Metabolic Syndrome and Stroke Risk

 

To evaluate the association between ischemic stroke and metabolic syndrome, DeBoer and Gurka reviewed more than 13,000 participants in prior studies and their stroke outcomes. Among that group, there were 709 ischemic strokes over a mean period of 18.6 years assessed in the studies. (Ischemic strokes are caused when blood flow to the brain is obstructed by blood clots or clogged arteries. Hemorrhagic strokes, on the other hand, are caused when blood vessels rupture.)

DeBoer developed the scoring tool, an online calculator to assess the severity of metabolic syndrome, with Matthew J. Gurka, PhD, of the Department of Health Outcomes and Biomedical Informatics at the University of Florida, Gainesville. The tool is available for free at https://metscalc.org/.

Journal Reference: Mark D. DeBoer, Stephanie L. Filipp, Mario Sims, Solomon K. Musani, Matthew J. Gurka. Risk of Ischemic Stroke Increases Over the Spectrum of Metabolic Syndrome Severity. Stroke, 2020; 51 (8): 2548 DOI: 10.1161/STROKEAHA.120.028944

This online calculator can predict your stroke risk

Presented with the following caveat:

I tried the calculator but I’m not quite sure how useful it will be in clinical settings.  As far as insurance underwriting is concerned I probably won’t use it.

Stroke Rounds: Long Work Hours, Stroke and CHD Risk Associated | Medpage Today

via Stroke Rounds: Long Work Hours, Stroke and CHD Risk Associated | Medpage Today.

“Working 55 hours or more a week was associated with significant 33% increase in stroke risk and a more modest 13% increase in risk of developing coronary heart disease, compared to working 35 to 40 hours weekly, in the analysis of published and previously unpublished prospective cohort studies from the U.S., Europe, and Australia.”

One could argue for causation given the strength of association identified by this study.  Common sense tells us that anyone working more than 60 hours a week is going to have considerably less time for other activities like exercise and time with family and friends.  Long hours working also can lead to neglect of one’s health.

Untreated Sleep Apnea Boosts Risk of Heart Disease, Stroke | Medpage Today

Untreated Sleep Apnea Boosts Risk of Heart Disease, Stroke | Medpage Today.

Compared with OSA-negative patients, untreated OSA was associated with an 86% higher mortality risk (adjusted hazard ratio 1.86, 95% CI 1.81 to 1.91), and treated OSA was associated with a 35% higher mortality risk (aHR 1.35, 95% CI 1.21 to 1.51), wrote Miklos Z. Molnar, MD, PhD, of the University of Tennessee Health Science Center in Memphis, and colleagues, in the journal Thorax.

Untreated OSA also was associated with a 3.5 times higher risk of incident coronary heart disease (aHR 3.54, 95% CI 3.40 to 3.69), and a 3.5 times higher risk of incident strokes (aHR 3.48, 95% CI 3.28 to 3.64), while treated OSA was associated with a threefold higher risk of incident CHD (aHR 3.06, 95% CI 2.62 to 3.56) and 3.5-fold higher risk of incident strokes (aHR 3.50, 95% CI 2.92 to 4.19). The risk of incident kidney disease also was significantly higher in untreated (aHR 2.27, 95% CI 2.19 to 2.36) and treated OSA (aHR 2.79, 95% CI 2.48 to 3.13).

Sleep Apnea Linked to Cancer

Sleep Apnea Linked to Cancer.

Moderate-to-severe OSA was associated with a 2.5-fold higher likelihood of incident cancer (95% CI 1.2-5.0) after adjustment for obesity and a full range of other factors, Nathaniel Marshall, PhD, of the University of Sydney Nursing School in Australia, and colleagues found.

Cancer mortality was 3.4 times more common (95% CI 1.1-10.2) in those with sleep apnea than with no sleep apnea during 20 years of follow-up, they reported in the April 15 issue of theJournal of Clinical Sleep Medicine.

Testosterone Treatment Tied to Worse Cardiac Outcomes

After adjustment for the presence of coronary artery disease, testosterone therapy was associated with a greater risk of all-cause mortality, myocardial infarction, and ischemic stroke 3 years after angiography (25.7% versus 19.9%; HR 1.29, 95% CI 1.04-1.58), according to P. Michael Ho, MD, PhD, of the Department of Veterans Affairs (VA) Eastern Colorado Health Care System in Denver, and colleagues.

via Testosterone Tx Tied to Worse Cardiac Outcomes.

How come the television commercials don’t tell you this information when they try to make you think you have a disease called Low T?

Annual prescriptions for testosterone increased more than five-fold from 2000 to 2011. In 2011, the total number of prescriptions numbered 5.3 million and make up a market of 1.6 billion, the authors wrote.

Never mind.

Afib Linked to Silent Stroke

MRI indicated silent cerebral ischemia lesions in 89% patients with paroxysmal Afib and 92% with persistent Afib compared with 46% of controls, which wasn’t significantly different between the two types of Afib but was for both versus controls (P<0.01).

The number of these lesions averaged 41 in persistent Afib, 33 in paroxysmal Afib, and 12 in controls, which was significantly different for all three groups.

The high prevalence of these lesions in the control group compared with what has been reported in the general population may have reflected the moderate to high cardiovascular risk among these patients referred for cardiovascular prevention or treatment, the researchers suggested.

The lesions can have either ischemic and embolic origins, but the peculiar “spotted” distribution of “small sharply demarcated lesions, often in cluster, with bilateral distribution, prevalently in the frontal lobe” seen in 50% and 67% of the paroxysmal and persistent Afib patients, respectively, strongly supported an embolic mechanism, they noted.

via Afib Linked to Silent Stroke.

If these findings are replicated in future studies, the question for underwriters is should any Afib risk be Standard mortality?

Heavy Drinking May Lead to Early Stroke

Drinking three or more alcoholic beverages a day may raise the risk for spontaneous intracerebral hemorrhage at a much younger age than typical, researchers found.

These strokes occurred at an average age of 60 with such high alcohol consumption, 14 years earlier than seen without heavy drinking (P<0.0001), Charlotte Cordonnier, MD, PhD, of the University of Lille Nord de France in Lille, France, and colleagues,

Heavy drinking also predicted a near doubling in 2-year mortality risk after a deep intracerebral hemorrhage before age 60, the group reported in the Sept. 11 issue of Neurology.

via Heavy Drinking May Lead to Early Stroke.