Abstract
Background and PurposeDeterminants 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).MethodsPatients 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.ResultsOverall, 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.ConclusionThe 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.
Highlights
Metabolic syndrome (MetS) is a constellation of conditions which singly are associated with increased risk of cardiovascular diseases (CVD) [1,2]
In the absence of cutoff values specific to populations of African ethnicity, those derived from Caucasians have been recommended in Africans, yet no evidence is available on the correlation of metabolic syndrome (MetS) based on those criteria and major incident health outcomes among black Africans [7,8,9,10]
The prevalence of MetS but not its components was higher in stroke patients who died after 28 days, 1 and 5 years even after adjustment for age and gender
Summary
Metabolic syndrome (MetS) is a constellation of conditions which singly are associated with increased risk of cardiovascular diseases (CVD) [1,2]. The presence of MetS in an individual confers a risk of cardiovascular disease higher than that from each of the components of the syndrome [3,4]. There have been recent efforts to harmonize the clinical definition of MetS by accounting for ethnic differences in the cutoff values of key components such as central obesity and atherogenic dyslipidemia [5,6]. We assessed the association of metabolic syndrome (MetS) and insulin resistance with post-stroke mortality in patients with first-ever-inlifetime stroke in the capital city of Cameroon (sub-Saharan Africa)
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