BACKGROUND The obesity paradox refers to the finding in observational studies that patients with obesity have a better prognosis after stroke than normal weight patients. AIM To test the hypothesis that there might be important heterogeneity within the obese stroke population, such that those with metabolic syndrome would be at higher risk for stroke or myocardial infarction and all-cause mortality compared to patients without metabolic syndrome. METHODS The Insulin Resistance Intervention after Stroke trial enrolled non-diabetic patients with a recent ischemic stroke or transient ischemic attack and insulin resistance. We examined the association between metabolic syndrome and outcome risk in patients with normal weight at entry (body mass index (BMI) = 18.5-24.9 kg/m2), overweight (BMI = 25-29.9 kg/m2), or obesity (BMI ≥ 30 kg/m2). Analyses were adjusted for demographic features, treatment assignment, smoking, and major comorbid conditions. RESULTS Metabolic syndrome was not associated with greater risk for stroke or myocardial infarction among 1536 patients who were overweight (adjusted hazard ratio (HR), 0.95; 95% confidence interval (CI): 0.69-1.31) or 1626 obese patients (adjusted HR, 1.00; 95% CI: 0.70-1.41). However, among 567 patients with a normal BMI, metabolic syndrome was associated with increased risk for stroke or myocardial infarction (adjusted HR, 2.05; 95% CI: 1.25-3.37), and all-cause mortality (adjusted HR, 1.70; 95% CI: 1.03-2.81) compared to patients without metabolic syndrome. CONCLUSIONS The presence of metabolic syndrome identified normal weight patients with insulin resistance but no diabetes who have a higher risk of adverse cardiovascular outcomes, compared with patients without metabolic syndrome.

中文翻译：

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代谢综合症确定了正常体重的胰岛素抵抗性中风患者存在复发性血管疾病的风险。

背景技术肥胖悖论是指观察性研究发现肥胖患者中风后比正常体重患者预后更好。目的为了检验以下假设：肥胖中风人群中可能存在重要的异质性，从而使那些患有代谢综合征的人与没有代谢综合征的患者相比，罹患中风或心肌梗塞和全因死亡率的风险更高。方法中风试验后的胰岛素抵抗干预招募了患有非缺血性中风或短暂性脑缺血发作和胰岛素抵抗的非糖尿病患者。我们检查了体重正常（入院体重指数（BMI）= 18.5-24.9 kg / m2），超重（BMI = 25-29.9 kg / m2）或肥胖症（BMI≥ 30公斤/平方米）。针对人口统计学特征，治疗分配，吸烟和主要合并症条件对分析进行了调整。结果代谢综合征与超重（调整后的危险比（HR）为0.95； 95％置信区间（CI）：0.69-1.31）或1626肥胖的患者（调整后的HR）中的1536例患者的中风或心肌梗塞风险较高无关。 1.00； 95％CI：0.70-1.41）。但是，在567名BMI正常的患者中，代谢综合征与中风或心肌梗死的风险增加（HR调整后为2.05； 95％CI：1.25-3.37）和全因死亡率（HR调整后为1.70； 95％）有关CI：1.03-2.81）与无代谢综合征的患者相比。