title: Components of the metabolic syndrome and risk for first-ever acute ischemic nonembolic stroke in elderly subjects.
abstract: OBJECTIVE
  Metabolic syndrome (MetSyn) represents a constellation of lipid and nonlipid risk factors for cardiovascular disease and is a recognized target for increased behavioral therapy.
  
  
  OBJECTIVE
  The association between acute ischemic/nonembolic stroke and the MetSyn in elderly individuals was assessed in a population-based case-control study in the prefecture of Ioannina, Greece.
  
  
  METHODS
  A total of 163 patients aged older than 70 years admitted with first-ever-in-a-lifetime acute ischemic/nonembolic stroke and 166 controls were included.
  
  
  RESULTS
  The prevalence of MetSyn (defined according to NCEP/ATP III criteria) was high in stroke patients (46.0% versus 15.7%, P<0.001). Compared with controls as a group (with and without MetSyn), stroke patients with the MetSyn showed higher concentrations of triglycerides, lipoprotein(a), uric acid, and fibrinogen, and lower high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I levels. In logistic regression analysis, crude and adjusted odd ratios (ORs) for MetSyn were 5.33 (95% confidence interval [CI], 2.91 to 9.79; P<0.0001) and 2.59 (95% CI, 1.24 to 5.42; P=0.012), respectively. The analysis of interaction between MetSyn and its individual components revealed significant associations with abdominal obesity (adjusted OR, 2.74; 95% CI, 1.15 to 6.50; P=0.02), hypertension (OR, 2.03; 95% CI, 0.91 to 4.49; P=0.08), high fasting glucose levels (OR, 2.95; 95% CI, 1.19 to 7.35; P=0.02), high triglyceride (OR, 5.55; 95% CI, 2.71 to 11.37; P<0.0001]), and low HDL cholesterol (OR, 5.42; 95% CI, 2.85 to 10.30; P<0.0001). Notably, in stroke patients with the MetSyn the inverse relationship between HDL cholesterol levels and ischemic stroke was negated (OR, 1.04; 95% CI, 1.02 to 1.05; P<0.0001).
  
  
  CONCLUSIONS
  MetSyn is associated with an increased risk for acute ischemic/nonembolic stroke in elderly subjects with significant contributions from its individual components. In the presence of MetSyn, HDL cholesterol loses its protective role against ischemic stroke.
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece. hmilioni@cc.uoi.gr
authors.forename: Haralampos J
authors.initials: HJ
authors.lastname: Milionis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Rizos
authors.forename: John
authors.initials: J
authors.lastname: Goudevenos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Seferiadis
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Moses S
authors.initials: MS
authors.lastname: Elisaf
mesh_terms: D000368:Aged; D016632:Apolipoprotein A-I / Q000378:metabolism; D002545:Brain Ischemia / Q000473:pathology*; D016022:Case-Control Studies; D002784:Cholesterol / Q000378:metabolism; D008076:Cholesterol, HDL / Q000378:metabolism; D048909:Diabetes Complications / Q000473:pathology; D003920:Diabetes Mellitus / Q000473:pathology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000473:pathology; D007511:Ischemia; D017270:Lipoprotein(a) / Q000378:metabolism; D008075:Lipoproteins, HDL / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000473:pathology; D009765:Obesity / Q000473:pathology; D016017:Odds Ratio; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology; D014280:Triglycerides / Q000378:metabolism; D014527:Uric Acid / Q000378:metabolism
chemical_list: D016632:Apolipoprotein A-I; D008076:Cholesterol, HDL; D017270:Lipoprotein(a); D008075:Lipoproteins, HDL; D014280:Triglycerides; D014527:Uric Acid; D005340:Fibrinogen; D002784:Cholesterol