Original Article

Correlation between Metabolic Syndrome and Intracranial versus Extracranial Arteriosclerosis among Chinese Patients with Stroke


Background: We aimed to explore the correlation between metabolic syndrome and intracranial and extracranial arteriosclerosis. Overall, 318 over 60-yr-old patients with cerebral infarction or TIA who were examined by digital subtraction angiography (DSA) in our hospital were enrolled in the study.

Methods: Overall, 192 patients with intracranial and extracranial arteriosclerosis were admitted to the case group (the intracranial and extracranial arteriosclerosis group). Also, 196 patients, suffering from the same condition, were selected from our outpatient clinic and enrolled in the control group.

Results: The prevalence of metabolic syndrome was 31.4%. The prevalence of each metabolic syndrome component in the intracranial arteriosclerosis group was higher than those of the extracranial arteriosclerosis and the control groups. The average component values in the intracranial arteriosclerosis group was higher than those observed in other groups. The prevalence rate of metabolic syndrome had no significant difference among different degrees of stenosis for extracranial arteriosclerosis group. There was a remarkable correlation between intracranial arteriosclerosis and metabolic syndrome (P<0.001), while no correlation was detected between extracranial arteriosclerosis and metabolic syndrome (P<0.001). We concluded that metabolic syndrome may increase the prevalence risk of intracranial arteriosclerosis. There was a significant correlation between intracranial arteriosclerosis and metabolic syndrome components including hyperglycemia and hypertension. Also, there was a significant correlation between extracranial arteriosclerosis and metabolic syndrome components including hyperglycemia.

Conclusion: We believe that at least three components of metabolic syndrome can obviously increase the risk of intracranial arteriosclerosis.

1. Wang LD, Wang JH, Peng B, Xu YM (2017). Re-port on the Chinese Stroke Prevention 2016 Summay. Chinese Journal of Cerebrovascular Diseases, 14 (04): 217-24.
2. Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL (2007). The impact of increasing age on anatomic factors affecting carotid angio-plasty and stenting. J Vasc Surg, 45 (5): 875-80.
3. Sitzer M, Skutta M, Siebler M, Sitzer G, Siegrist J, Steinmetz H (1998). Modifiable stroke risk factors in volunteers willing to participate in a prevention program. Neuroepidemiology, 17 (4): 179-87.
4. Leung SY, Ng TH, Yuen ST, Lauder IJ, Ho FC (1993). Pattern of cerebral atherosclerosis in Hong Kong Chinese. Severity in intracranial and extra-cranial vessels. Stroke, 24 (6): 779-86.
5. Kasner SE, Chimowitz MI, Lynn MJ, et al (2006). Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation, 113 (4): 555-63.
6. Higashida RT, Meyers PM, Connors JJ, et al (2009). Intracranial angioplasty and stenting for cerebral atherosclerosis: a position statement of the Amer-ican Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiol-ogy, and the American Society of Neuroradiology. J Vasc Interv Radiol, 20 (7 Suppl): S312-6.
7. Sacco RL, Adams R, Albers G, et al (2006). Guide-lines for prevention of stroke in patients with is-chemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and In-tervention: the American Academy of Neurology affirms the value of this guideline. Circulation, 113 (10): e409-49.
8. Wong KS, Li H, Chan YL, et al (2000). Use of tran-scranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive dis-ease. Stroke, 31 (11): 2641-7.
9. Kim JS, Kim YJ, Ahn SH, Kim BJ (2018). Location of cerebral atherosclerosis: Why is there a differ-ence between East and West. Int J Stroke, 13 (1): 35-46.
10. Kalita J, Misra UK, Kumar B, Somarajan BI, Kumar S, Mittal B (2018). ACE and ADD1 gene in extra and intracranial atherosclerosis in ischaemic stroke. Neurol Res, 35 (4): 429-34.
11. Kim BJ, Lee KM, Lee SH, et al (2018). Ethnic Differ-ences in Intracranial Artery Tortuosity: A Possible Reason for Different Locations of Cerebral Ath-erosclerosis. J Stroke, 20 (1): 140-1.
12. He YN, Zhao WH, Zhao LY, (2017). [Prevalence of metabolic syndrome in Chinese adults in 2010-2012]. Zhonghua Liu Xing Bing Xue Za Zhi, 38 (2): 212-5.
13. De Silva DA, Woon FP, Lee MP, Chen CL, Chang HM, Wong MC (2009). Metabolic syndrome is associated with intracranial large artery disease among ethnic Chinese patients with stroke. J Stroke Cerebrovasc Dis, 18 (6): 424-7.
14. Park JH, Kwon HM, Roh JK (2007). Metabolic syn-drome is more associated with intracranial athero-sclerosis than extracranial atherosclerosis. Eur J Neurol, 14 (4): 379-86.
15. North American Symptomatic Carotid Endarterec-tomy Trial Collaborators, HJM B, Taylor DW, et al (1991). Beneficial effect of carotid endarterecto-my in symptomatic patients with high-grade ca-rotid stenosis. N Engl J Med, 325 (7): 445-53.
16. Alberti KG, Zimmet P, Shaw J (2005). The metabolic syndrome--a new worldwide definition. Lancet, 366 (9491): 1059-62.
17. Moossy J (1966). Cerebral infarction and intracranial arterial thrombosis. Necropsy studies and clinical implications. Arch Neurol, 14 (2): 119-23.
18. Suemoto CK, Grinberg LT, REP L, et al (2018). Morphometric measurements of extracranial and intracranial atherosclerotic disease: A population-based autopsy study. Atherosclerosis, 270: 218-23.
19. Nishimaru K, McHenry LC, Toole JF (1984). Cere-bral angiographic and clinical differences in carotid system transient ischemic attacks between Ameri-can Caucasian and Japanese patients. Stroke, 15 (1): 56-9.
20. Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995). Race-ethnicity and determinants of intra-cranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke, 26 (1): 14-20.
21. Suh DC, Lee SH, Kim KR, et al (2003). Pattern of atherosclerotic carotid stenosis in Korean patients with stroke: different involvement of intracranial versus extracranial vessels. AJNR Am J Neuroradiol, 24 (2): 239-44.
22. Wong KS, Huang YN, Yang HB, et al (2007). A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology, 68 (23): 2031-4.
23. Jung KH, Lee SH, Kim BJ, et al (2012). Secular trends in ischemic stroke characteristics in a rapidly de-veloped country: results from the Korean Stroke Registry Study (secular trends in Korean stroke). Circ Cardiovasc Qual Outcomes, 5 (3): 327-34.
24. Lei C, Wu B, Liu M, Chen Y (2014). Risk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke. J Stroke Cerebrovasc Dis, 23 (5): 1112-7.
25. Zou C, Wei C, Wang Z, Jin Y (2017). Sex differences in outcomes and risk factors among elderly pa-tients with ischemic stroke. Oncotarget, 8 (61): 104582-93.
26. Higashi Y, Miyata T, Shigematsu H, et al (2017). Base-line Characterization of Japanese Peripheral Arteri-al Disease Patients - Analysis of Surveillance of Cardiovascular Events in Antiplatelet-Treated Ar-teriosclerosis Obliterans Patients in Japan (SEA-SON). Circ J, 80 (3): 712-21.
27. Csordas A, Bernhard D (2017). The biology behind the atherothrombotic effects of cigarette smoke. Nat Rev Cardiol, 10 (4): 219-30.
28. Chen H, Hong H, Xing S, et al (2015). Intracranial versus extracranial artery dissection cases present-ing with ischemic stroke. J Stroke Cerebrovasc Dis, 24 (4): 852-9.
29. Uehara T, Tabuchi M, Mori E, Yamadori A (2003). Evolving atherosclerosis at carotid and intracranial arteries in Japanese patients with ischemic heart disease: a 5-year longitudinal study with MR angi-ography. Eur J Neurol, 10 (5): 507-12.
30. Seo WK, Yong HS, Koh SB, et al (2008). Correlation of coronary artery atherosclerosis with atheroscle-rosis of the intracranial cerebral artery and the ex-tracranial carotid artery. Eur Neurol, 59 (6): 292-8.
31. Bae HJ, Yoon BW, Kang DW, et al (2006). Correla-tion of coronary and cerebral atherosclerosis: dif-ference between extracranial and intracranial arter-ies. Cerebrovasc Dis, 21 (1-2): 112-9.
32. Park JH, Kwon HM (2008). Association between metabolic syndrome and previous ischemic le-sions in patients with intracranial atherosclerotic stroke. Clin Neurol Neurosurg, 110 (3): 215-21.
33. Bang OY, Kim JW, Lee JH, et al (2005). Association of the metabolic syndrome with intracranial ath-erosclerotic stroke. Neurology, 65 (2): 296-8.
34. D'Armiento FP, Bianchi A, de Nigris F, et al (2001). Age-related effects on atherogenesis and scaven-ger enzymes of intracranial and extracranial arteries in men without classic risk factors for atheroscle-rosis. Stroke, 3 (11): 2472-9.
35. Huang HW, Guo MH, Lin RJ, et al (2007). Preva-lence and risk factors of middle cerebral artery stenosis in asymptomatic residents in Rongqi County, Guangdong. Cerebrovasc Dis, 24 (1): 111-5.
36. Campia U, Sullivan G, Bryant MB, Waclawiw MA, Quon MJ, Panza JA (2004). Insulin impairs endo-thelium-dependent vasodilation independent of insulin sensitivity or lipid profile. Am J Physiol Heart Circ Physiol, 286 (1): H76-82.
37. Palmieri VO, Grattagliano I, Portincasa P, Palasciano G (2006). Systemic oxidative alterations are associ-ated with visceral adiposity and liver steatosis in patients with metabolic syndrome. J Nutr, 136 (12): 3022-6.
38. Ritz K, Denswil NP, Stam OC, van Lieshout JJ, Daemen MJ (2014). Cause and mechanisms of intracranial atherosclerosis. Circulation, 130 (16): 1407-14.
39. Caplan LR, Gorelick PB, Hier DB (1986). Race, sex and occlusive cerebrovascular disease: a review. Stroke, 17 (4): 648-55.
40. Rincon F, Sacco RL, Kranwinkel G, et al (2009). Inci-dence and risk factors of intracranial atherosclerot-ic stroke: the Northern Manhattan Stroke Study. Cerebrovasc Dis, 28 (1): 65-71.
41. López-Cancio E, Galán A, Dorado L, et al (2012). Biological signatures of asymptomatic extra- and intracranial atherosclerosis: the Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) study. Stroke, 43 (10): 2712-19.
42. Wong KS, Ng PW, Tang A, Liu R, Yeung V, Tom-linson B (2007). Prevalence of asymptomatic in-tracranial atherosclerosis in high-risk patients. Neu-rology, 68 (23): 2035-8.
43. Kim JS, Nah HW, Park SM, et al (2012). Risk factors and stroke mechanisms in atherosclerotic stroke: intracranial compared with extracranial and anteri-or compared with posterior circulation disease. Stroke, 43 (12): 3313-18.
44. Uehara T, Tabuchi M, Mori E (1998). Frequency and clinical correlates of occlusive lesions of cerebral ar-teries in Japanese patients without stroke. Evalua-tion by MR angiography. Cerebrovasc Dis, 8 (5): 267-72.
45. Kim YD, Choi HY, Jung YH, et al (2009). Classic risk factors for atherosclerosis are not major de-terminants for location of extracranial or intracra-nial cerebral atherosclerosis. Neuroepidemiology, 32 (3): 201-7.
IssueVol 48 No 11 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v48i11.3518
Metabolic syndrome Intracranial arteriosclerosis Extracranial arteriosclerosis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
LIU C, YANG X, CHEN C. Correlation between Metabolic Syndrome and Intracranial versus Extracranial Arteriosclerosis among Chinese Patients with Stroke. Iran J Public Health. 2019;48(11):1997-2006.