Concomitant diabetes or hypertension with metabolic syndrome on the extent of intracranial atherosclerotic stenosis.
BACKGROUND
Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, especially in Asia. Assessing relationships between novel risk factors and ICAS could lead strategies for improving outcomes. We aimed to evaluate the link between severity of metabolic syndrome (MetS) and extent of ICAS (≥ 50% stenosis).


METHODS
We conducted a cross-sectional study of consecutive Korean patients with acute ischemic stroke, admitted from March 2009 through May 2013, who underwent brain MRI/MRA. Patients were stratified into hypertension only, diabetes mellitus (DM), MetS only, MetS and hypertension, MetS and DM, and neither. MetS was defined using the harmonized criteria.


RESULTS
Of 1220 patients (mean age, 68.2 ± 12.7; female, 42.6%), 238 had hypertension only, 67 DM, 48 MetS only, 311 MetS and hypertension, 403 MetS and DM (88.3% having concomitant hypertension), and 153 neither. Patients with MetS and DM had higher prevalence of ICAS and more ICAS lesions vs. those with neither (all P < 0.001). Compared with neither condition (1.3 ± 0.8), extent of MetS component were greater by increasing MetS severity category (1.7 ± 0.5, 1.8 ± 0.4, 3.3 ± 0.5, 3.4 ± 0.6, and 3.9 ± 0.7, P < 0.001). Odds of ICAS (OR 3.40, 95% CI, 1.82-6.36), ICAS (≥ 2) (4.65, 2.15-10.05), and ICAS (≥ 3) (2.82, 1.02-7.82) remained independently higher in patients with MetS and DM. DM, MetS only, or MetS and hypertension trended towards higher ICAS lesions.


CONCLUSION
MetS and DM along with hypertension is associated with more extensive ICAS than MetS and hypertension or MetS only. Patients with MetS at high risk of hypertension and DM may benefit from therapeutic lifestyle changes to prevent stroke risk.
['Park|Jong-Ho|JH|http://orcid.org/0000-0002-2681-1878', 'Kim|Byoung Seok|BS|', 'Ovbiagele|Bruce|B|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002545:Brain Ischemia D003251:Constriction, Pathologic D003430:Cross-Sectional Studies D003920:Diabetes Mellitus D005260:Female D006801:Humans D006973:Hypertension D002537:Intracranial Arteriosclerosis D008279:Magnetic Resonance Imaging D008297:Male D024821:Metabolic Syndrome D008875:Middle Aged D056910:Republic of Korea D020521:Stroke
Hypertension Metabolic syndrome Intracranial Diabetes mellitus Atherosclerosis