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This study assessed their combined association with stroke mortality in a general population cohort using NHANES III participants. MetS was defined by Adult Treatment Panel III criteria, while AtCM was identified by deep terminal negativity of the P wave in V1 (DTNPV1). Survey-weighted Firth penalized Cox models estimated adjusted hazard ratios (HRs) and 95% confidence intervals.",{"@graph":69,"@context":127},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/metabolic-syndrome-and-atrial-cardiomyopathy-on-the-risk-of-stroke-mortality-in-the-general-population/407837/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/metabolic-syndrome-and-atrial-cardiomyopathy-on-the-risk-of-stroke-mortality-in-the-general-population/407837.png","ImageObject",300,407,{"name":92,"@type":93},"Adam","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119,123],{"name":110,"@type":111,"acceptedAnswer":112},"What was the study aiming to determine?","Question",{"text":113,"@type":114},"To determine the combined impact of metabolic syndrome (MetS) and atrial cardiomyopathy (AtCM) on stroke mortality in the general population.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How were MetS and AtCM defined in the study?",{"text":118,"@type":114},"MetS was defined using Adult Treatment Panel III criteria, while AtCM was defined as deep terminal negativity of the P wave in V1 (DTNPV1).",{"name":120,"@type":111,"acceptedAnswer":121},"What did the results show about stroke mortality across groups?",{"text":122,"@type":114},"Stroke mortality rates increased across MetS-AtCM status categories, with the highest rate in the metabolically unhealthy with AtCM (MUA) group.",{"name":124,"@type":111,"acceptedAnswer":125},"What is the main implication for future research?",{"text":126,"@type":114},"The findings suggest a joint association of MetS and AtCM with stroke mortality, supporting further randomized controlled trials to evaluate anticoagulation for individuals with both conditions.","https://schema.org",{"og:url":83,"og:type":129,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":131,"canonical":83},"index,follow",{"doc_id":133,"site_id":62},407837,1791178376,{"code":4,"msg":5,"data":136},{"doc_id":133,"user_id":137,"nickname":92,"user_avatar":138,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":139,"file_id":140,"file_url":141,"file_type":142,"file_size":143,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":144,"language":145,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":146,"faqs":147,"seo_title":148,"seo_description":67,"update_tm":149,"read_time":150,"preview_page_count":4},1374404737137,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Annals of Noninvasive Electrocardiology   \n ORIGINAL ARTICLE  OPEN ACCESS   \nMetabolic Syndrome and Atrial Cardiomyopathy on the Risk of Stroke Mortality in the General Population  \nYaodongqin Xia1,2 | Xuan Lu3 | Minglong Chen1  | Mingfang Li1,4   \n1Division of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China | 2Department of Critical Care Medicine, Kunshan Hospital of Chinese Medicine, Suzhou, China | 3Department of Gastroenterology, Kunshan Hospital of Chinese Medicine, Suzhou, China | 4Division of  \nCardiology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China Correspondence: Minglong Chen ([chenminglong@njmu.edu.cn](chenminglong@njmu.edu.cn)) | Mingfang Li ([mingfangli@njmu.edu.cn](mingfangli@njmu.edu.cn))  \nReceived: 20 May 2025 | Revised: 25 November 2025 | Accepted: 18 December 2025  \nKeywords: atrial cardiomyopathy | electrocardiography | metabolic syndrome | stroke mortality  \nABSTRACT  \nIntroduction: Metabolic syndrome (MetS) and atrial cardiomyopathy (AtCM) are recognized as risk factors for cardiovascular disease, including stroke. We aimed to determine the combined impact of MetS and AtCM on stroke mortality.  \nMethods: Participants were selected from the Third National Health and Nutrition Examination (NHANES III) Survey. MetS was defined according to the Adult Treatment Panel III, while AtCM was defined as deep terminal negativity of the P wave in V1 (DTNPV1). Survey-weighted Firth penalized Cox analysis was performed to determine the adjusted HRs and 95% CIs of stroke mortality by MetS-AtCM status, including metabolically healthy without AtCM (MHNA; reference), metabolically unhealthy without AtCM (MUNA), metabolically healthy with AtCM (MHA), metabolically unhealthy with AtCM (MUA) .  \nResults: A total of 4315 participants were included in the analysis. Throughout the follow-up, the rates of stroke mortality increased across the MetS-AtCM status categories: 1.56, 2.78, 4.68, and 8.24 per 1000 person-years in MHNA, MUNA, MHA, and MUA groups, respectively. Compared to the MHNA participants, MUA were at a higher risk of stroke mortality (HR = 3.33, 95% CI 1.24–8.94, p = 0.018). Stroke mortality showed a non-significant upward trend in both MUNA (HR = 1.57, 95% CI 0.96–2.59, p = 0.074) and MHA (HR = 1.61, 95% CI 0.52–5.00, p = 0.401) groups.  \nConclusions: Our findings suggest a potential joint association of MetS and AtCM on stroke mortality. Further RCTs are warranted to evaluate the efficacy of anticoagulation in preventing ischemic stroke and reducing stroke mortality among individuals with both MetS and AtCM.  \n1 | Introduction  \nStroke continues to be a leading cause of mortality worldwide with an annual mortality rate of approximately 5.5 million (Feigin et al. 2022; Sidney et al. 2022) . Therefore, the burden of stroke largely lies in its high mortality. In recent years, there has been growing concern about the factors influencing stroke mortality. AF has long been acknowledged as an independent risk factor for stroke, with the highest mortality rate among stroke  \nsubtypes according to the TOAST criteria (Kolominsky-Rabaset al. 2001) . Additionally, hypertension, smoking, obstructive sleep apnea, obesity, and underweight are all related to increased risk of fatal stroke as well (Lackland et al. 2014) .  \nMetabolic syndrome (MetS) is a prevalent metabolic disorder characterized by the existence of a cluster of cardiovascular risk factors such as abnormal obesity, hypertension, hyperglycemia, increased triglyceride levels, and low levels of high-density lipoprotein  \n\n| Yaodongqin Xia and Xuan Lu, contribute equally. |\n| --- |\n| This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.\u003Cbr>© 2025 The Author(s). Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC. ","cbCairOaZUYEVIA6","https://ap.wps.com/l/cbCairOaZUYEVIA6","pdf",452794,11,"English","# Introduction\n# Methods\n# Results\n# Conclusions","[{\"question\":\"What was the study aiming to determine?\",\"answer\":\"To determine the combined impact of metabolic syndrome (MetS) and atrial cardiomyopathy (AtCM) on stroke mortality in the general population.\"},{\"question\":\"How were MetS and AtCM defined in the study?\",\"answer\":\"MetS was defined using Adult Treatment Panel III criteria, while AtCM was defined as deep terminal negativity of the P wave in V1 (DTNPV1).\"},{\"question\":\"What did the results show about stroke mortality across groups?\",\"answer\":\"Stroke mortality rates increased across MetS-AtCM status categories, with the highest rate in the metabolically unhealthy with AtCM (MUA) group.\"},{\"question\":\"What is the main implication for future research?\",\"answer\":\"The findings suggest a joint association of MetS and AtCM with stroke mortality, supporting further randomized controlled trials to evaluate anticoagulation for individuals with both conditions.\"}]","Metabolic Syndrome and Atrial Cardiomyopathy on the Risk of Stroke Mortality in the General Population | PDF",1790576382,28]