Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus
Authors: Chen Weiqi , Pan Yuesong , Jing Jing , Zhao Xingquan , Liu Liping , Meng Xia , Wang Yilong , Wang Yongjun , Johnston S. Claiborne , Wang Zhimin , Xia Haiqin , Li Bin , Zhang Guiru , Ren Xudong , Ji Chunling , Zhang Guohua , Li Jianhua , Lu Bohua , Wang Liping , Feng Shutao , Wang Dali , Tang Weiguo , Li Juntao , Zhang Hongtian , Li Guanglai , Wang Baojun , Chen Yuhua , Lian Ying , Liu Bin , Teng Junfang , Sui Rubo , Li Lejun , Yuan Zhiling , Zang Dawei , Lu Zuneng , Sun Li , Wang Dong , Hou Liying , Yuan Dongcai , Cao Yongliang , Li Hui , Tan Xiuge , Wang Huicong , Du Haisong , Liu Mingyi , Wang Suping , Liu Qiuwu , Zhang Zhong , Cui Qifu , Wang Runqing , Zhao Jialin , Zhang Jiewen , Zhao Jianping , Bi Qi , Qi Xiyou , Liu Junyan , Li Changxin , Li Ling , Pan Xiaoping , Zhang Junling , Jiao Derang , Han Zhao , Qian Dawei , Xiao Jin , Xing Yan , Du Huishan , Huang Guang , Cui Yongqiang , Li Yan , Feng Lianyuan , Gao Lianbo , Xiao Bo , Cao Yibin , Wu Yiping , Liu Jinfeng , Zhang Zhiming , Dong Zhengxie , Wang Limin , He Li , Wang Xinchen , Guo Xueying , Wang Ming , Wang Xiaosha , Jiang Jiandong , Zhao Renliang , Zhou Shengnian , Hu Hao , He Maolin , Yu Fengchun , Ouyang Quping , Zhang Jingbo , Xu Anding , Qi Xiaokun , Wang Lei , Shi Fuming , Guo Fuqiang , Wang Jianfeng , Zhao Fengli , Dou Ronghua , Wei Dongning , Meng Qingwei , Xia Yilu , Wang Shimin , Xue Zhangcang , Xu Yuming , Ma Liping , Wang Chun , Wu Jiang , Du Yifeng , Wang Yinzhou , Xiao Lijun , Song Fucong , Hu Wenli , Chen Zhigang , Liu Qingrui , Zhang Jiemin , Chen Mei , Yuan Xiaodong , Liu Zhihui , Li Guozhong , Li Xiaohong , Tian Tingchen 
Published: June 2017

Background

We aimed to determine the risk conferred by metabolic syndrome (
METS
) and diabetes mellitus (
DM
) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.

Methods and Results

In total, 3044 patients were included. Patients were stratified into 4 groups: neither,
METS
only,
DM
only, or both.
METS
was defined using the Chinese Diabetes Society (
CDS
) and International Diabetes Foundation (
IDF
) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of
METS
and
DM
status to the risk of recurrent stroke adjusted for potential covariates. Using the
CDS
criteria of
METS
, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither,
METS
only,
DM
only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with
DM
only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95%
CI
1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different
METS
or
DM
status for the risk of recurrent stroke (
P
=0.82 for interaction in the fully adjusted model of
CDS
) was observed. Using the
METS
(
IDF
) criteria demonstrated similar results.

Conclusions

Concurrent
METS
and
DM
was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.