1. International Journal of Medicine and Medical Sciences Vol. 3(8) pp. 247-251, August 2011
Available online http://www.academicjournals.org/ijmms
ISSN 2006-9723 ©2011 Academic Journals
Full Length Research Paper
Frequency of metabolic syndrome and its’ various
components in patients with ischemic stroke
Shaikh Samiullah*, Soomro Hafiz, Qazi Iftikhar and Shaikh Khalid
Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, Pakistan.
Accepted 4 August, 2011
The aim of this study was to observe the frequency of metabolic syndrome and its’ various components
in patients with ischemic stroke. This descriptive case study was conducted in Liaquat University
Medical and Health Sciences hospital Hyderabad, Pakistan from June 2008 to November 2009. The
study included 357 consecutive patients of either sex, presenting with ischemic stroke. Stroke was
defined as a focal neurological disorder with rapid onset, which persisted at least 24 h or until death
and had a brain Computerised tomography (CT) that showed a compatible low-density lesion. Patients
were diagnosed as metabolic syndrome on the basis of ATPIII criteria which include the presence of at
least three features: 1) blood pressure of at least 130/85 mmHg or treated hypertension, 2) serum
triglyceride level of at least 150 mg/dl (1.7 mmol/l), 3) HDL cholesterol of < 40 mg/dl (1.03 mmol/l) in men
and < 50 mg/dl (1.29 mmol/l) in women, 4) fasting glucose of >100 mg/dl (5.6 mmol/l) or previously
diagnosed with type 2 diabetes and 5) central obesity, waist circumference greater than 90 cm in men
and 80 cm in women according to the ethnic criteria for Asians. Continuous variables were expressed
as range, and categorical variables as frequency and percentage. The chi-square test was applied to
compare categorical variables with ischemic stroke. A p-value of 0.05 was considered as statistically
significant. All calculations were done using SPSS version 16 (Chicago, IL, USA). This study included
357 patients of which 131 (36.7%) were male and 226 (63.3%) were female. The age of the patients range
was from 35 to 95 years. The three components of metabolic syndrome were present in 165 (46.2%)
patients, of which 41 (24.8%) were male and 124 (75.2%) were female. A strong association was found
between waist circumference and low HDL. Metabolic syndrome is a frequent occurrence in patients
with ischemic stroke.
Key words: Ischemic stroke, metabolic syndrome, risk factors.
INTRODUCTION
Stroke is the ninth leading cause of death with more than (Syed et al., 2003). Over the years, much stress has
5.5 million people dying annually, only second after been given to the traditional risk factors such as age,
ischemic heart disease. Stroke not only adds to mortality gender, body mass index (BMI), hypertension, smoking,
but morbidity as well (WHO, 2008). Stroke is now the diabetes mellitus and dyslipidemia as possible contribu-
sixth most common cause of disability adjusted life in ting factors in the development of ischemic stroke.
years (DALYs) in the world (Lopez, 2006). As 85% of the Metabolic syndrome, defined as clustering of fasting
world population resides in low-income and middle - glucose, high blood pressure (BP), high levels of
income countries, the burden of disease is definitely triglyceride (TG), low level of high-density lipoprotein
greater in these countries (Strong et al., 2007). In cholesterol (HDL-C), and abdominal obesity, was first
Pakistan, prevalence of stroke was found to be 4.5% described by Reaven in 1983 (Reaven, 2001). Since
then, metabolic syndrome has been linked to increased
risk of ischemic stroke (Ninomiya et al., 2004). It is pre-
sumed that various components of metabolic syndrome
*Corresponding author. E-mail: shaikhsamiullah@yahoo.com. interacts synergistically thereby accelerating athero-
Tel: 0300-3019233, 022-2771711. sclerosis (Park et al., 2007). The aim of this study was to

2. 248 Int. J. Med. Med. Sci.
Table 1. Baseline characteristics of all patients (n=357).
Characteristic Value
Continuous variable Range Min-maximum
Age (years) 63 35-95
Categorical variable Frequency Percentage
Male 226 63.3
Female 131 36.7
Components of metabolic syndrome Male Female Male Female
Three 41/165 124/165 24.8 75.2
Systolic blood pressure >130 mmHG 65/165 100/165 39.39 60.60
Triglyceride levels >150 mg /dl 62/183 121/183 33.87 66.12
HDL levels < 50 mg/dl female and < 40 mg/dl in male 62/234 172/234 26.49 73.50
waist circumference >90 cm in male and >80 cm in female 123 34.45
FBS >100 mg/dl 126 35.29
FBS = fasting blood sugar; HDL= high density lipoprotein.
observe the frequency of metabolic syndrome and its’ HDL and LDL cholesterol levels. Glucose levels were measured by
various components in patients with ischemic stroke. enzymatic assay using an Eppendorf 5060 auto-analyzer.
Patients were diagnosed as metabolic syndrome on the basis of
ATPIII (Alberti, 2005) criteria which include presence of at least
MATERIALS AND METHODS three features: 1) blood pressure of at least 130/85 mmHg or trea-
ted hypertension, 2) serum triglyceride level of at least 150 mg/dl
This descriptive case study was conducted in Liaquat University (1.7 mmol/l), 3) HDL cholesterol of < 40 mg/dl (1.03 mmol/L) in men
Medical and Health Sciences hospital, Hyderabad, Pakistan from and < 50 mg/dl (1.29 mmol/L) in women, 4) fasting glucose of > 100
June, 2008 to November, 2009. This is a tertiary care hospital for mg/dl (5.6 mmol/l) or previously diagnosed with type 2 diabetes and
about 20 million urban, rural and multi-ethnic populations. The 5) central obesity, waist circumference greater than 90 cm in men
study included 357 consecutive patients of either sex presented and 80 cm in female according to Population- and country-specific
with ischemic stroke. The study was started after approval of the definitions (WHO Expert Consultation, 2004).
university ethical committee. Informed consent was taken from the
patients or their relatives. During the first visit, records were
Statistical procedure
obtained on the patient’s medical history. The conventional risk fac-
tors such as body weight, body mass index (BMI), blood pressure
measurement, history of smoking, a past history of stroke, family Continuous variables such as age was expressed as range with
history of stroke, use of antidiabetic, antihypertensive, and minimum and maximum. Categorical variables such as sex, pres-
antihyperlipidemic drugs were enrolled in well designed proforma. A ence or absence of metabolic syndrome, components of metabolic
complete physical examination was performed. Stroke was defined syndrome HDL levels > or < 50mg/dl in female and > or < 40 mg/dl
as a focal neurological disorder with rapid onset which persisted at in male, waist circumference > or < 90 cm in men and > or < 80 cm
least 24 h or until death and had a brain CT that showed a in women, triglyceride levels > or < 150 mg /dl, fasting glucose of >
compatible low-density lesion (Shimamoto et al., 1989). or < 100 mg/dl, blood pressure of at least 130/85 mmHg were
For each patient, blood pressure was taken after 15 min of rest. It expressed as percentage and frequency. The chi-square test was
was measured by a mercury sphygmomanometer with the subject applied to compare categorical variables such as metabolic syn-
seated comfortably with the arm supported and positioned at the drome, HDL levels, waist circumference, systolic blood pressure,
level of the heart. The final blood pressure estimate was the triglyceride levels and fasting blood sugar with the ischemic stroke.
average of three readings. Neither smoking nor caffeine was per- A p-value of 0.05 was considered as statistically significant. All
mitted before the blood pressure measurement. Individuals on calculations were done using SPSS version 16 (Chicago, IL, USA).
antihypertensive medications were considered as hypertension
patients regardless of blood pressure levels. Waist circumference
was measured by a trained examiner using a measuring tape RESULTS
positioned midway between the lowest rib and the iliac crest. All
study participants were individually interviewed by trained medical This study included 357 patients of which 131 (36.7%)
students with a structured questionnaire to obtain information on were male and 226 (63.3%) were female. The age of the
socio-demographic characteristics, physical activity and exercise patients ranged from 35 to 95 years. Table 1 shows the
habits (yes vs. no, defined by less than 20 min exercise per week), baseline characteristics of patients. The three compo-
smoking, and alcohol consumption. For baseline examination,
nents of metabolic syndrome was present in 165 (46.2%)
blood was drawn from patients into a plain, siliconized glass tube
and the serum was separated. Fasting serum samples were stored patients of which 41/165(24.8%) were male and 124/165
at -7° prior to the batch assay using standard enzymatic tests for
C (75.2%) were female (0.001). Systolic blood pressure g
cholesterol and triglyceride levels and precipitation methods for was present in 165 patients of which 65 were male and

3. Shaikh et al. 249
Table 2. Comparision of various categorical variables with ischemic stroke.
Variable Frequency Percentage P value
Three components of metabolic syndrome 165 46.2 0.001*
Gender 0.001*
Male 41 24.8
Female 124 75.2
HDL levels < 50mg/dl female and < 40 mg/dl in male 234 65.5 0.001*
Triglyceride levels >150 mg /dl 183 51.26 0.153
Systolic blood pressure >130mm Hg 165 46.21 0.001*
FBS > 100mg/dl 126 35.29 0.421
Waist circumference >90 cms in male and >80cms in female 123 34.45 0.001*
*P value < 0.05 is statistically significant . FBS = fasting blood sugar; HDL= high density lipoprotein.
100 were female (0.137). FBS > 100 mg/dl was present 23 times greater in female than male persons with
in 126 patients of which 57 had metabolic Syndrome metabolic syndrome. The Northern Manhattan study
(0.421).Triglyceride levels >150 mg/dl was present in183 which included Hispanic, African-American, and
cases of which 62 were male and 121 female (0.153). Caucasian subjects, reported an increased risk of stroke
Waist circumference greater than 90 cm in men and 80 among women with metabolic syndrome [hazard ratio
cm in female was present in 123 patients of which 90 had (HR=2.1)] compared to men (HR=0.9) (Rincon et al.,
other components of metabolic syndrome (0.001) HDL 2009). Koren and Morag (2005) similarly reported that
levels < 50mg/dl was present in172 female and >40 metabolic syndrome without diabetes mellitus was a
mg/dl in 62 male (0.001). Table 2 shows comparison of significant risk factor for ischemic stroke in both sexes,
different categorical variables with the ischemic stroke. but the effect was more pronounced in women [odds ratio
(OR=2. 10)] than in men (OR=1. 39). On the other hand,
Kurl et al. (2006) reported that the risk of ischemic stroke
DISCUSSION is significantly increased in men with metabolic syndrome
in Finland. The result of theirs might be due to the long
In this case study, metabolic syndrome was found in follow-up period (average follow-up of 14.3 years).
46.3% of patients, with ischemic stroke making a signifi- Dyslipidemia which is characterized by high
cant association. Our observation was supported by triglycerides and low HDL has always been considered
Gorter et al. (2004) who found metabolic syndrome in 40 as a hallmark of the MetSyn. Our data has shown strong
to 50% of patients with various cardiovascular diseases. association between dyslipidemia and ischemic stroke as
Metabolic syndrome was present in 56% of patients with triglyceride levels >150 mg /dl was present in183 cases
ischemic stroke in a study conducted by Koren and and HDL levels <50mg/dl was present in 172 female and
Morag (2005). De Silva (2007) recorded metabolic syn- >40 mg/dl in 62 male. According to Copenhagen City
drome in 61% of South Asian patients. In Third National Heart Study, a 47% reduction in ischemic stroke was
Health and Nutrition Examination survey of 15922 sub- found for 1.0 mmol/l (39 mg/dl) rise in HDL (Lindenstrom,
jects, metabolic syndrome was significantly associated 1994). Our study is also in consistence with Milionis et al.
with self reported stroke (odds ratio 2.2; 95% CI, 1.5 to (2005) which stated that high TG levels and low HDL-C
3.2) (National Institutes of Health , 2001). In Framingham levels had a relationship with ischemic stroke. The British
offspring study, metabolic syndrome was found more regional heart study, a prospective study consisting 7735
important risk factor for ischemic stroke as compared to men followed up for 16.8 years, also revealed a signifi-
diabetes mellitus (19 vs. 7%) (Najarian et al., 2006) .The cant association between HDL levels and stroke with a
Atherosclerosis Risk in Communities (ARIC) study also relative risk (RR) for nonfatal stroke was 0.59 (95% confi-
noted that patients with metabolic syndrome have higher dence interval, CI, 50.39 to 0.90; P50.03) (Wannamethee
risk of incident stroke (hazard ratio, 2.74 to 4.16 com- et al., 2000).
pared to the reference group) provided the metabolic In the Finnmark study, a 51.29% increase in stroke in
syndrome contains either high blood pressure or elevated women was seen for each 1.0 mm/l (88.5 mg/dl) increase
fasting blood sugar (Sol et al., 2009). In our study, meta- in TG levels (Njolstad et al., 1996). The Framingham
bolic syndrome was found in 75.2% female as compared study (Gordon et al., 1981) contradicts these results by
to 24.8% male. Takahashi et al. (2007) in their study observing that HDL had a non-significant effect on the
noted that the chances of developing ischemic stroke are development of ischemic stroke in either sex. The

4. 250 Int. J. Med. Med. Sci.
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