Association of Carotid Atherosclerosis with Metabolic Syndrome in Patients with Ischemic Stroke

Abstract

Background: Metabolic syndrome (MetS) consists of a constellation of metabolic abnormalities that increase the risk for stroke and cardiovascular disease. This study evaluated the association of carotid atherosclerosis with MetS and also assessed the association between intracranial and extracranial carotid atherosclerosis with metabolic syndrome among first-ever ischemic stroke patients.

Methods: This cross-sectional observational study was conducted at the Stroke and Neuro intervention clinic, the indoor and outdoor Department of Neurology, BSMMU, from November 2021 to September 2022, following ethical approval. A total of 60 patients with first-ever ischemic stroke (≥40 years of age) were included in this study. After obtaining informed written consent, a detailed history, physical examination and necessary investigations were performed. Revised NCEP ATPIII criteria for the Asia-Pacific region defined MetS. Duplex study of Neck vessels and CT Angiogram of Brain and Neck vessels were done to diagnose carotid atherosclerosis. Stenosis was labeled in cases showing ≥50% of luminal narrowing. The association between carotid atherosclerosis and metabolic syndrome was then investigated.

Results: The mean age of the study patients was 62.38±12.38 (SD) years with male predominance (55%). Approximately half of the study patients had diabetes mellitus (51.7%) and hypertension (46.7%). Overall, metabolic syndrome was found in 65% of cases. About 41.7% of patients had carotid atherosclerosis, whereas 58.3% had intracranial atherosclerosis. Mets patients had a significantly higher frequency of carotid atherosclerosis than those without MetS (53.85% vs 19.04%, p=0.009). Carotid atherosclerosis patients had a significantly higher frequency of having raised FPG (56% vs 28.6%, p=0.033), triglyceride (80% vs 45.7%, p=0.008), blood pressure >130/85 mmHg (80% vs 40%, p=0.002) and reduced HDL-C (72% vs 42.9%, p=0.025) than patients without any carotid atherosclerosis. MetS containing 5 components, raised FPG raised TG and HTN were independent predictors of carotid atherosclerosis. No association was found between intracranial and extracranial carotid atherosclerosis with MetS.

Conclusion: MetS, especially raised FPG, blood pressure and triglyceride were significantly associated with carotid atherosclerosis among first-ever ischemic stroke patients.