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Metabolic Syndrome and Risk of Ischemic Stroke in Atrial Fibrillation: ARIC Study.

TitleMetabolic Syndrome and Risk of Ischemic Stroke in Atrial Fibrillation: ARIC Study.
Publication TypeJournal Article
Year of Publication2019
AuthorsDecker JJ, Norby FL, Rooney MR, Soliman EZ, Lutsey PL, Pankow JS, Alonso A
Secondary AuthorsChen LYee
JournalStroke
Volume50
Issue11
Pagination3045-3050
Date Published2019 11
ISSN1524-4628
KeywordsAtrial Fibrillation, Brain Ischemia, Cohort Studies, Female, Follow-Up Studies, Humans, Independent Living, Male, Metabolic Syndrome, Middle Aged, Prospective Studies, Risk Factors, Stroke
Abstract

Background and Purpose- Metabolic syndrome (MetS), a prothrombotic state, is associated with an increased risk of atrial fibrillation (AF) and stroke. The CHADS-VASc score does not account for the MetS components of prehypertension, prediabetes mellitus, abdominal obesity, elevated triglycerides, and low HDL (high-density lipoprotein). Data are limited on the association of MetS with stroke in AF, independent of CHADS-VASc variables. Our aim was to identify MetS components associated with ischemic stroke in participants with AF in the ARIC study (Atherosclerosis Risk in Communities). Methods- We included 1172 participants with incident AF within 5 years of measurement of MetS components. MetS was defined by ATP criteria and International Diabetes Federation criteria. Incident ischemic stroke was physician adjudicated. Multivariable Cox proportional hazards regression was used to assess the association of MetS components with stroke. Results- After a median follow-up of 14.8 years, there were 113 ischemic stroke cases. Of the individual MetS components, low HDL was borderline associated with increased stroke risk (hazard ratio, 1.48 [95% CI, 0.99-2.21]) after adjustment for CHADS-VASc variables while the remaining MetS variables were not associated with stroke risk. The presence of ≥3 components of MetS was not significantly associated with ischemic stroke after adjustment for CHADS-VASc variables (hazard ratio, 1.38 [95% CI, 0.91-2.11]). The risk of stroke increased by 13% for each additional component of MetS; however, this association was borderline significant (hazard ratio, 1.13 [95% CI, 0.99-1.28]). Conclusions- The presence of MetS was not significantly associated with ischemic stroke after adjustment for CHADS-VASc variables. Consideration of MetS is unlikely to improve stroke prediction in AF.

DOI10.1161/STROKEAHA.119.025376
Alternate JournalStroke
PubMed ID31623543
PubMed Central IDPMC6817422
Grant List16EIA26410001 / AHA / American Heart Association-American Stroke Association / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States