The mean age of the 1851 participants was 61.2 (SD 9.7) years and 36.5% women. Compared with men, women were older, less likely to be educated, smoke, drink alcohol, had higher level of waist circumference, systolic blood pressure, blood glucose, triglycerides, and HDL-C, had lower level of diastolic blood pressure (all p < 0.01) (Table 2). There was no significant sex difference in the prevalence of physical inactivity and daily eating fruits and vegetables (p > 0.10).
Table 2
Characteristics of participants by sex
Characteristics* | Total (n = 1851) | Men (n = 1176) | Women (n = 675) | P |
Age (years), mean (SD) | 61.2 (9.7) | 60.1 (9.5) | 63.1 (9.7) | < 0.001 |
Education, n (%) | | | | < 0.001 |
Illiteracy | 476 (26.7) | 125 (11.1) | 351 (53.8) |
Primary School | 463 (26.0) | 306 (27.1) | 157 (24.0) |
Middle School | 501 (28.1) | 398 (35.2) | 103 (15.8) |
High School and Above | 343 (19.2) | 301 (26.6) | 42 (6.4) |
Ever smoking, n (%) | 841 (45.4) | 795 (67.6) | 46 (6.8) | < 0.001 |
Alcohol drinking, n (%) | 611 (35.6) | 594 (56.8) | 17 (2.5) | < 0.001 |
Physically inactive, n (%) | 533 (28.9) | 326 (27.8) | 207 (30.8) | 0.176 |
Daily eating fruits and vegetables, n (%) | 1659 (90.3) | 1049 (89.8) | 610 (91.0) | 0.391 |
Waist circumference (cm), mean (SD) | 81.7 (6.7) | 82.4 (6.6) | 80.6 (6.6) | < 0.001 |
Systolic blood pressure (mmHg), mean (SD) | 140.8 (16.6) | 139.7 (16.9) | 142.9 (16.0) | < 0.001 |
Diastolic blood pressure (mmHg), mean (SD) | 81.7 (11.3) | 82.6 (11.5) | 80.1 (10.8) | < 0.001 |
Blood glucose (mmol/l), mean (SD) | 6.1 (2.3) | 5.9 (2.2) | 6.4 (2.5) | < 0.001 |
Triglycerides (mmol/l), median (IQR) | 1.3 (0.9–1.8) | 1.2 (0.9–1.8) | 1.4 (1.0-1.9) | 0.004 |
HDL-C (mmol/l), mean (SD) | 1.2 (0.4) | 1.1 (0.4) | 1.2 (0.4) | < 0.001 |
SD standard deviation, IQR interquartile range, HDL-C high density lipoprotein cholesterol |
*The number of missing values was 68 for education, 135 for alcohol drinking, 5 for physical activity, 13 for diet, 51 for waist circumference, 27 for blood pressure, 26 for blood glucose, 34 for triglycerides, 51 for HDL-C. |
Figure 1 shows the age- and sex-specific prevalence of MetS defined by three criteria. The overall prevalence of MetS was 34.0% by NECP criteria, 47.8% by IDF criteria, and 32.9% by CDS criteria. For each criteria, women had a higher prevalence than men at each age group, and the sex difference disappeared after the age of 75 years. The prevalence of MetS decreased with age overall and for both men and women.
The overall prevalence of CHD among patients with ischemic stroke was 41.0% (48.0% in women; 37.0% in men, p < 0.05). The prevalence increased from 34.0% in those aged 40–54 years old, 39.3% in those aged 55–64 years old, 46.8% in those aged 65–74 years old, to 51.2% in those aged ≥ 75 years old, and the prevalence increased with age for both men and women (Fig. 2). The prevalence of CHD was higher in women than in men across all age groups.
In the total sample, abdominal obesity, high blood pressure, high triglycerides, and low HDL-C were significantly associated with CHD (OR ranged from 1.27 to 1.43), however, there was no significant association between high blood glucose and CHD (Table 3). The MetS defined by three criteria was associated with an increased likelihood of CHD, with the adjusted OR ranging from 1.29 to 1.46 (P < 0.05). When the analysis was stratified by sex, abdominal obesity, high blood pressure, high triglycerides, and MetS defined by IDF criteria was significantly associated with an increased likelihood of CHD in men, whereas among women, abdominal obesity, high triglycerides, low HDL-C, and MetS defined by all three criteria were associated with CHD.
Table 3
The associations of metabolic syndrome and its individual components with coronary heart diseases in patients with acute ischemic stroke
Metabolic syndrome | Total sample (n = 1851) | Men (n = 1176) | Women (n = 675) |
and individual components* | No. of patients | No. of CHD cases | OR (95% CI)# | No. of patients | No. of CHD cases | OR (95% CI) # | No. of patients | No. of CHD cases | OR (95% CI) # |
Abdominal obesity | | | | | | | | | |
No | 1185 | 455 | 1.00 (Ref) | 861 | 307 | 1.00 (Ref) | 324 | 148 | 1.00 (Ref) |
Yes | 610 | 284 | 1.43 (1.15–1.77) | 280 | 118 | 1.45 (1.09–1.94) | 330 | 166 | 1.42 (1.03–1.96) |
High blood pressure | | | | | | | | | |
No | 413 | 143 | 1.00 (Ref) | 295 | 90 | 1.00 (Ref) | 118 | 53 | 1.00 (Ref) |
Yes | 1419 | 616 | 1.36 (1.08–1.72) | 868 | 347 | 1.51 (1.13–2.01) | 551 | 269 | 1.14 (0.75–1.72) |
High blood glucose | | | | | | | | | |
No | 993 | 391 | 1.00 (Ref) | 674 | 245 | 1.00 (Ref) | 319 | 146 | 1.00 (Ref) |
Yes | 844 | 366 | 1.14 (0.94–1.38) | 492 | 190 | 1.15 (0.90–1.48) | 352 | 176 | 1.14 (0.83–1.56) |
High triglycerides | | | | | | | | | |
No | 1221 | 480 | 1.00 (Ref) | 805 | 294 | 1.00 (Ref) | 416 | 186 | 1.00 (Ref) |
Yes | 607 | 277 | 1.38 (1.12–1.70) | 362 | 143 | 1.31 (1.00-1.72) | 245 | 134 | 1.50 (1.08–2.09) |
Low HDL-C | | | | | | | | | |
No | 855 | 323 | 1.00 (Ref) | 642 | 231 | 1.00 (Ref) | 213 | 92 | 1.00 (Ref) |
Yes | 957 | 427 | 1.27 (1.04–1.55) | 515 | 202 | 1.18 (0.92–1.52) | 442 | 225 | 1.49 (1.06–2.10) |
NCEP criteria | | | | | | | | | |
No | 1203 | 467 | 1.00 (Ref) | 845 | 310 | 1.00 (Ref) | 358 | 157 | 1.00 (Ref) |
Yes | 619 | 284 | 1.29 (1.04–1.59) | 316 | 123 | 1.16 (0.88–1.54) | 303 | 161 | 1.50 (1.08–2.06) |
IDF criteria | | | | | | | | | |
No | 957 | 354 | 1.00 (Ref) | 698 | 245 | 1.00 (Ref) | 259 | 109 | 1.00 (Ref) |
Yes | 878 | 406 | 1.46 (1.20–1.78) | 469 | 192 | 1.40 (1.08–1.80) | 409 | 214 | 1.62 (1.16–2.24) |
CDS criteria | | | | | | | | | |
No | 1228 | 481 | 1.00 (Ref) | 817 | 297 | 1.00 (Ref) | 411 | 184 | 1.00 (Ref) |
Yes | 602 | 273 | 1.29 (1.05–1.59) | 348 | 137 | 1.20 (0.92–1.58) | 254 | 136 | 1.47 (1.06–2.04) |
HDL-C high density lipoprotein cholesterol, CHD coronary heart disease, OR odds ratio, CI confidence interval, NCEP National Cholesterol Education Program, IDF International Diabetes Federation, CDS Chinese Diabetes Society |
*The individual components were defined according to the IDF criteria. |
#Controlled for age, education, smoking, alcohol drinking, physical activity, and dietary, and if applicable, for sex. |
Furthermore, we categorized all participants into three groups according to the number of abnormal MetS components that were defined by each of the three MetS criteria, i.e., 0 (reference), 1–2, and ≥ 3 components. In the total sample, compared to patients without abnormality in any of the five MetS components, having 1–2 and ≥ 3 abnormal MetS components was significantly associated with an increased likelihood of CHD (Table 4). There was no statistical interaction of MetS with sex on CHD. However, when the analysis was stratified by sex, the results showed that for, the for having 1–2 and ≥ 3 abnormal MetS components (vs. none) defined both NCEP and IDF criteria was significantly associated with an elevated likelihood of CHD in men, but not in women. When MetS components were defined by the CDS criteria, having ≥ 3 abnormal components (vs. none) was signifivcantly associated with an increased likelihood of CHD in both men and women (Table 4).
Table 4
The associations between number of metabolic syndrome components and coronary heart diseases in patients with acute ischemic stroke
| Total sample (n = 1851) | Men (n = 1176) | Women (n = 675) |
No. of MetS components | No. of patients | No. of CHD cases | OR (95% CI)* | No. of patients | No. of CHD cases | OR (95% CI)* | No. of patients | No. of CHD cases | OR (95% CI)* |
NCEP criteria | | | | | | | | | |
0 | 150 | 44 | 1.00 (Ref) | 124 | 33 | 1.00 (Ref) | 26 | 11 | 1.00 (Ref) |
1–2 | 1102 | 447 | 1.63 (1.12–2.39) | 738 | 285 | 1.85 (1.20–2.85) | 364 | 162 | 1.18 (0.52–2.68) |
≥3 | 599 | 274 | 1.97 (1.32–2.94) | 314 | 122 | 1.97 (1.22–3.17) | 285 | 152 | 1.70 (0.74–3.89) |
IDF criteria | | | | | | | | | |
0 | 125 | 34 | 1.00 (Ref) | 106 | 27 | 1.00 (Ref) | 19 | 7 | 1.00 (Ref) |
1–2 | 875 | 334 | 1.63 (1.07–2.50) | 615 | 225 | 1.77 (1.10–2.84) | 260 | 109 | 1.37 (0.50–3.70) |
≥3 | 851 | 397 | 2.37 (1.54–3.65) | 455 | 188 | 2.39 (1.46–3.90) | 396 | 209 | 2.29 (0.86–6.11) |
CDS criteria | | | | | | | | | |
0 | 169 | 48 | 1.00 (Ref) | 122 | 33 | 1.00 (Ref) | 47 | 15 | 1.00 (Ref) |
1–2 | 1108 | 458 | 1.73 (1.20–2.48) | 716 | 272 | 1.76 (1.14–2.72) | 392 | 186 | 1.78 (0.91–3.49) |
≥3 | 574 | 259 | 2.08 (1.41–3.05) | 338 | 135 | 2.02 (1.26–3.24) | 236 | 124 | 2.32 (1.16–4.64) |
CHD coronary heart disease, OR odds ratio, CI confidence interval, NCEP National Cholesterol Education Program, IDF International Diabetes Federation, CDS Chinese Diabetes Society |
*Controlled for age, sex, education, smoking, alcohol drinking, physical activity, and dietary, and if applicable, for sex. |