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Impact of metabolic syndrome on prognosis of symptomatic intracranial atherostenosis

From the Stroke Center and Department of Neurology (B.O., J.L.S.), UCLA Medical Center, Los Angeles, CA, and Department of Biostatistics (M.J.L.), Rollins School of Public Health, Emory University, and Department of Neurology (M.C.), Emory University School of Medicine, Atlanta, GA.

Address correspondence and reprint requests to Dr. B. Ovbiagele, Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095; e-mail: Ovibes{at}mednet.ucla.edu

Background: The metabolic syndrome (MetS) is a cluster of risk factors linked to insulin resistance that increase an individual's risk of atherosclerotic vascular disease. The authors evaluated the prevalence and prognosis of the MetS among individuals with symptomatic intracranial arterial stenosis.

Methods: Patients enrolled in the Warfarin–Aspirin Symptomatic Intracranial Disease trial were evaluated in this post-hoc analysis. Baseline characteristics and outcome were compared in patients with the MetS vs patients without the MetS.

Results: Among 476 patients, the prevalence of the MetS was 43%. MetS patients were more likely to be younger, female, and white. During a mean follow-up period of 1.8 years, time to the first of ischemic stroke, myocardial infarction, or vascular death was shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.6 (95% CI = 1.1 to 2.4, p = 0.0097). Time to ischemic stroke alone was also shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.7 (95% CI = 1.1 to 2.6, p = 0.012). When controlling for individual factors of the definition, MetS was not significant (combined outcome: p = 0.14; ischemic stroke: p = 0.074).

Conclusions: The metabolic syndrome is present in about half of individuals with symptomatic intracranial atherosclerotic disease and is associated with a substantially higher risk of major vascular events. The metabolic syndrome may not provide additional ability to predict outcomes beyond the individual factors for patients with intracranial stenosis.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the May 9 issue to find the title link for this article.

*See the Appendix for a list of group members.

Funded by a research grant (1R01 NS36643, Principal Investigator: Chimowitz MI) from the US Public Health Service, National Institute of Neurological Disorders and Stroke (National Institute of Neurological Disorders and Stroke). In addition, the following General Clinical Research centers, funded by the NIH, provided local support for the evaluation of patients in the trial: Emory University (M01 RR00039), Case Western University, MetroHealth Medical Center (5M01 RR00080), San Francisco General Hospital (M01 RR00083-42), Johns Hopkins University School of Medicine (M01 RR000052), Indiana University School of Medicine (5M01 RR000750-32), Cedars–Sinai Hospital (M01 RR00425), and the University of Maryland (M01 RR165001).

Disclosure: The authors report no conflicts of interest.

Received October 6, 2005. Accepted in final form January 23, 2006.

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