Association of Metabolic Syndrome and Its Components With Risk of Stroke Recurrence and Mortality: A Meta-analysis.

OBJECTIVE: Since metabolic syndrome is a significant risk factor for cardio-cerebrovascular diseases, and the relationship between metabolic syndrome (including its components) and the prognosis of stroke are controversial, this study was conducted to evaluate whether metabolic syndrome is associated with a high recurrence and mortality of stroke.

METHODS: This study was registered in the PROSPERO database (CRD42020177118). We searched for relevant observational cohort studies published from inception to April 23, 2020 using PubMed, Embase, and the Cochrane Library. Effect estimates with 95% CIs were pooled using the random-effects model. The primary and secondary outcomes were stroke recurrence and all-cause mortality, respectively. Leave-one-out sensitivity analyses and nonparametric trim and fill method were used to identify the stability of the results.

RESULTS: Thirteen cohort studies comprising 59,919 participants aged >60 years were included for analysis. Overall, metabolic syndrome was significantly associated with stroke recurrence (RR 1.46, 95% CI 1.07-1.97, P = 0.02). Among the metabolic syndrome components, low levels of high density lipoprotein cholesterol (HDL-C) (RR 1.32, 95% CI 1.11-1.57, P = 0.002) and number of metabolic syndrome components(≥ 2) (RR 1.68, 95% CI 1.44-1.94, P <0.001) significantly predicted stroke recurrence, whereas elevated triglyceride, elevated waist circumference, hyperglycemia, or hypertension failed to account for risk factors for stroke recurrence. Moreover, metabolic syndrome, not its components, was significantly associated with all-cause mortality (RR 1.27, 95% CI 1.18-1.36, P < 0.001). The stability of these results was further confirmed by the leave-one-out sensitivity analyses and nonparametric trim and fill method.

CONCLUSIONS: The present study indicates that metabolic syndrome and some of its components (low HDL-C and number of metabolic syndrome components) seem to be risk factors for stroke recurrence. Though metabolic syndrome is also associated with all-cause mortality, the role of its components to predict all-cause mortality deserves further study.