Current Diabetes Reports

, Volume 8, Issue 1, pp 37–41 | Cite as

Metabolic syndrome and stroke



The metabolic syndrome is highly prevalent worldwide, and its cardiovascular toll is expected to rise with the growing obesity epidemic. Mounting evidence points to an association between metabolic syndrome and first or recurrent stroke. This article discusses the emerging data supporting a link between stroke and the metabolic syndrome and underscores the need to better understand the syndrome’s pathophysiology, with a goal to appropriately and intensively limit the burden of this multiple risk factor entity.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Alberts MJ, Ovbiagele B: Current strategies for ischemic stroke prevention: role of multimodal combination therapies. J Neurol 2007, 254:1414–1426.PubMedCrossRefGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Curtin LR, et al.: Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006, 295:1549–1555.PubMedCrossRefGoogle Scholar
  3. 3.
    Grundy SM: Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds. J Am Coll Cardiol 2006, 47:1093–1100.PubMedCrossRefGoogle Scholar
  4. 4.
    Grundy SM, Cleeman JI, Daniels SR, et al.: Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary. Cardiol Rev 2005, 13:322–327.PubMedGoogle Scholar
  5. 5.
    Gami AS, Witt BJ, Howard DE, et al.: Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 2007, 49:403–414.PubMedCrossRefGoogle Scholar
  6. 6.
    IDF. The IDF consensus worldwide definition of the metabolic syndrome. Available at Accessed October 13, 2007.
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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) final report [no authors listed]. Circulation 2002, 106:3143–3421.Google Scholar
  9. 9.
    Sacco RL, Benson RT, Kargman DE, et al.: High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study. JAMA 2001, 285:2729–2735.PubMedCrossRefGoogle Scholar
  10. 10.
    Kernan WN, Inzucchi SE, Viscoli CM, et al.: Impaired insulin sensitivity among nondiabetic patients with a recent TIA or ischemic stroke. Neurology 2003, 60:1447–1451.PubMedGoogle Scholar
  11. 11.
    Kernan WN, Inzucchi SE, Viscoli CM, et al.: Insulin resistance and risk for stroke. Neurology 2002, 59:809–815.PubMedGoogle Scholar
  12. 12.
    Bonora E, Tessari R, Micciolo R, et al.: Intimal-medial thickness of the carotid artery in nondiabetic and NIDDM patients. Relationship with insulin resistance. Diabetes Care 1997, 20:627–631.PubMedCrossRefGoogle Scholar
  13. 13.
    Agewall S, Fagerberg B, Attvall S, et al.: Carotid artery wall intima-media thickness is associated with insulin-mediated glucose disposal in men at high and low coronary risk. Stroke 1995, 26:956–960.PubMedGoogle Scholar
  14. 14.
    Howard G, O’Leary DH, Zaccaro D, et al.: Insulin sensitivity and atherosclerosis. The Insulin Resistance Atherosclerosis Study (IRAS) Investigators. Circulation 1996, 93:1809–1817.PubMedGoogle Scholar
  15. 15.
    Suzuki M, Shinozaki K, Kanazawa A, et al.: Insulin resistance as an independent risk factor for carotid wall thickening. Hypertension 1996, 28:593–598.PubMedGoogle Scholar
  16. 16.
    Laakso M, Sarlund H, Salonen R, et al.: Asymptomatic atherosclerosis and insulin resistance. Arterioscler Thromb 1991, 11:1068–1076.PubMedGoogle Scholar
  17. 17.
    Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group [no authors listed]. Lancet 1998, 352:854–865.Google Scholar
  18. 18.
    Minamikawa J, Tanaka S, Yamauchi M, et al.: Potent inhibitory effect of troglitazone on carotid arterial wall thickness in type 2 diabetes. J Clin Endocrinol Metab 1998, 83:1818–1820.PubMedCrossRefGoogle Scholar
  19. 19.
    Koshiyama H, Shimono D, Kuwamura N, et al.: Rapid communication: inhibitory effect of pioglitazone on carotid arterial wall thickness in type 2 diabetes. J Clin Endocrinol Metab 2001, 86:3452–3456.PubMedCrossRefGoogle Scholar
  20. 20.
    Suk SH, Sacco RL, Boden-Albala B, et al.: Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke 2003, 34:1586–1592.PubMedCrossRefGoogle Scholar
  21. 21.
    Pearson TA, Mensah GA, Alexander RW, et al.: Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003, 107:499–511.PubMedCrossRefGoogle Scholar
  22. 22.
    Ridker PM, Buring JE, Cook NR, Rifai N: C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women. Circulation 2003, 107:391–397.PubMedCrossRefGoogle Scholar
  23. 23.
    Park JH, Kwon HM, Roh JK: Metabolic syndrome is more associated with intracranial atherosclerosis than extracranial atherosclerosis. Eur J Neurol 2007, 14:379–386.PubMedCrossRefGoogle Scholar
  24. 24.
    Golden SH, Folsom AR, Coresh J, et al.: Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the atherosclerosis risk in communities study. Diabetes 2002, 51:3069–3076.PubMedCrossRefGoogle Scholar
  25. 25.
    Bonora E, Kiechl S, Willeit J, et al.: Carotid atherosclerosis and coronary heart disease in the metabolic syndrome: prospective data from the Bruneck study. Diabetes Care 2003, 26:1251–1257.PubMedCrossRefGoogle Scholar
  26. 26.
    Park K, Yasuda N, Toyonaga S, et al.: Significant association between leukoaraiosis and metabolic syndrome in healthy subjects. Neurology 2007, 69:974–978.PubMedCrossRefGoogle Scholar
  27. 27.
    Ninomiya JK, L’Italien G, Criqui MH, et al.: 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.PubMedCrossRefGoogle Scholar
  28. 28.
    Shah IM, Ghosh SK, Collier A: Stroke presentation in Type 2 diabetes and the metabolic syndrome. Diabetes Res Clin Pract 2007, [Epub ahead of print.]Google Scholar
  29. 29.
    Ovbiagele B, Saver JL, Lynn MJ, Chimowitz M: Impact of metabolic syndrome on prognosis of symptomatic intracranial atherostenosis. Neurology 2006, 66:1344–1349.PubMedCrossRefGoogle Scholar
  30. 30.
    Bang OY, Kim JW, Lee JH, et al.: Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology 2005, 65:296–298.PubMedCrossRefGoogle Scholar
  31. 31.
    Chobanian AV, Bakris GL, Black HR, 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, 289:2560–2572.PubMedCrossRefGoogle Scholar
  32. 32.
    Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.PubMedCrossRefGoogle Scholar
  33. 33.
    Boden-Albala B: Current understanding of multiple risk factors as the metabolic syndrome: distillation or deconstruction. Semin Neurol 2006, 26:108–116.PubMedCrossRefGoogle Scholar
  34. 34.
    Takahashi K, Bokura H, Kobayashi S, et al.: Metabolic syndrome increases the risk of ischemic stroke in women. Intern Med 2007, 46:643–648.PubMedCrossRefGoogle Scholar
  35. 35.
    Wannamethee SG, Shaper AG, Lennon L, Morris RW: Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Arch Intern Med 2005, 165:2644–2650.PubMedCrossRefGoogle Scholar
  36. 36.
    Najarian RM, Sullivan LM, Kannel WB, et al.: Metabolic syndrome compared with type 2 diabetes mellitus as a risk factor for stroke: the Framingham Offspring Study. Arch Intern Med 2006, 166:106–111.PubMedCrossRefGoogle Scholar
  37. 37.
    McNeill AM, Rosamond WD, Girman CJ, et al.: The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005, 28:385–390.PubMedCrossRefGoogle Scholar
  38. 38.
    Despres JP, Golay A, Sjostrom L: Effects of rimonabant on metabolic risk factors in overweight patients with dyslipidemia. N Engl J Med 2005, 353:2121–2134.PubMedCrossRefGoogle Scholar
  39. 39.
    Pi-Sunyer FX, Aronne LJ, Heshmati HM, et al.: Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA 2006, 295:761–775.PubMedCrossRefGoogle Scholar
  40. 40.
    Van Gaal LF, Rissanen AM, Scheen AJ, et al.: Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 2005, 365:1389–1397.PubMedCrossRefGoogle Scholar
  41. 41.
    Orchard TJ, Temprosa M, Goldberg R, et al.: The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 2005, 142:611–619.PubMedGoogle Scholar
  42. 42.
    He K, Liu K, Daviglus ML, et al.: Magnesium intake and incidence of metabolic syndrome among young adults. Circulation 2006, 113:1675–1682.PubMedCrossRefGoogle Scholar
  43. 43.
    Szapary PO, Bloedon LT, Samaha FF, et al.: Effects of pioglitazone on lipoproteins, inflammatory markers, and adipokines in nondiabetic patients with metabolic syndrome. Arterioscler Thromb Vasc Biol 2006, 26:182–188.PubMedCrossRefGoogle Scholar
  44. 44.
    Vitale C, Mercuro G, Castiglioni C, et al.: Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome. Cardiovasc Diabetol 2005, 4:6.PubMedCrossRefGoogle Scholar
  45. 45.
    Thoenes M, Oguchi A, Nagamia S, et al.: The effects of extended-release niacin on carotid intimal media thickness, endothelial function and inflammatory markers in patients with the metabolic syndrome. Int J Clin Pract 2007, 61:1942–1948.PubMedCrossRefGoogle Scholar
  46. 46.
    Wilding J, Van Gaal L, Rissanen A, et al.: A randomized double-blind placebo-controlled study of the long-term efficacy and safety of topiramate in the treatment of obese subjects. Int J Obes Relat Metab Disord 2004, 28:1399–1410.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Division of Stroke and Critical Care, Department of NeurologyUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations