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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
  • 27 Downloads

Abstract

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.

Keywords

Intracranial Atherosclerosis Metabolic syndrome Diabetes mellitus Hypertension 

Notes

Acknowledgements

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)

References

  1. 1.
    Bang OY (2014) Intracranial atherosclerosis: current understanding and perspectives. J Stroke 16:27–35CrossRefGoogle Scholar
  2. 2.
    Wong LK (2006) Global burden of intracranial atherosclerosis. Int J Stroke 1:158–159CrossRefGoogle Scholar
  3. 3.
    Bang OY, Kim JW, Lee JH, Lee MA, Lee PH, Joo IS, Huh K (2005) Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology 65:296–298CrossRefGoogle Scholar
  4. 4.
    Wong KS, Huang YN, Yang HB, Gao S, Li H, Liu JY, Liu Y, Tang A (2007) A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology 68:2031–2034CrossRefGoogle Scholar
  5. 5.
    Chaturvedi S, Turan TN, Lynn MJ, Kasner SE, Romano J, Cotsonis G, Frankel M, Chimowitz MI (2007) WASID Study Group: Risk factor status and vascular events in patients with symptomatic intracranial stenosis. Neurology 69:2063–2068CrossRefGoogle Scholar
  6. 6.
    Liou CW, Tan TY, Lin TK, Wang PW, Yip HK (2008) Metabolic syndrome and three of its components as risk factors for recurrent ischaemic stroke presenting as large-vessel infarction. Eur J Neurol 15:802–809CrossRefGoogle Scholar
  7. 7.
    Zhu S, McClure LA, Lau H, Romero JR, White CL, Babikian V, Nguyen T, Benavente OR, Kase CS, Pikula A (2015) Recurrent vascular events in lacunar stroke patients with metabolic syndrome and/or diabetes. Neurology 85:935–941CrossRefGoogle Scholar
  8. 8.
    Chen W, Pan Y, Jing J, Zhao X, Liu L, Meng X, Wang Y, Wang Y, Investigators CHANCE (2017) Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus. J Am Heart Assoc 6:e005446PubMedPubMedCentralGoogle Scholar
  9. 9.
    Fang X, Liu H, Zhang X, Zhang H, Qin X, Ji X (2016) Metabolic Syndrome, Its Components, and Diabetes on 5-Year Risk of Recurrent Stroke among Mild-to-Moderate Ischemic Stroke Survivors: A Multiclinic Registry Study. J Stroke Cerebrovasc Dis 25:626–634CrossRefGoogle Scholar
  10. 10.
    Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41CrossRefGoogle Scholar
  11. 11.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453CrossRefGoogle Scholar
  12. 12.
    Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI (2000) A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 21:643–646PubMedGoogle Scholar
  13. 13.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640–1645CrossRefGoogle Scholar
  14. 14.
    Pantoni L, Basile AM, Pracucci G, Asplund K, Bogousslavsky J, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O'brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D (2005) Impact of age-related cerebral white matter changes on the transition to disability -- the LADIS study: rationale, design and methodology. Neuroepidemiology 24:51–62CrossRefGoogle Scholar
  15. 15.
    Arenillas JF, Molina CA, Chacón P, Rovira A, Montaner J, Coscojuela P, Sánchez E, Quintana M, Alvarez-Sabín J (2004) High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis. Neurology 63:27–32CrossRefGoogle Scholar
  16. 16.
    Thomas GN, Lin JW, Lam WW, Tomlinson B, Yeung V, Chan JC, Liu R, Wong KS (2004) Increasing severity of cardiovascular risk factors with increasing middle cerebral artery stenotic involvement in type 2 diabetic Chinese patients with asymptomatic cerebrovascular disease. Diabetes Care 27:1121–1126CrossRefGoogle Scholar
  17. 17.
    Cuspidi C, Meani S, Fusi V, Severgnini B, Valerio C, Catini E, Leonetti G, Magrini F, Zanchetti A (2004) Metabolic syndrome and target organ damage in untreated essential hypertensives. J Hypertens 22:1991–1998CrossRefGoogle Scholar
  18. 18.
    Schillaci G, Pirro M, Vaudo G, Gemelli F, Marchesi S, Porcellati C, Mannarino E (2004) Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol 43:1817–1822CrossRefGoogle Scholar
  19. 19.
    Ferrannini E, Natali A, Capaldo B, Lehtovirta M, Jacob S, Yki-Jarvinen H (1997) Insulin resistance, hyperinsulinemia, and blood pressure: role of age and obesity, European Group for the Study of Insulin Resistance (EGIR). Hypertension 30:1144–1149CrossRefGoogle Scholar
  20. 20.
    Ford ES (2005) Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 28:1769–1778CrossRefGoogle Scholar
  21. 21.
    Cheung BM, Li C (2012) Diabetes and hypertension: is there a common metabolic pathway? Curr Atheroscler Rep 14:160–166CrossRefGoogle Scholar

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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