Concomitant diabetes or hypertension with metabolic syndrome on the extent of intracranial atherosclerotic stenosis

  • Jong-Ho ParkEmail author
  • Byoung Seok Kim
  • Bruce Ovbiagele
Original Article



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).


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.


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.


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.


Intracranial Atherosclerosis Metabolic syndrome Diabetes mellitus Hypertension 



The authors thank Dr. Eun-Ja Lee for helping review the brain MRI and MRA of each study patient.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards statements

Approval for this study was obtained from the institutional review board of Hanyang University Myongji Hospital (IRB No. MJH 2018-01-009), and the requirement for informed consent was waived because of a retrospective data analysis, for which the study did not involve patients.

Supplementary material

10072_2019_4105_MOESM1_ESM.docx (33 kb)
ESM 1 (DOCX 33 kb)


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of Neurology, Myongji HospitalHanyang University College of MedicineGoyangSouth Korea
  2. 2.Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA

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