Abstract 156: Impact Of Obesity And Metabolic Syndrome In Stroke Patients Undergoing Intravenous Thrombolysis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Raymond C Seet ◽  
Yi Zhang ◽  
Eelco F Wijdicks ◽  
Alejandro A Rabinstein
Keyword(s):  
Metabolic Syndrome ◽  
Functional Recovery ◽  
Intravenous Thrombolysis ◽  
Normal Weight ◽  
Stroke Recovery ◽  
Stroke Severity ◽  
Metabolic Risk ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
The Metabolic Syndrome

Background: The influence of high body mass index (BMI) in acute stroke patients treated with intravenous thrombolysis has not been extensively studied. Previous studies have observed an “obesity paradox” among stroke patients, where better outcomes were observed among overweight and obese patients. The purpose of this study is to determine the influence of obesity and risk components of metabolic syndrome to stroke recovery in patients undergoing intravenous recombinant tissue plasminogen activator (rtPA) treatment. Methods: Patients with acute ischemic stroke who received intravenous rtPA within three-hour from symptom onset at St. Marys Hospital, Mayo Clinic, Rochester, between April 2006 and January 2011, were included in this study. Information on vascular risk factors, stroke severity, and baseline hemodynamic and laboratory indices, were collected. Study outcomes, consisting symptomatic intracerebral hemorrhage (sICH) and poor functional recovery (modified Rankin scale >2), were compared between obese (body mass index, BMI >30 kg/m 2 ), overweight (BMI 25-30 kg/m 2 ) and normal weight (BMI <25 kg/m 2 ) patients. The association between BMI, risk components of the metabolic syndrome and dose of rtPA per kg body weight to stroke outcomes were assessed in a multivariable model. Results: A total of 158 patients (mean age, 75 years; baseline NIHSS, 11), frequency-matched by age and baseline stroke severity, were included in this study. No differences in the frequency of SICH and poor functional recovery were observed among obese, overweight and normal weight patients, before and after adjusting for their baseline characteristics. A linear trend towards worse stroke recovery was observed in patients with a greater number of metabolic risk components (p-trend=0.043). By contrast, there were no significant associations between the number of risk components of metabolic syndrome with respect to sICH. Using stepwise regression analyses, age, baseline stroke severity and the number of risk components of the metabolic syndrome accounted for 52% variation in functional recovery following rtPA treatment. Conclusions: Acute stroke outcomes do not differ between obese and overweight patients. The presence of metabolic risk factors contributes significantly to functional outcomes following rtPA treatment. These results suggest that decreasing the prevalence of metabolic syndrome in the community could reduce the societal burden of stroke-related disability.

Abstract W P386: Matrix Metalloproteinase Levels May Mediate Ischemic Stroke Incidence and Recovery in Stroke Patients with Metabolic Syndrome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ashley B Petrone ◽  
Taura L Barr ◽  
Kelly Devlin ◽  
Sara B Fournier ◽  
Evan D Devallance ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Stroke Risk ◽  
Plasma Concentrations ◽  
Stroke Recovery ◽  
Ultrasound Images ◽  
Stroke Patients ◽  
Stroke Incidence ◽  
The Metabolic Syndrome ◽  
Diabetes Status ◽  
Increased Risk

Intro: The metabolic syndrome (MetS) is highly prevalent in the US characterized by a combination of risk factors that can lead to cardiovascular disease (CVD). While the association between CVD, inflammation, and stroke risk has been characterized, the immune mechanisms underlying increased risk of stroke in MetS is unclear. While stroke risk is higher among MetS, MetS individuals tend to have better stroke recovery than controls. The immune response may mediate these paradoxical observations in stroke. In particular, matrix metalloproteinases (MMP) enzymes play a role in stroke incidence and recovery. Similar to MetS, MMPs have a dual role in stroke, as they are harmful immediately after stroke, but play a vital role in brain repair and recovery following stroke. We hypothesize that elevated levels of MMPs in MetS may account for the paradoxical increased stroke risk, yet better recovery seen in stroke patients with MetS. Methods: MMP protein concentrations were obtained from fasting venous samples and quantified using a Multi-Analyte Profiling Kit (Millipore) on the Luminex®. Each subject was assigned a metabolic risk score (MRS) based on sex, age, SBP, treatment for hypertension, smoking and diabetes status, HDL, and total cholesterol. B-mode ultrasound images of the right common carotid artery were obtained to measure intima-medial thickness (cIMT). Spearman correlations were used to measure the relationship between MRS, cIMT, and MMP levels. Results: In n=68 subjects (60% female) with a mean age of 48+14 yrs, MRS of 25+12, and cIMT of 0.57+0.12 mm. MRS was significantly correlated with cIMT (r=0.39, p< .001). Further, cIMT was positively correlated with MMP1 (r=0.025, p=0.04), MMP7 (r=0.5, p=0.01), and MMP9 (r=0.31, p=0.01). Conclusion: Plasma concentrations of MMP1, 7, and 9 were significantly correlated with cIMT, indicating that increased severity of MetS is associated with increased inflammation. Elevated MMP protein levels may account for the increased stroke risk, yet better recovery seen in stroke patients with MetS.

scholarly journals Homeostasis model assessment of insulin resistance (HOMA-IR) and metabolic syndrome at baseline of a multicentric Brazilian cohort: ELSA-Brasil study

2020 ◽  
Vol 36 (8) ◽  
Author(s):  
Maria de Fátima Haueisen Sander Diniz ◽  
Alline Maria Rezende Beleigoli ◽  
Maria Inês Schmidt ◽  
Bruce B. Duncan ◽  
Antônio Luiz P. Ribeiro ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Model Assessment ◽  
Adult Health ◽  
Homeostasis Model Assessment ◽  
The Metabolic Syndrome ◽  
Brazilian Cohort ◽  
Overweight Or Obesity

Abstract: Homeostasis model assessment of insulin resistance (HOMA-IR) is a method to measure insulin resistance. HOMA-IR cut-offs for identifying metabolic syndrome might vary across populations and body mass index (BMI) levels. We aimed to investigate HOMA-insulin resistance cut-offs that best discriminate individuals with insulin resistance and with metabolic syndrome for each BMI category in a large sample of adults without diabetes in the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Among the 12,313 participants with mean age of 51.2 (SD 8.9) years, the prevalence of metabolic syndrome was 34.6%, and 60.1% had overweight or obesity. The prevalence of metabolic syndrome among normal weight, overweight and obesity categories were, respectively, 13%, 43.2% and 60.7%. The point of maximum combined sensitivity and specificity of HOMA-IR to discriminate the metabolic syndrome was 2.35 in the whole sample, with increasing values at higher BMI categories. This investigation contributes to better understanding HOMA-IR values associated with insulin resistance and metabolic syndrome in a large Brazilian adult sample, and that use of cut-off points according to ROC curve may be the better strategy. It also suggests that different values might be appropriate across BMI categories.

Childhood growth and future risk of the metabolic syndrome in normal-weight men and women

2009 ◽  
Vol 35 (2) ◽  
pp. 143-150 ◽  
Author(s):  
M.K. Salonen ◽  
E. Kajantie ◽  
C. Osmond ◽  
T. Forsén ◽  
H. Ylihärsilä ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Normal Weight ◽  
Men And Women ◽  
Childhood Growth ◽  
The Metabolic Syndrome ◽  
Future Risk

Abstract TP148: The Hydration Influence on the Risk of Ischemic Stroke Outcomes (THIRST-EXPANSION STUDY)

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mohammad Moussavi ◽  
Gustavo Rodriguez ◽  
Joseph Alario ◽  
Ravjot Sodhi ◽  
Aaron Nizam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Negative Impact ◽  
Serum Osmolality ◽  
Hydration Status ◽  
Stroke Severity ◽  
Past Study ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Significant Difference ◽  
The Mean

Introduction: Extensive studies have not been done in patients presenting with ischemic stroke regarding hydration status. It is unclear whether all of the elements of hydration status affect disability on discharge. Our past study suggests that high serum osmolality has a negative impact on ischemic stroke severity. This continuation of our prior study aims to test the effect of all laboratory elements of dehydration on severity and outcome of ischemic stroke patients. Methods: We conducted a retrospective analysis of ischemic stroke patients admitted between 2004 and 2009 at a community teaching hospital. Serum BUN/Creatinine and serum osmolality (sOsm) was calculated at initial presentation. sOSm, BUN/Cr, hematocrit and bicarbonate levels were analyzed for association with NIHSS and mRS. Patients were divided into two groups by sOsm as follows: (1) sOsm < 295, (2) sOsm ≥ 295; and two groups by BUN/Cr as follows: (3) BUN/Cr < 20, (4) BUN/Cr ≥ 20. Discharge mRS score was compared between (1) and (2); and (3) and (4) to determine the effect of sOsm and BUN/Cr on stroke outcomes. All data was analyzed using SPSS software version 20. Results: Of 1350 patients, 543 (mean age = 72.5 +/-14.2, 56% female) were included. There was a significant difference between the mean admission NIHSS in (1) 8.57, n = 222 and (2) 7.09, n = 319, p < .05 and between (3) 8.90, n = 219 and (4) 6.87, n = 322, p < .05. There was a significant difference in the mean mRS score between (1) 2.92, n = 222 and (2) 2.54, n = 317, p < .05, and (3) 2.92, n = 218 and (4) 2.56, n = 321, p < .05. The same results were found when comparing discharge sOsm values to predict patient outcome. Discharge sOsm correlated with mRS (r = .147, p < .05). Initial BUN/Cr correlated with NIHSS (r = .128, p < .05) and mRS (r = .107, p < .05) and final BUN/Cr with mRS (r = .161, p < .001). Bicarbonate levels at admission correlated with NIHSS at admission (r = -0.134), p < 0.05. Hematocrit levels at discharge correlated with mRS (r= -0.183), p <0.001. Conclusion: Our study suggests that patients with BUN/Cr and sOsm above normal levels at admission and dishcarge have worse outcome at discharge. We also found a correlation between other laboratory variables of dehydration status, namely hematocrit levels and outcome. A future prospective randomized study is warranted.

Metabolic syndrome and endothelial fibrinolytic capacity in obese adults

2008 ◽  
Vol 294 (1) ◽  
pp. R39-R44 ◽  
Author(s):  
Gary P. Van Guilder ◽  
Greta L. Hoetzer ◽  
Jared J. Greiner ◽  
Brian L. Stauffer ◽  
Christopher A. DeSouza
Keyword(s):  
Metabolic Syndrome ◽  
Defense Mechanism ◽  
Normal Weight ◽  
Tissue Type ◽  
Vascular Events ◽  
Obese Adults ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Artery Disease

The metabolic syndrome (MetS) often accompanies obesity and contributes to the increased risk of atherothrombotic events with increased body fatness. Indeed, the risks for coronary artery disease and acute vascular events are greater with obesity combined with MetS compared with obesity alone. Endothelial release of tissue-type plasminogen activator (t-PA) is a key defense mechanism against thrombosis and has been shown to be impaired with obesity. The aim of the present study was to determine whether the presence of MetS exacerbates endothelial fibrinolytic dysfunction in obese adults. Net endothelial release of t-PA was determined in vivo in response to intrabrachial infusions of bradykinin and sodium nitroprusside in 47 sedentary adults: 15 normal weight (age 57 ± 2 yr; body mass index 22.9 ± 0.5 kg/m2), 14 obese but otherwise healthy (55 ± 1 yr; 29.4 ± 0.3 kg/m2), and 18 obese with MetS (55 ± 2 yr; 32.3 ± 1 kg/m2). MetS was established according to National Cholesterol Education Program ATP III criteria. Net release of t-PA antigen to bradykinin was ∼50% lower ( P < 0.01) in the obese (from 2.5 ± 1.9 to 37.1 ± 5.3 ng·100 ml tissue−1·min−1) and obese with MetS (from 0.4 ± 0.8 to 32.5 ± 3.8 ng·100 ml tissue−1·min−1) compared with normal-weight (from 0.9 ± 1.0 to 74.3 ± 8.1 ng·100 ml tissue−1·min−1) subjects. However, there were no significant differences in the capacity of the endothelium to release t-PA in the obese and obese with MetS adults. These results indicate that the presence of the MetS does not worsen the obesity-related endothelial fibrinolytic dysfunction.

Relationship of C-reactive protein with components of the metabolic syndrome in normal-weight and overweight elderly

2005 ◽  
Vol 15 (4) ◽  
pp. 270-278 ◽  
Author(s):  
Tiny Hoekstra ◽  
Johanna M. Geleijnse ◽  
Evert G. Schouten ◽  
Frans J. Kok ◽  
Cornelis Kluft
Keyword(s):  
Metabolic Syndrome ◽  
Normal Weight ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Metabolic Syndrome ◽  
Relationship Of
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