Metabolic Syndrome and Stroke

대사증후군과 뇌졸중

Kim, Yong-Jae
김용재

  • Published : 2005.10.01

Abstract

Metabolic syndrome, comprising of abdominal obesity, elevated triglyceride levels, low levels of high-density lipoprotein cholesterol, elevated blood pressure, and impaired glucose metabolism, greatly increases the risk of cardiovascular disease, including stroke. The high prevalence of metabolic syndrome among individuals who experience stroke makes the metabolic syndrome a target for aggressive intervention and therapy. Primary intervention for stroke focuses on achievement of a healthy body weight and regular physical activity to prevent or correct dyslipidemia, insulin resistance, and high blood pressure. Statins favorably affect both lipid and nonlipid risk factors for stroke, making them a useful tool for stroke prevention.

Keywords

References

  1. 통계청. 2001년 사망원인통계결과. 2002. www.nso.go.kr
  2. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-1607 https://doi.org/10.2337/diabetes.37.12.1595
  3. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991;14:173?194 https://doi.org/10.2337/diacare.14.3.173
  4. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989;149:1514-1520 https://doi.org/10.1001/archinte.149.7.1514
  5. Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome:prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004;33:351-375 https://doi.org/10.1016/j.ecl.2004.03.005
  6. Himsworth HP. Diabetes mellitus: its differentiation into insulinsensitive and insulin-insensitive types. Lancet 1936;i:127-130
  7. Yalow RS, Berson SA. Immunoassay of endogenous plasma insulin in man. J Clin Invest 1960;39:1157-1175 https://doi.org/10.1172/JCI104130
  8. Avogaro P, Crepaldi G. Essential hyperlipemia, obesity and diabetes. Diabetologia 1965;I:137.Abstract
  9. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-553 https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S
  10. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486- 2497 https://doi.org/10.1001/jama.285.19.2486
  11. World Health Organization, Western Pacific Region. The Asia- Pacific Perspective. Redefining Obesity and its Treatment. WHO/ IASO/IOTF, 2000
  12. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999;16:442-443 https://doi.org/10.1046/j.1464-5491.1999.00059.x
  13. Aronne LJ. Classification of obesity and assessment of obesityrelated health risks. Obes Res 2002;10 Suppl 2:105-115 https://doi.org/10.1038/oby.2002.203
  14. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356- 359 https://doi.org/10.1001/jama.287.3.356
  15. Park HS, Oh SW, Kang JH, Park YW, Choi JM, Kim YS, et al. Prevalence and associated factors with metabolic syndrome in South Korea-from the Korean National Health and Nutrition Examination Survey, 1998- Journal of Korean Society for the Study of Obesity 2003;12:1-14
  16. Cho HK. Handbook of Atherosclerosis and Lipid metabolism. Seoul, Jin Publishing & Printing Co. 2004;238-318
  17. Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med 2002;136:575-581 https://doi.org/10.7326/0003-4819-136-8-200204160-00006
  18. Klein BE, Klein R, Lee KE. Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in beaver dam. Diabetes Care 2002;25:1790-1794 https://doi.org/10.2337/diacare.25.10.1790
  19. Lakka HM, Laaksonen DE, Lakka TA, Niskaren LK, Kumpusalo E, Tuamilehto, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288:2709-2716 https://doi.org/10.1001/jama.288.21.2709
  20. Olijhoek JK, van der Graaf Y, Banga JD, Algra A, Rabelink TJ, Visseren FL; the SMART Study Group. The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. Eur Heart J 2004;25:342-348 https://doi.org/10.1016/j.ehj.2003.12.007
  21. Kim YJ, Park KD, Choi KG, Han SR, Kho SB, Cho HK, et al. Carotid intima-media thickness in healthy koreans: Is it also useful in cerebrovascular risk assessment in intracranial disease prone population? Cerebrovas Dis 2002;13 suppl 4. Abstract
  22. Brunzell JD, Ayyobi AF. Dyslipidemia in the metabolic syndrome and type 2 diabetes mellitus. Am J Med 2003;115 Suppl 8A: 24-28
  23. Steinmetz A, Fenselau S, Schrezenmeir J. Treatment of dyslipoproteinemia in the metabolic syndrome. Exp Clin Endocrinol Diabetes 2001:109:548-559 https://doi.org/10.1055/s-2001-15117
  24. Packard CJ. LDL subfractions and atherogenicity: an hypothesis from the University of Glasgow. Curr Med Res Opin 1996;13: 379-390 https://doi.org/10.1185/03007999609111557
  25. Pyorala M, Miettinen H, Laakso M, Pyorala K. Hyperinsulinemia and the risk of stroke in healthy middle-aged men. The 22 year follow-up results of the Helsinki Policemen Study. Stroke 1998; 29:1860-1866 https://doi.org/10.1161/01.STR.29.9.1860
  26. Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. Diabetes Care 1999;22:1077-1083 https://doi.org/10.2337/diacare.22.7.1077
  27. Kernan WN, Inzucchi SE, Viscoli CM, Brass LM, Bravata DM, Horwitz RI. Insulin resistance and risk of stroke. Neurology 2002;59:809-815 https://doi.org/10.1212/WNL.59.6.809
  28. Gorelick PB. Stroke prevention therapy beyond antithrombotics: unifying mechanisms in ischemic stroke pathogenesis and implications for therapy. Stroke 2002;33:862-875 https://doi.org/10.1161/hs0302.103657
  29. Ishizaka N, Ishizaka Y, Toda E, Hashimoto H, Nagai R, Yamakado M. Hypertension is the most common component of metabolic syndrome and the greatest contributor to carotid arteriosclerosis in apparently healthy Japanese individuals. Hypertens Res 2005;28:27-34 https://doi.org/10.1291/hypres.28.27
  30. Scott CL. Diagnosis, prevention, and intervention for the metabolic syndrome. Am J Cardiol 2003;92 Suppl 1A:35-42 https://doi.org/10.1016/S0002-9149(03)00507-1
  31. Schiffrin EL, and (CIHR) Multidisciplinary Research Group on Hypertension. Beyond blood pressure: the endothelitml and atherosclerosis progression. Am J Hypertens 2002; 15 Suppl 1:115- 122 https://doi.org/10.1016/S0895-7061(02)03006-6
  32. Benfante R, Yano K, Hwang LJ, Curb JD, A Kagan, Ross W. Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk. Stroke 1994;25:814-820 https://doi.org/10.1161/01.STR.25.4.814
  33. Rexrode KM, Hennekens CH, Willett WC, Colditz GA, Stampfer MJ, Rich-Edwards JW, et al. A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 1997;277:1539-1545 https://doi.org/10.1001/jama.277.19.1539
  34. Suk SH, Sacco RL, Boden-Albala B, Cheun JF, Pittman JG, Elkind MS, et al. Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke 2003;34:1586-1592 https://doi.org/10.1161/01.STR.0000075294.98582.2F
  35. Aubert H, Frere C, Aillaud MF, Morange PE, Juhan-Vague I, Alessi MC. Weak and non-independent association between plasma TAFI antigen levels and the insulin resistance syndrome. J Thromb Haemost 2003;1:791-797 https://doi.org/10.1046/j.1538-7836.2003.00147.x
  36. Bajaj M, Banerji MA. Type 2 diabetes in South Asians: a pathophysiologic focus on the Asian-Indian epidemic. Curr Diab Rep 2004;4:213-218 https://doi.org/10.1007/s11892-004-0026-4
  37. Gil-Nunez AC, Villanueva JA. Advantages of lipid lowering therapy in cerebral ischemia: role of HMG CoA reductase inhibitors. Cerebrovasc Dis 2001;11 Suppl 1:85-95 https://doi.org/10.1159/000049130
  38. Ninomiya JK, L'Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation 2004;109:42-46 https://doi.org/10.1161/01.CIR.0000116602.10533.2E
  39. Cho HJ, Choi YJ, Kim YJ. The clustered metabolic risk factors among patient with ischemic stroke-A preliminary study. Korean J Stroke 2003;5:Abstract
  40. Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, et al. The Finnish Diabetes Prevention Study(DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003;26:3230-3236 https://doi.org/10.2337/diacare.26.12.3230
  41. Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, et al. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Circulation 2004;109: 2031-2041 https://doi.org/10.1161/01.CIR.0000126280.65777.A4
  42. Steinmetz A, Fenselau S, Schrezenmeir J. Treatment of dyslipoproteinemia in the metabolic syndrome. Exp Clin Endocrinol Diabetes 2001:109:S548-559 https://doi.org/10.1055/s-2001-15117
  43. Robins SJ, Rubins HB, Faas FH, Schaefer EJ, Elam MB, Anderson JW, et al. Insulin resistance and cardiovascular events with low HDL cholesterol: the Veterans Affairs HDL Intervention Trial (VA-HIT). Diabetes Care 2003;26:1513-1517 https://doi.org/10.2337/diacare.26.5.1513
  44. Avema M, Verde AL. Statins and metabolic syndrome. Int Congress Series 2003;1253:283-246
  45. Bedi A, Flaker GC. How do HMG-CoA reductase inhibitors prevent stroke? Am J Cardioovasc Drugs 2002;2:7-14 https://doi.org/10.2165/00129784-200202010-00002
  46. Kim YJ. Use of statin and angiotensin converting enzyme inhibitor in stroke prevention. Korean J Stroke 2005;7:39-45
  47. Amarenco P, Tonkin AM. Statins for stroke prevention: disappointment and hope. Circulation 2004;109:44-49 https://doi.org/10.1161/01.CIR.0000116206.77324.5B
  48. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study(4S). Lancet 1994;344:1383-1389
  49. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360:7-22 https://doi.org/10.1016/S0140-6736(02)09327-3
  50. Sever PS, Dahlof B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo- Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial ASCOTLLA. Lancet 2003;361:1149-1158 https://doi.org/10.1016/S0140-6736(03)12948-0
  51. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004;364:685-696 https://doi.org/10.1016/S0140-6736(04)16895-5
  52. Knowler WC, Barrett-Connor E, Fowler SE Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403 https://doi.org/10.1056/NEJMoa012512
  53. Durbin RJ. Thiazolidinedione therapy in the prevention/delay of type 2 diabetes in patients with impaired glucose tolerance and insulin resistance. Diabetes Obes Metabo 2004;6:280-285 https://doi.org/10.1111/j.1462-8902.2004.0348.x
  54. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA 2003;290:486-494 https://doi.org/10.1001/jama.290.4.486
  55. Chobanian VA, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003;289: 2560-2571 https://doi.org/10.1001/jama.289.19.2560
  56. American Diabetes Association. Prevention or delay of type 2 diabetes. Clinical Practice Recommendations 2004. Diabetes Care 2004;27:47-53 https://doi.org/10.2337/diacare.27.1.47