Association Between Metabolic Syndrome And Asymptomatic Cerebral Arterial Stenosis: A Cross-Sectional Study In Shandong, China

Background:Cerebral arterial stenosis is important pathological basis of ischemic stroke.According to the anatomical position of cerebral artery,it can be classified as intracranial artery stenosis(ICAS)and extracranial artery stenosis(ECAS).Studies have shown that metabolic syndrome(MetS)is more closely related to ICAS in patients with stroke.However,its effect on participants without stroke or transient ischemic attack(TIA)remains ambiguous.Therefore,it is important to investigate whether there is a difference in the correlation between MetS and ICAS or ECAS in the asymptomatic stage of cerebral arterial stenosis for the primary prevention of stroke.Objectives:This study explored the association of MetS and its individual components with asymptomatic intracranial arterial stenosis(aICAS)and asymptomatic extracranial arterial stenosis(aECAS)among middle-aged and older adults in rural areas of Shandong Province,China.Methods:A total of 1988 participants from the Kongcun Town Asymptomatic Intracranial Artery Stenosis(KT-aICAS)study aged ≥40 years and without a history of stroke or TIA were enrolled.Baseline examination was conducted from October 2017 to October 2018,during which information on demographics,personal and family medical history,and lifestyle factors was collected through face-to-face interviews,physical examination and blood tests.aICAS was detected through a two-phase procedure:a screening phase with transcranial Doppler ultrasound,followed by a diagnostic phase with magnetic resonance angiography(MRA)examination.The evaluation of aECAS was performed using bilateral carotid ultrasonography.MetS was defined according to International Diabetes Federation criteria.All participants were classified as aICAS group,aECAS group,and non-stenosis group.The aICAS and aECAS groups were 1:1 matched separately to the non-stenosis group by age and sex to balance the statistics.The T-test and Chi-square test were used to compare whether there were statistical differences in demographic and clinical characteristics between the stenosis group and the nonstenosis group.The association between MetS and aICAS or aECAS was analyzed using multivariate logistic regression.Results:Among the 1988 participants,909(45.7%)were diagnosed with MetS.The prevalence of MetS in aICAS group,aECAS group,and non-stenosis group was 71.9%,60.4%,and 43.4%,respectively.The prevalence of MetS was higher in the aICAS group than in the non-stenosis group(p<0.001),but did not differ significantly between the aECAS and non-stenosis groups.The prevalence of aICAS increased with the number of MetS components from 3.4%in the ≤1 component group to 12.7%in the ≥4 components group(p for trend<0.001).After adjusting for confounding factors,MetS was positively associated with aICAS,and participants with more MetS components number were more likely to have aICAS;MetS components associated with aICAS included central obesity,elevated triglyceride levels,and elevated blood pressure.None of the MetS components was associated with aECAS.Conclusions:Among middle-aged and older adults in rural areas of Shandong Province,China,MetS was positively associated with aICAS,but not with aECAS.Further,participants with more MetS components number were more likely to have aICAS,and MetS components(central obesity,elevated triglyceride levels,and elevated blood pressure)play important roles in the pathological process leading to aICAS.