神経疾患とメタボリックシンドローム : 通院患者における合併頻度

Abstract

Background and Objective: Metabolic syndrome (MetS) is highly prevalent in Japan; however, most previous surveys have studied only adults able to engage fully in normal daily activities, after excluding persons with diseases or disabilities. Recently, lifestyle-related risk factors have been strongly linked to a number of major diseases. In particular, the incidence of atherosclerotic vascular diseases associated with MetS has increased markedly, and this trend is projected to continue. We focused on the prevalence of MetS among out-patients with neurological diseases. Patients and methods: The subjects for this hospital-based study were 713 out-patients with various neurological diseases (329 men, mean age 65.2 ± 14.5 yr, age range 40-78 yr, and 384 women, mean age 64.6 ± 15.3 yr, age range 40-88 yr) who presented at the Department of Neurology, Nara Medical University Hospital. A total of 120 patients had cerebral infarction, 102 Parkinson's disease, 32 spinal spondylosis, 30 headache, 32 myositis, and the rest various other neurological diseases. MetS was diagnosed according to the criteria proposed by The Japanese Society of Internal Medicine in 2005. The cutoff values for waist circumference (WC) were greater than 85 cm in men and 90 cm in women. A diagnosis of MetS additionally required two or more of the following: a serum triglyceride level (TG) of at least 150 mg/dl and/or a high-density lipoprotein cholesterol level (HDLC) of less than 40 mg/dl; a blood pressure (BP) of greater than 130/85; or a fasting plasma glucose level (FPG) of greater than 110 mg/dl. Visceral fat accumulation was measured by abdominal CT scanning (N2systern, K.K., Japan). Results: WC positively correlated with visceral fat area as determined by CT scanning. WC also positively correlated with TG in both sexes and FBS in women, but negatively correlated with HDL-C in both sexes. The mean prevalence of MetS among subjects 40 to 70 years of age was 25.1% in men and 12.6% in women. To assess the incidence of MetS in the absence of cerebrovascular disease (CVD), we performed a subgroup analysis of patients with and without CVD. The risk of MetS was similar in out- patients without CVD and those with CVD. The prevalence of Pre MetS (defined as WC plus one risk factor) plus MetS was 50% in men and 20% in women. The prevalence of MetS in outpatients with neurological diseases was similar to that in the general population. Conclusion: The risk of atherosclerotic diseases in out-patients with neurological diseases is similar to that in the general population, potentially increasing the risk of unfavorable outcomes. The recognition and management of MetS represents an important challenge for physicians and other healthcare professionals. Strategies aimed at reducing risk factors for MetS are urgently required.