The effect of metabolic factors on the post-stroke depression of ischemic stroke patients

Objective: To investigate the relationship between metabolic syndrome (MetS) risk factors and the risk of post-stroke depression (PSD) in ischemic stroke patients. Methods: A total of 667 ischemic stroke patients participated in blood sample collection for the analysis of MetS risk factors, and in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) testing. The association between MetS risk factors and the risk of PSD was assessed using Cox regression proportional hazards models, and the Chi-squared test was used to evaluate differences in demographic variables and clinical characteristics in the subgroups. Results: In our study, the incidence of PSD in the 2-year follow-up was 35.4%. The risk of PSD was elevated with increased blood glucose levels (Hazard ratio [HR]: 2.147, 95% confidence interval [CI]: 1.331-3.463; top vs. bottom quartile) and glycosylated hemoglobin (HbA1c) (HR: 2.348, 95% CI: 1.424-3.871; top vs. bottom quartile). The hazard ratio was increased for z-scores of blood glucose and HbA1c, and for the combined metabolic syndrome score. In addition, the risk of PSD was increased in ischemic stroke patients with high blood glucose levels (>= 6.0mmol/l) and with HbA1c (>= 6.5%). However, we did not find significant associations between PSD and other MetS risk factors, including body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), cholesterol, and triglycerides. Conclusions: Depression is prevalent among ischemic stroke patients. Blood glucose levels and HbA1c are positively associated with the risk of PSD and might be useful bio-markers to predict its development.