Metabolic profile of sub-Saharan African patients presenting with first-ever-in-lifetime stroke: association with insulin resistance.

ABSTRACT

BACKGROUND: To assess the pattern of metabolic profile associated with first stroke episode in a hospital setting in Cameroon. METHODS: All patients admitted for first-ever-in-lifetime stroke over a 6-month period were eligible for inclusion in the study. The 84% participation rate yielded 57 of 68 patients between 16 and 85 years of age. Fifty-seven control subjects were selected to match patients included for age range, sex, and known hypertension and diabetes. We measured fasting serum glucose, insulin, and lipids in controls and in patients between days 3 and 7 after admission. RESULTS: Total cholesterol was comparable in patients and controls (172.6 ± 39.5 v 175.4 ± 49.7 mg/dL; P = .75), as were triglycerides (129.4 ± 56.1 v 122.4 ± 60.7 mg/dL; P = .53). high-density lipoprotein cholesterol (HDL-C) levels were lower in patients than in controls (37.4 ± 20.6 v 50.2 ± 18.0 mg/dL; P = .001), with comparable levels of low-density lipoprotein cholesterol (LDL-C; 109.4 ± 43.0 v 100.7 ± 48.8 mg/dL; P = .32). The LDL-C/HDL-C ratio was higher in patients compared to controls (4.0 ± 3.0 v 2.3 ± 1.7; P = .0001), as was the total cholesterol/HDL-C ratio (5.9 ± 3.5 v 3.9 ± 1.8; P = .0001). Compared to controls, stroke patients had higher fasting insulin levels (5.9 ± 5.4 v 2.3 ± 3.2 IU/mL; P < .001) and higher insulin resistance as measured by the homeostatic model assessment of insulin resistance (1.9 ± 2.2 v 0.7 ± 1.0; P = .001). CONCLUSIONS: Stroke is associated with markers of insulin resistance, low serum levels of HDL, and high total cholesterol/HDL ratio in this African population. Studies with a larger sample size and cohort designs are warranted to explore the causal pathways, persistence of these abnormalities, and population-specific cut points.