title: Metabolic syndrome and fatal outcomes in the post-stroke event: a 5-year cohort study in Cameroon.
abstract: OBJECTIVE
  Determinants of post-acute stroke outcomes in Africa have been less investigated. We assessed the association of metabolic syndrome (MetS) and insulin resistance with post-stroke mortality in patients with first-ever-in-lifetime stroke in the capital city of Cameroon (sub-Saharan Africa).
  
  
  METHODS
  Patients with an acute first-stroke event (n = 57) were recruited between May and October 2006, and followed for 5 years for mortality outcome. MetS definition was based on the Joint Interim Statement 2009, insulin sensitivity/resistance assessed via glucose-to-insulin ratio, quantitative insulin sensitivity check index and homeostatic model assessment.
  
  
  RESULTS
  Overall, 24 (42%) patients deceased during follow-up. The prevalence of MetS was higher in patients who died after 28 days, 1 year and 5 years from any cause or cardiovascular-related causes (all p≤0.040). MetS was associated with an increased overall mortality both after 1 year (39% vs. 9%) and 5 years of follow-up (55% vs. 26%, p = 0.022). Similarly, fatal events due to cardiovascular-related conditions were more frequent in the presence of MetS both 1 year (37% vs. 9%) and 5 years after the first-ever-in-lifetime stroke (43% vs. 13%, p = 0.017). Unlike biochemical measures of insulin sensitivity and resistance (non-significant), in age- and sex-adjusted Cox models, MetS was associated with hazard ratio (95% CI) of 2.63 (1.03-6.73) and 3.54 (1.00-12.56) respectively for all-cause and cardiovascular mortality 5 years after stroke onset.
  
  
  CONCLUSIONS
  The Joint Interim Statement 2009 definition of MetS may aid the identification of a subgroup of black African stroke patients who may benefit from intensification of risk factor management.
authors.affiliation: Diabetes Research Center, Faculty of Medicine and Pharmacy, Brussels Free University, Brussels, Belgium.
authors.forename: Eric Vounsia
authors.initials: EV
authors.lastname: Balti
authors.forename: André Pascal
authors.initials: AP
authors.lastname: Kengne
authors.forename: Jean Valentin Fogha
authors.initials: JV
authors.lastname: Fokouo
authors.forename: Brice Enid
authors.initials: BE
authors.lastname: Nouthé
authors.forename: Eugene
authors.initials: E
authors.lastname: Sobngwi
mesh_terms: D000368:Aged; D002163:Cameroon / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000150:complications*
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