A Cross Sectional study of Metabolic Syndrome in 100 Stroke Patients

1. Ischemic stroke is the most common stroke pattern seen in Indian adults, more prevalent in males than in females; 80% being thrombotic episodes as compared to 12% hemorrhagic ones. 2. The most common territory involved in both ischemic and hemorrhagic stroke was middle cerebral artery (85% and 16.7% respectively).Anterior cerebral artery was not involved in hemorrhagic stroke in this study. 3. In both sexes, ischemic stroke had predilection for left middle cerebral artery (63%) whereas right middle cerebral artery (32%) was most frequently involved in hemorrhagic stroke. 4. In females, sedentary life style (67%) was the most common contributory factor to stroke whereas in males, manual labourers were affected the most by stroke. 5. In both sexes, stroke was most common in the age group>60 years (male-56%; females-73%). 6. Mean age of stroke presentation in this study was 56+ 3 years in males and 63 + 4.2 years in females signifying earlier onset of risk factors in males as compared to females. 7. The prevalence of hypertension in stroke patients was high (77% males, 80% females). 8. The prevalence of diabetes (FBG >126 mg/dl) in stroke patients was higher in females (27%) than in males (17%). 9. Mean triglyceride ( 140.6 + 7 mg/dl in males,147 + 9.8 mg/dl in females) and waist circumference ( 31+ 1.1 inches in males,30+ 1.4 inches in females) were in the normal range in both sexes, whereas mean HDL cholesterol was well below the normal desired range (38.6+ 1.6 mg/dl in males,39+ 2.9mg/dl in females). 10. In both sexes, mean blood pressure was in the stage I hypertensive range and mean fasting blood glucose was in the prediabetic range of 100-125 mg/dl suggesting that both hypertension and diabetes are independent strong risk factors for stroke and prediabetics are prone for macro vascular complications even before they are labeled as diabetics. 11. Most common age group affected in males with FBG> 100 mg/dl was < 40 years (89%). 12. Most frequently affected age group by low HDL cholesterol and high blood pressure in males was > 60 years (62% & 90% respectively) and the same in females was 41-59 years (100% and 88% respectively) emphasizing the high prevalence rate of metabolic syndrome in this age group.41-59 years was the most affected age group due to triglyceride (41%) and waist circumference (28%) parameters. 13. In females, the age group most frequently affected by FBG > 100mg/dl, Waist circumference and Triglyceride was > 60 years (64%, 46%& 46 % respectively). 14) Overall the prevalence of Metabolic syndrome was 53%.It was more prevalent in females (73%) than in males (44%) & all the 5 parameters affected them more than males. 15. Overall, blood pressure was the parameter that contributed most (80%) to metabolic syndrome followed by HDL cholesterol (62%) and FBG (56%) in that order. 16) The parameter that contributed most to metabolic syndrome was high blood pressure in males and low HDL cholesterol in females. 17. In this study, none of the females smoked or consumed alcohol. In males, 73% were smokers and 74% were alcoholics; but only 37% and 44% respectively had metabolic syndrome. Further, 63% non smokers and 44% non alcoholics had metabolic syndrome. This implies that though smoking and alcohol are important risk factors for stroke, they don’t contribute to metabolic syndrome in a significant way. 18. Ischemic stroke was the most common stroke pattern observed in metabolic syndrome patients. 19. Prevalence of both diabetes & hypertension was seen in 19% stroke patients which increased to 26% in metabolic syndrome patients signifying the consistent strong association between these two factors & their strong contribution to the syndrome. 20. HDL Cholesterol significantly contributed to the syndrome in both sexes (73% in males & 72% in females). Also, % of metabolic syndrome patients associated with abnormal HDL levels was also significant (77% in male metabolics &96% in female metabolics). All females with normal HDL levels were non metabolic and only 19% males with normal HDL levels had metabolic syndrome. So both HDL and metabolic syndrome were strongly associated with each other. 21. Triglyceride levels significantly contributed to the syndrome in both sexes (83% in males & 92% in females). Also, metabolic syndrome was associated significantly with high triglyceride in both sexes (65% in males &50 % in females). But 24% males &61% females with normal TGL levels conversely had metabolic syndrome. Both high TGL & Metabolic syndrome were associated with each other but not as strong as low HDL & high blood pressure. 22. Waist circumference significantly contributed to the syndrome in both sexes (90% in males & 100% in females). Also, % of metabolic syndrome patients associated with abnormal waist circumference was significant in both sexes (55% in males &60 % in females). But 28% males & 53% females with normal waist circumference had metabolic syndrome. All female patients with abnormal waist circumference had metabolic syndrome and all nonmetabolics had normal waist circumference showing strong association between waist circumference and metabolic syndrome in them