Semin Neurol 2017; 37(03): 267-273
DOI: 10.1055/s-0037-1603753
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Role of Diabetes, Obesity, and Metabolic Syndrome in Stroke

Xian Nan Tang
1   Department of Neurology, UCLA Stroke Center, Geffen School of Medicine at UCLA, Los Angeles, California
,
David S. Liebeskind
1   Department of Neurology, UCLA Stroke Center, Geffen School of Medicine at UCLA, Los Angeles, California
,
Amytis Towfighi
2   Division of Stroke and Neurocritical Care, Keck School of Medicine, University of Southern California, Los Angeles, California
3   Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California
› Author Affiliations
Further Information

Publication History

Publication Date:
31 July 2017 (online)

Abstract

The prevalence of obesity, diabetes, and metabolic syndrome has increased globally. These epidemiologic changes are likely responsible for a rise in stroke incidence among young adults, despite declining stroke incidence rates in the elderly. In this review, the authors summarize the current understanding of the epidemiology and pathophysiology of stroke associated with obesity, diabetes, and metabolic syndrome.

 
  • References

  • 1 Benjamin EJ, Blaha MJ, Chiuve SE. , et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135 (10) e146-e603
  • 2 Carandang R, Seshadri S, Beiser A. , et al. Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 2006; 296 (24) 2939-2946
  • 3 Fang MC, Coca Perraillon M, Ghosh K, Cutler DM, Rosen AB. Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008. Am J Med 2014; 127 (07) 608-615
  • 4 Khoury JC, Kleindorfer D, Alwell K. , et al. Diabetes mellitus: a risk factor for ischemic stroke in a large biracial population. Stroke 2013; 44 (06) 1500-1504
  • 5 Kleindorfer DO, Khoury J, Moomaw CJ. , et al. Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke 2010; 41 (07) 1326-1331
  • 6 Koton S, Schneider AL, Rosamond WD. , et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA 2014; 312 (03) 259-268
  • 7 Morgenstern LB, Smith MA, Sánchez BN. , et al. Persistent ischemic stroke disparities despite declining incidence in Mexican Americans. Ann Neurol 2013; 74 (06) 778-785
  • 8 Kissela BM, Khoury JC, Alwell K. , et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology 2012; 79 (17) 1781-1787
  • 9 George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol 2011; 70 (05) 713-721
  • 10 Ramirez L, Kim-Tenser MA, Sanossian N. , et al. Trends in acute ischemic stroke hospitalizations in the United States. J Am Heart Assoc 2016; 5 (05) 5
  • 11 Heidenreich PA, Trogdon JG, Khavjou OA. , et al; American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123 (08) 933-944
  • 12 George MG, Tong X, Bowman BA. Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA Neurol 2017. [Epub ahead of print]
  • 13 Williams DL, Schwartz MW. Neuroanatomy of body weight control: lessons learned from leptin. J Clin Invest 2011; 121 (06) 2152-2155
  • 14 Page KA, Seo D, Belfort-DeAguiar R. , et al. Circulating glucose levels modulate neural control of desire for high-calorie foods in humans. J Clin Invest 2011; 121 (10) 4161-4169
  • 15 Kernan WN, Inzucchi SE, Sawan C, Macko RF, Furie KL. Obesity: a stubbornly obvious target for stroke prevention. Stroke 2013; 44 (01) 278-286
  • 16 Ng M, Fleming T, Robinson M. , et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384 (9945): 766-781
  • 17 Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief 2015; (219) 1-8
  • 18 Towfighi A, Markovic D, Ovbiagele B. Current national patterns of comorbid diabetes among acute ischemic stroke patients. Cerebrovasc Dis 2012; 33 (05) 411-418
  • 19 Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes 2010; 2 (03) 180-193
  • 20 Lekoubou A, Ovbiagele B, Markovic D, Sanossian N, Towfighi A. Age, sex, and race/ethnic temporal trends in metabolic syndrome prevalence among individuals with myocardial infarction or stroke in the United States. J Neurol Sci 2017; 376: 24-28
  • 21 Peters SA, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet 2014; 383 (9933): 1973-1980
  • 22 Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B. Effect of pre-diabetes on future risk of stroke: meta-analysis. BMJ 2012; 344: e3564
  • 23 Shou J, Zhou L, Zhu S, Zhang X. Diabetes is an independent risk factor for stroke recurrence in stroke patients: a meta-analysis. J Stroke Cerebrovasc Dis 2015; 24 (09) 1961-1968
  • 24 Patel SS. Cerebrovascular complications of diabetes: alpha glucosidase inhibitor as potential therapy. Horm Metab Res 2016; 48 (02) 83-91
  • 25 Patel TP, Rawal K, Bagchi AK. , et al. Insulin resistance: an additional risk factor in the pathogenesis of cardiovascular disease in type 2 diabetes. Heart Fail Rev 2016; 21 (01) 11-23
  • 26 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. Curr Opin Cardiol 2006; 21 (01) 1-6
  • 27 Yaturu S, Mousa S. Diabetes and aspirin resistance. In: Zimering MB. , ed. Diabetes and Aspirin Resistance in Recent Advances in the Pathogenesis, Prevention and Management of Type 2 Diabetes and its Complications. Rijeka, Croatia: InTech; 2011: 91-104
  • 28 Karapanayiotides T, Piechowski-Jozwiak B, van Melle G, Bogousslavsky J, Devuyst G. Stroke patterns, etiology, and prognosis in patients with diabetes mellitus. Neurology 2004; 62 (09) 1558-1562
  • 29 Lin Y, Zhang L, Bao J. , et al. Risk factors and etiological subtype analysis of brainstem infarctions. J Neurol Sci 2014; 338 (1-2): 118-121
  • 30 Jauch EC, Saver JL, Adams Jr HP. , et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (03) 870-947
  • 31 Tziomalos K, Spanou M, Bouziana SD. , et al. Type 2 diabetes is associated with a worse functional outcome of ischemic stroke. World J Diabetes 2014; 5 (06) 939-944
  • 32 Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001; 32 (10) 2426-2432
  • 33 Béjot Y, Aboa-Eboulé C, Hervieu M. , et al. The deleterious effect of admission hyperglycemia on survival and functional outcome in patients with intracerebral hemorrhage. Stroke 2012; 43 (01) 243-245
  • 34 Feng W, Tauhid S, Goel S, Sidorov EV, Selim M. Hyperglycemia and outcome in intracerebral hemorrhage: from bedside to bench-more study is needed. Transl Stroke Res 2012; 3 (Suppl. 01) 113-118
  • 35 Zhang G, Wu F, Xu Y. , et al. Prestroke glycemic status is associated with the functional outcome in spontaneous intracerebral hemorrhage. Neurol Sci 2015; 36 (06) 927-934
  • 36 Won SJ, Tang XN, Suh SW, Yenari MA, Swanson RA. Hyperglycemia promotes tissue plasminogen activator-induced hemorrhage by increasing superoxide production. Ann Neurol 2011; 70 (04) 583-590
  • 37 Poppe AY, Majumdar SR, Jeerakathil T, Ghali W, Buchan AM, Hill MD. ; Canadian Alteplase for Stroke Effectiveness Study Investigators. Admission hyperglycemia predicts a worse outcome in stroke patients treated with intravenous thrombolysis. Diabetes Care 2009; 32 (04) 617-622
  • 38 Bruno A, Durkalski VL, Hall CE. , et al; SHINE investigators. The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke. Int J Stroke 2014; 9 (02) 246-251
  • 39 Kernan WN, Viscoli CM, Furie KL. , et al; IRIS Trial Investigators. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med 2016; 374 (14) 1321-1331
  • 40 Viscoli CM, Kernan WN, Young LH. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med 2016; 375 (07) 704
  • 41 Meschia JF, Bushnell C, Boden-Albala B. , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (12) 3754-3832
  • 42 Ogawa H, Nakayama M, Morimoto T. , et al; Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA 2008; 300 (18) 2134-2141
  • 43 American Diabetes Association. Professional Practice Committee for the Standards of Medical Care in Diabetes-2016. Diabetes Care 2016; 39 (Suppl. 01) S107-S108
  • 44 Tasdemir E, Toptas T, Demir C, Esen R, Atmaca M. Aspirin resistance in patients with type II diabetes mellitus. Ups J Med Sci 2014; 119 (01) 25-31
  • 45 Raghavan RP, Laight DW, Cummings MH. Aspirin in type 2 diabetes, a randomised controlled study: effect of different doses on inflammation, oxidative stress, insulin resistance and endothelial function. Int J Clin Pract 2014; 68 (02) 271-277
  • 46 Committee CS. ; CAPRIE Steering Committee. A Randomised, Blinded, Trial of Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE). Lancet 1996; 348 (9038): 1329-1339
  • 47 Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 2015; 313 (06) 603-615
  • 48 Xie XX, Liu P, Wan FY. , et al. Blood pressure lowering and stroke events in type 2 diabetes: a network meta-analysis of randomized controlled trials. Int J Cardiol 2016; 208: 141-146
  • 49 Marso SP, Kennedy KF, House JA, McGuire DK. The effect of intensive glucose control on all-cause and cardiovascular mortality, myocardial infarction and stroke in persons with type 2 diabetes mellitus: a systematic review and meta-analysis. Diab Vasc Dis Res 2010; 7 (02) 119-130
  • 50 Guo Y, Yue XJ, Li HH. , et al. Overweight and obesity in young adulthood and the risk of stroke: a meta-analysis. J Stroke Cerebrovasc Dis 2016; 25 (12) 2995-3004
  • 51 Rexrode KM, Hennekens CH, Willett WC. , et al. A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 1997; 277 (19) 1539-1545
  • 52 Kurth T, Gaziano JM, Berger K. , et al. Body mass index and the risk of stroke in men. Arch Intern Med 2002; 162 (22) 2557-2562
  • 53 Hu G, Tuomilehto J, Silventoinen K, Sarti C, Männistö S, Jousilahti P. Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med 2007; 167 (13) 1420-1427
  • 54 Winter Y, Rohrmann S, Linseisen J. , et al. Contribution of obesity and abdominal fat mass to risk of stroke and transient ischemic attacks. Stroke 2008; 39 (12) 3145-3151
  • 55 Yatsuya H, Yamagishi K, North KE, Brancati FL, Stevens J, Folsom AR. ; ARIC Study Investigators. Associations of obesity measures with subtypes of ischemic stroke in the ARIC Study. J Epidemiol 2010; 20 (05) 347-354
  • 56 Walker SP, Rimm EB, Ascherio A, Kawachi I, Stampfer MJ, Willett WC. Body size and fat distribution as predictors of stroke among US men. Am J Epidemiol 1996; 144 (12) 1143-1150
  • 57 Suk SH, Sacco RL, Boden-Albala B. , et al; Northern Manhattan Stroke Study. Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke 2003; 34 (07) 1586-1592
  • 58 Lu M, Ye W, Adami HO, Weiderpass E. Prospective study of body size and risk for stroke amongst women below age 60. J Intern Med 2006; 260 (05) 442-450
  • 59 Vemmos K, Ntaios G, Spengos K. , et al. Association between obesity and mortality after acute first-ever stroke: the obesity-stroke paradox. Stroke 2011; 42 (01) 30-36
  • 60 Ovbiagele B, Bath PM, Cotton D, Vinisko R, Diener HC. Obesity and recurrent vascular risk after a recent ischemic stroke. Stroke 2011; 42 (12) 3397-3402
  • 61 Doehner W, Schenkel J, Anker SD, Springer J, Audebert HJ. Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial. Eur Heart J 2013; 34 (04) 268-277
  • 62 Andersen KK, Olsen TS. The obesity paradox in stroke: lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients. Int J Stroke 2015; 10 (01) 99-104
  • 63 Gerbier G, Baldet T. , A Tran, et al. Modelling local dispersal of bluetongue virus serotype 8 using random walk. Prev Vet Med 2008; 87 (1-2): 119-130
  • 64 Huang K, Liu F, Han X. , et al. Association of BMI with total mortality and recurrent stroke among stroke patients: a meta-analysis of cohort studies. Atherosclerosis 2016; 253: 94-101
  • 65 Dehlendorff C, Andersen KK, Olsen TS. Body mass index and death by stroke: no obesity paradox. JAMA Neurol 2014; 71 (08) 978-984
  • 66 McLaughlin T, Carter S, Lamendola C. , et al. Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Am J Clin Nutr 2006; 84 (04) 813-821
  • 67 Reisin E, Abel R, Modan M, Silverberg DS, Eliahou HE, Modan B. Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. N Engl J Med 1978; 298 (01) 1-6
  • 68 Wing RR, Lang W, Wadden TA. , et al; Look AHEAD Research Group. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011; 34 (07) 1481-1486
  • 69 Joseph LJ, Prigeon RL, Blumenthal JB, Ryan AS, Goldberg AP. Weight loss and low-intensity exercise for the treatment of metabolic syndrome in obese postmenopausal women. J Gerontol A Biol Sci Med Sci 2011; 66 (09) 1022-1029
  • 70 Blumenthal JA, Babyak MA, Hinderliter A. , et al. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med 2010; 170 (02) 126-135
  • 71 LeBlanc E, O'Connor E, Whitlock EP, Patnode C, Kapka T. Screening for and Management of Obesity and Overweight in Adults. Rockville, MD: Agency for Healthcare Research and Quality; 2011
  • 72 Sarrafzadegan N, Gharipour M, Sadeghi M. , et al. Metabolic syndrome and the risk of ischemic stroke. J Stroke Cerebrovasc Dis 2017; 26 (02) 286-294
  • 73 Wang GS, Tong DM, Chen XD, Yang TH, Zhou YT, Ma XB. Metabolic syndrome is a strong risk factor for minor ischemic stroke and subsequent vascular events. PLoS One 2016; 11 (08) e0156243
  • 74 Fang X, Liu H, Zhang X, Zhang H, Qin X, Ji X. Metabolic syndrome, its components, and diabetes on 5-year risk of recurrent stroke among mild-to-moderate ischemic stroke survivors: a multiclinic registry study. J Stroke Cerebrovasc Dis 2016; 25 (03) 626-634