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BRIEF COMMUNICATIONS: O. Y. Bang, J. W. Kim, J. H. Lee, M. A. Lee, P. H. Lee, I. S. Joo, and K. Huh Association of the metabolic syndrome with intracranial atherosclerotic stroke Neurology 2005; 65: 296-298 [Abstract] [Full text] [PDF]

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Reply to Ovbiagele

Oh Young Bang   (22 August 2005)

Association of the metabolic syndrome with intracranial atherosclerotic stroke

Bruce Ovbiagele   (22 August 2005)

Reply to Ovbiagele 22 August 2005
Oh Young Bang, Department of Neurology, School of Medicine, Ajou University Woncheon-dong San 5, Paldal-ku, Suwon, South Korea Send Correspondence to journal: Re: Reply to Ovbiagele nmboy{at}unitel.co.kr Oh Young Bang	I thank Dr. Ovbiagele for his comments. I agree that the Adult Treatment Panel-III (ATP-III) definition does not include the use of antihypertensive medication or antidiabetic medication in its criteria for the clinical identification of the metabolic syndrome [1]. In addition, there is growing evidence that such medications may be an insulin sensitizer. However, our multiple regression analysis showed that the metabolic syndrome, but not conventional risk factors such as hypertension or diabetes, was independently associated with intracranial atherosclerosis. [2] In addition, because of the high prevalence of hypertension and diabetes in patients with stroke or coronary heart disease, the previous studies concerning the prevalence of metabolic syndrome in those patients often used the ATP-III criteria for metabolic syndrome with some modification (i.e., participants who reported currently using antihypertensive or antidiabetic medication were designated as having high blood pressure or diabetes). [3-7] References 1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486?497. 2. Bang OY, Kim JW, Lee JH, et al. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology. 2005;65:296- 298. 3. Gorter PM, Olijhoek JK, van der Graaf Y, Algra A, Rabelink TJ, Visseren FL, SMART Study Group. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis 2004;173:363?69. 4. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 2002:287;356?59. 5. Ford ES. The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study. Atherosclerosis 2004;173:309-314. 6. Ninomiya JK, L'Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation 2004;109:42-46. 7. McNeill AM, Rosamond WD, Girman CJ, et al. Prevalence of coronary heart disease and carotid arterial thickening in patients with the metabolic syndrome (The ARIC Study). Am J Cardiol 2004;94:1249-1254.
Association of the metabolic syndrome with intracranial atherosclerotic stroke 22 August 2005
Bruce Ovbiagele, UCLA School of Medicine 710 Westwood Blvd, Rm 1-240, Los Angeles, CA 90095 Send Correspondence to journal: Re: Association of the metabolic syndrome with intracranial atherosclerotic stroke ovibes{at}mednet.ucla.edu Bruce Ovbiagele	Bang et al study the association of metabolic syndrome with intracranial atherosclerotic disease. [1] The authors state in the methods section of their study that the Adult Treatment Panel III (ATP-III) defines the metabolic syndrome as the presence of three or more risk factors including 'hypertension (systolic blood pressure >or= 130 mmHg, diastolic blood pressure >or= 85 mmHg or use of antihypertensive medication); and impaired fasting glucose levels (>or= 110 mg/dl or use of antidiabetic medication).' This may not be the case. The ATP-III definition does not include the use of antihypertensive medication or antidiabetic medication in their criteria for the clinical identification of the metabolic syndrome. [2] The definition utilized in the Bang study actually represents a revised ATP-III definition--another important factor to consider--[3] when comparing the results of their study to previous studies that have evaluated (or future studies which will evaluate), the relationship between the metabolic syndrome and vascular disease. References 1. Bang O, Kim JW, Lee JH, et al. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology. 2005;65:296-298. 2. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. 3. Bushnell C, Guzick D. Metabolic syndrome and intracranial atherosclerosis: a new link? Neurology. 2005;65:188-189.