Metabolic Syndrome and Stroke Prevention

How does the metabolic syndrome affect stroke risk?

Metabolic syndrome increases the risk of stroke in all ethnic groups and both sexes.^{2, 6-9} Having the metabolic syndrome approximately doubles your risk of having a stroke compared with healthy persons,^{9, 10} and the syndrome is estimated to account for 30% of all blocked-vessel (ischemic) strokes in women.⁹ Nearly half of all strokes occur in people who have the metabolic syndrome.^{6, 11}

Each component of the metabolic syndrome increases your risk of a first or repeat blocked-vessel stroke. The more of these components you have, the higher your risk of developing stroke.^{7, 12} High blood pressure, high cholesterol, and low HDL (good) cholesterol are all individual risk factors for atherosclerosis, meaning they can cause fatty deposits ( plaque) to build up on the walls of your blood vessels and reduce blood flow to the brain. In a study of 1895 adults (59% were women), the metabolic syndrome increased by 36% the risk of developing plaque in the carotid arteries in the neck.¹³ Another study, of 1588 adults (37% were women), found that the metabolic syndrome increased the risk of developing atherosclerosis in the carotid arteries more in women than in men.¹⁴

How can the metabolic syndrome be prevented?

Even if you already have 1 or 2 of the risk factors that are part of the metabolic syndrome, you can take steps to prevent getting the syndrome and the serious risks that come with it, including stroke.¹⁰

The safest and most effective way to do this is by making heart-healthy lifestyle changes.

• Weight control: If you are overweight or obese, particularly if you have excess fat around the waist, you are at increased risk for developing metabolic syndrome.
• Exercise: As little as 30 minutes a day of moderate exercise can help you lose weight, lower your insulin levels, blood pressure, and LDL (bad) cholesterol, and increase HDL (good) cholesterol
• Diet: Eating a heart-healthy diet will help you lose weight and reduce your risk of developing stroke, heart disease, or diabetes.

Sometimes lifestyle changes are not enough to fully control your risk factors. You may need medications to improve some risk factors such as high blood pressure and high cholesterol and lipids.

How is the metabolic syndrome treated?

The goal of treating the metabolic syndrome is to prevent type 2 diabetes, heart disease, heart attack, and stroke. The same lifestyle changes that help prevent the metabolic syndrome (weight control, changing your diet, getting more exercise, and quitting smoking) also help if you are diagnosed with the metabolic syndrome. Improving your diet and exercising regularly can delay or prevent the metabolic syndrome from progressing to type 2 diabetes, a major risk factor for stroke.¹⁵

If healthy lifestyle changes are not enough, your doctor may prescribe medications to treat the individual risk factors of the metabolic syndrome, such as high blood pressure, high blood sugar, and high cholesterol. You may also receive low-dose aspirin to help reduce your risk of blood clots. There is no one medication that treats the metabolic syndrome as a whole.

Does treating the metabolic syndrome prevent stroke?

The treatment of the risk factors that make up the metabolic syndrome reduces your chances of having a first or repeat blocked-vessel stroke.^{11, 12, 16, 17} As a set of risk factors that occur together, the metabolic syndrome helps doctors identify people who are at an increased—but potentially manageable—risk for diabetes, heart disease, and stroke.¹⁸ Treatment and other preventive measures can then be taken to reverse or reduce the risk of developing any of these diseases in people who perhaps would not be treated as early or at all.^{9, 12, 17}

References

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15. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. N Engl J Med. May 3, 2001;344(18):1343-1350.
16. Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Jun 20 2006;113(24):e873-923.
17. Scott CL. Diagnosis, prevention, and intervention for the metabolic syndrome. Am J Cardiol. 2003;92(1):35-42.
18. Wang J, Ruotsalainen S, Moilanen L, Lepisto P, Laakso M, Kuusisto J. The Metabolic Syndrome Predicts Incident Stroke: A 14-Year Follow-Up Study in Elderly People in Finland. Stroke. April 1, 2008;39(4):1078-1083.