Metabolic profile in elderly patients with ischemic stroke: a university hospital study in Morocco

Authors

Abstract

Aim This study aims to assess lipid and glucose metabolism in elderly ischemic stroke patients in Morocco, highlighting the prevalence of metabolic disturbances as key risk factors. Given the strong link between aging and stroke, understanding metabolic profiles may improve prevention and management strategies.
Materials and Methods A retrospective analysis included 213 patients aged ≥60 years hospitalized for ischemic stroke between January 1 and December 31, 2024. Lipid profile, fasting blood glucose, and HbA1c were measured within 24 hours of admission using enzymatic colorimetric assays and UV/Visible spectrophotometry (500 nm ± 20). Data were analyzed using JAMOVI software (v2.21).
Results Mean age was 75.31 ± 9.43 years. Metabolic disorders were highly prevalent: 25% had glucose metabolism abnormalities, including 18% with diabetes (HbA1c >6.5%). Dyslipidemia affected 60% of patients, with 82.6% exhibiting elevated LDL (>1.6 g/L), 80.5% low HDL (<0.4 g/L), and 77.7% below protective HDL levels. Furthermore, 81.7% had a total cholesterol/HDL ratio >2, indicating high cardiovascular risk.
Discussion The high prevalence of dyslipidemia and glycemic disorders underscores their critical role in ischemic stroke among the elderly. These findings confirm strong associations between metabolic syndrome, type 2 diabetes, and stroke risk. Early detection and strict control of lipid and glucose metabolism are essential to reduce neurovascular recurrence. Integrated metabolic screening should be part of routine stroke care in older adults, particularly in populations with limited preventive health strategies. Improving metabolic management could significantly impact stroke outcomes in this vulnerable group.

Keywords

Introduction

Stroke is a major challenge for healthcare systems in developing countries. Epidemiological and intervention studies have clearly demonstrated that dyslipidemia plays a causal role in the development of atherosclerosis, responsible for ischemic cardiovascular diseases such as myocardial infarction and stroke. Today, these pathologies are among the leading causes of morbidity and mortality worldwide. A complete lipid profile - including total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides - is therefore strongly recommended for an accurate assessment of overall cardiovascular risk [1].
Diabetes mellitus is more common in the elderly population. In Japan and other countries, at least one-sixth of the elderly population suffers from diabetes [2, 3].
Elderly diabetic patients may be at increased risk of functional dependence and frailty. Consequently, a comprehensive geriatric assessment may be necessary in the treatment of elderly patients [4].
Diabetes mellitus is associated with an increased prevalence and incidence of geriatric syndrome: functional disabilities, depression, falls, urinary incontinence, malnutrition, and cognitive impairment [5].
Dyslipidemia is a frequent cause of morbidity worldwide, and the most common form is hypercholesterolemia, defined as a total cholesterol level above 5.0mmol/L or 190mg/L. One third of ischemic heart disease worldwide is secondary to hypercholesterolemia, and it is estimated that hypercholesterolemia is responsible for 2.6 million (4.5%) deaths worldwide [4].. There are currently three types of dyslipidemia: hypercholesterolemia, hypertriglyceridemia, and mixed hyperlipidemia, due to elevated cholesterol and triglycerides [6].
The clinical manifestations of arteriosclerosis are found in coronary artery disease, ischemic stroke, and peripheral vascular occlusive disease. Dyslipidemia is a metabolic abnormality characterized by a persistent increase in plasma cholesterol and triglyceride concentrations. Advanced age is associated not only with primary stroke, but also with increased mortality and reduced functional status after stroke [9, 10]. Stroke is the 1st cause of acquired physical disability in adults [7]. Various risk factors underpinned by socio-economic, political, and environmental determinants have been identified and associated with the occurrence of ischemic stroke, including disturbances in carbohydrate and lipid metabolism. Several studies on the primary and secondary prevention of these factors have been carried out, and the quality of management has improved in recent years [8].

Materials and Methods

This is a retrospective study conducted at the CHU Souss Massa. The data were collected from patients aged 60 and over, hospitalized for AVCI. It covered the period from January 1 to December 31, 2024.
Patients included in this study had undergone a complete lipid and carbohydrate profile: fasting blood glucose and HbA1C within 48 hours of admission.
Sociodemographic variables, clinical, and biological data were studied and analyzed in univariate measures. Bivariate analysis was then performed, correlating the biological aspects with the various data. Analyses were performed using JAMOVI software ref: 2.3.21.
Ethical Approval
The study was approved by the Ethics Committee for Biomedical Research of the Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco (Date: 2025-09-28, No: 03/23).

Results

We collected 213 patient records. The mean age of our patients was 75.31 ±9.43 years, with a standard deviation of 13.89 years and extremes ranging from 10 to 99 years. The sex ratio was 1.20 in favor of women (54.5%). As for place of residence, 150 individuals (70.4%) lived in urban areas, compared with 62 (29.1%) in rural areas. This distribution reflects a clear majority of participants from urban areas (Table 1).
Glucidic Profile
Descriptive analysis of metabolic parameters reveals a significant prevalence of glycemic and lipid disorders in our cohort. Evaluation of fasting blood glucose levels showed that 47.9% of patients had moderate hyperglycemia (1.11-1.99 g/l), while 39.4% had normal values (0.7-1.1 g/l) and 12.7% exceeded the critical threshold of 2 g/l. As for glycated hemoglobin, 71.4% of patients had normal values (<6.5%), including 10.3% in the optimal range (4.8-5.9) and 18.3% with borderline values (6- 6.4). Dyslipidemia was particularly pronounced, with 79.6% of patients presenting elevated triglycerides (≥1.5 g/l) compared with only 21.3% within normal limits. These results highlight the high frequency of metabolic comorbidities, particularly dyslipidemia, in patients with ischemic stroke (Table 2).
Lipid Profile
Lipid analysis of the 213 participants revealed an overall unfavorable neurovascular risk profile. The vast majority of participants (82.6%) exhibited elevated LDL cholesterol concentrations (>1.6 g/L), whereas only 17.4% had values within the normal range. Concurrently, approximately 80.5% of participants presented with HDL cholesterol levels below 0.4 g/L—a threshold associated with increased neurovascular risk—and fewer than one-quarter (22.3%) achieved protective HDL concentrations. The total cholesterol/HDL ratio, a well- established prognostic indicator of neurovascular risk, exceeded 2 in 81.7% of individuals, indicating high risk, compared with only 18.3% who exhibited a ratio within the acceptable range. Collectively, these findings indicate that most participants displayed an atherogenic lipid profile characterized by elevated LDL cholesterol (hypercholesterolemia), low HDL cholesterol (hypoalphalipoproteinemia), and an elevated total cholesterol/ HDL ratio—features consistent with significantly increased neurovascular risk. These results corroborate the data presented in Tables 1 and 2, underscoring the high prevalence of metabolic comorbidities (e.g., diabetes and dyslipidemia) in this cohort. (Table 3) summarizes the lipid profile parameters for the 213 participants, including LDL (low-density lipoprotein) levels.

Discussion

The mean age of patients in this study was 75.31 ±9.43 years, with a sex ratio of 1.20 in favor of women (54.5). These results resemble those of a study by Hollander et al. [9], which also revealed a clear female predominance at 58.4%. This resemblance may be explained by the fact that his study focused on the elderly. Similarly, the study by Ousmane et al [10] found a female predominance (57.45%) in favor of women. The most frequent risk factors were hypertension (60.44%) and dyslipidemia (51.65%) [11]. According to the 2001 ESI study, stroke is associated with 56% of ischemic stroke in men and 66% in women in Europe.
Glycemic Profile
The results obtained from 213 individuals reveal an overall profile marked by a predominance of abnormal values or values close to critical thresholds for several metabolic parameters. Nearly half the sample (48.27%) had blood glucose levels above 2 g/l, suggesting a high potential prevalence of glycemic disorders, or even uncontrolled diabetes. This finding is set against a background where only 18.5% of participants weighed over 80 kg, which could indicate that insulin resistance or other genetic or environmental determinants play an important role in the observed hyperglycemia [12, 13]. Our rate is in paradox with that of Chan and Sweileh, where the rates were 21% and 45.2% respectively, and Ducluzeau with 11.76% and 11% respectively [14, 15]. Our rate is in paradox with that of Chan and Sweileh, where the rates were respectively 21% and 45.2% and Ducluzeau with respectively 11.76% and 11% [14, 15].
It should be noted that the study population was aged 70 and over, where ischemic strokes are more common. This suggests the predominant role of hyperglycemia in the occurrence of complications associated with this disease[18]. Several studies have shown that short- and long-term mortality rates and risk of death are higher in stroke patients with hyperglycemia on admission [12, 20]. Moreover, according to one study, this association translates into a two-fold increase in the risk of short-term mortality in these patients [16]. In another study of 656 patients hospitalized with ischemic stroke, it was found that hyperglycemia on admission was present in 40% of cases and independently increased the risk of mortality at 30 days, 1 year, and 6 years [17].
In our series, dyslipidemia is a more frequent factor than diabetes, but a case-control study is needed to assess its impact on the occurrence of ischemic stroke. Some studies have reported the same data [18]. The Multiple Risk Factor Intervention study demonstrated a significant relationship between serum cholesterol and the risk of ischemic stroke, and an inverse relationship with hemorrhagic stroke. Some studies have reported the same data [18]. The Multiple Risk Factor Intervention study demonstrated a significant relationship between serum cholesterol and the risk of stroke, and an inverse relationship with hemorrhagic stroke.
In the City Heart study [19], the overall association between LDL-cholesterol concentration and stroke was not significant. However, the incidence adjusted for age, sex, and type of stroke showed significantly increasing LDL levels. Compared with the first quartile of the LDL distribution, individuals in the fourth quartile were at greater risk of atherothrombotic cerebral infarction. A recent systematic review found that HDL- cholesterol concentrations were inversely associated with the risk of DALY and carotid atherosclerosis.
Lipid Profile
At the same time, analysis of lipid status reveals high frequency rates for total cholesterol (81.7%) and HDL (80.5%). These lipid imbalances, combined with frequent hyperglycemia, are key markers of metabolic syndrome in the study population.
In a systematic review, triglyceride concentration was found to be a significant predictor of all strokes (RR 1.10, 1.07 -1 / 13, p <0.0001)24. Similarly, the results of the Copenhagen Heart City Study showed a convincing association between triglyceride levels and the risk of ischemic stroke [20, 21].
Contrary to the findings of a recent systematic review, HDL- cholesterol concentrations were inversely associated with the risk of DALY and carotid atherosclerosis [22]. Similarly, with regard to behavioral measures, only 15.1% of participants followed a specific diet (diabetic and/or low-salt), despite the high frequency of abnormal blood glucose levels and dyslipidemia. This low adherence to dietary recommendations may reflect either a lack of information or motivation, or a poor perception of risk on the part of patients, or socio-economic or cultural barriers to therapeutic follow-up.

Limitations

Delays in feedback (>24 h) and the management of some patients in the private sector limit real-time access to balance data, potentially affecting data completeness temporarily without compromising the overall validity of the analysis.

Conclusion

This study reveals significant lipid and glycemic abnormalities in elderly patients with ischemic stroke. A personalized approach integrating lifestyle modifications, early detection, and therapeutic education is essential for reducing morbidity associated with metabolic syndrome and neurovascular complications in this vulnerable population.

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