, mean age 71 years). The HOMA-IR was higher in the group of patients with poor outcome (P = 0.02). The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile). A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67-43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23-54.44]; P = 0.029). CONCLUSIONS High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis.
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Affiliation(s)
- Ana I Calleja
- Department of Neurology, Stroke Unit, Hospital Clínico Universitario de Valladolid, University of Valladolid, Valladolid, Spain.
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Long-term exposure to high fat diet is bad for your brain: exacerbation of focal ischemic brain injury. Neuroscience 2011; 182:82-7. [DOI: 10.1016/j.neuroscience.2011.03.028] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/11/2011] [Accepted: 03/14/2011] [Indexed: 11/19/2022]
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Institoris A, Snipes JA, Katakam PV, Domoki F, Boda K, Bari F, Busija DW. Impaired vascular responses of insulin-resistant rats after mild subarachnoid hemorrhage. Am J Physiol Heart Circ Physiol 2011; 300:H2080-7. [PMID: 21421821 DOI: 10.1152/ajpheart.01169.2010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Insulin resistance (IR) impairs cerebrovascular responses to several stimuli in Zucker obese (ZO) rats. However, cerebral artery responses after subarachnoid hemorrhage (SAH) have not been described in IR. We hypothesized that IR worsens vascular reactions after a mild SAH. Hemolyzed blood (300 μl) or saline was infused (10 μl/min) into the cisterna magna of 11-13-wk-old ZO (n = 25) and Zucker lean (ZL) rats (n = 25). One day later, dilator responses of the basilar artery (BA) and its side branch (BA-Br) to acetylcholine (ACh, 10(-6) M), cromakalim (10(-7) M, 10(-6) M), and sodium nitroprusside (10(-7) M) were recorded with intravital videomicroscopy. The baseline diameter of the BA was increased both in the ZO and ZL rats 24 h after the hemolysate injection. Saline-injected ZO animals showed reduced dilation to ACh (BA = 9 ± 3 vs. 22 ± 4%; and BA-Br = 23 ± 5 vs. 37 ± 7%) compared with ZL rats. Hemolysate injection blunted the response to ACh in both the ZO (BA = 4 ± 2%; and BA-Br = 12 ± 3%) and ZL (BA = 7 ± 2%; and BA-Br = 11 ± 3%) rats. Cromakalim (10(-6) M)-induced dilation was significantly reduced in the hemolysate-injected ZO animals compared with the saline control (BA = 13 ± 3 vs. 26 ± 5%; and BA-Br = 28 ± 8 vs. 44 ± 9%) and in the hemolysate-injected ZL rats compared with their saline control (BA = 24 ± 4 vs. 32 ± 4%; but not BA-Br = 39 ± 6 vs. 59 ± 9%). No significant difference in sodium nitroprusside reactivity was observed. Western blot analysis of the BA showed a lower baseline level of neuronal nitric oxide synthase expression and an enhanced cyclooxygenase-2 level in the hemolysate-injected ZO animals. In summary, cerebrovascular reactivity to both endothelium-dependent and -independent stimuli is severely compromised by SAH in IR animals.
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Affiliation(s)
- Adam Institoris
- Dept. of Pharmacology, Tulane Univ., 1430 Tulane Ave., SL 83, New Orleans, LA, 70112-2632, USA
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Abstract
The guidelines of the Joint National Committee 7 from the USA on hypertension have unified the normal and high-normal blood pressure categories into a single entity termed ;prehypertension'. In contrast, The European Guidelines for the management of hypertension in 2007 considered ;prehypertensive' to be divided into normal and high-normal blood pressure. These patients with high-normal blood pressure or prehypertension might progress to hypertension over time. Previous studies have shown that high-normal blood pressure is a risk factor for cardiovascular disease (CVD) in Western countries and Japan. The combination of high-normal blood pressure and other cardiovascular risk factors increases the risks of CVD. Recently, metabolic syndrome has also been shown to be a risk factor for CVD. In Japan, the association between metabolic syndrome and CVD was also found to be significant. The risks for CVD incidence were similar among participants who had the same number of components, regardless of the presence of abdominal obesity. In the Japanese guidelines for the management of hypertension published in 2009, patients are considered to be in a high-risk group if they have diabetes, chronic kidney disease, 3 or more risk factors, target organ damage or CVD, even if they have only high-normal blood pressure, and appropriate antihypertensive therapy should be initiated.
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Affiliation(s)
- Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cardiovascular Center, Suita, Japan.
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49
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Zhang WW, Liu CY, Wang YJ, Xu ZQ, Chen Y, Zhou HD. Metabolic syndrome increases the risk of stroke: a 5-year follow-up study in a Chinese population. J Neurol 2009; 256:1493-9. [PMID: 19533205 DOI: 10.1007/s00415-009-5150-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 02/28/2009] [Accepted: 04/17/2009] [Indexed: 02/02/2023]
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.
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Affiliation(s)
- Wei-Wei Zhang
- Department of Neurology, Daping Hospital, The Third Military Medical University, Da Ping, YuZhong District, 400042 Chongqing, China
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50
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Arenillas JF, Sandoval P, Pérez de la Ossa N, Millán M, Guerrero C, Escudero D, Dorado L, López-Cancio E, Castillo J, Dávalos A. The metabolic syndrome is associated with a higher resistance to intravenous thrombolysis for acute ischemic stroke in women than in men. Stroke 2008; 40:344-9. [PMID: 19109538 DOI: 10.1161/strokeaha.108.531079] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The metabolic syndrome (MetS) might confer a higher resistance to intravenous thrombolysis in acute middle cerebral artery (MCA) ischemic stroke. MetS increases the risk of stroke in women to a greater extent than in men. We aimed to investigate whether there might be sex differences in the impact of MetS on the response to intravenous thrombolysis for acute MCA ischemic stroke. METHODS We prospectively studied consecutive ischemic stroke patients, treated with intravenous tissue-type plasminogen activator according to SITS-MOST criteria, with an MCA occlusion on prebolus transcranial Doppler examination. Resistance to thrombolysis was defined as the absence of complete MCA recanalization 24 hours after tissue-type plasminogen activator infusion by transcranial Doppler criteria. MetS was diagnosed according to the criteria established by the American Heart Association/National Heart, Lung, and Blood Institute 2005 statement. RESULTS A total of 125 patients (75 men, 50 women; mean age, 67.6+/-11 years) were included. MetS was diagnosed in 76 (61%) patients. Resistance to clot lysis at 24 hours was observed in 53 (42%) patients. Two multivariate-adjusted, logistic-regression models identified that MetS was associated with a higher resistance to tissue-type plasminogen activator, independently of other significant baseline variables (odds ratio=9.8; 95% CI, 3.5 to 27.8; P=0.0001) and of the individual components of the MetS. The MetS was associated with a significantly higher odds of resistance to thrombolysis in women (odds ratio=17.5; 95% CI, 1.9 to 163.1) than in men (odds ratio=5.1; 95% CI, 1.6 to 15.6; P for interaction=0.0004). CONCLUSIONS The effect of MetS on the resistance to intravenous thrombolysis for acute MCA ischemic stroke appears to be more pronounced in women than in men.
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Affiliation(s)
- Juan F Arenillas
- Department of Neurology, Stroke Unit, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain.
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