Metabolic syndrome, subclinical carotid atherosclerosis and risk of stroke: How strong is the link?

David Della-Morte, Tatjana Rundek

Research output: Chapter in Book/Report/Conference proceedingChapter


The metabolic syndrome (MetS) is a distinctive phenotype with clustering of risk factors associated with an increased risk of vascular disease. MetS is reaching epidemic proportions worldwide. MetS and its components (hypertension, insulin resistance, dyslipidemia, and obesity) are established risk factors for stroke. Surrogate markers of subclinical carotid atherosclerosis such as carotid intima-media thickness (cIMT), carotid plaque (CP) presence and morphology, and carotid artery stiffness (STIFF) also have been linked to an increased risk of stroke. As multiple risk factors increase risk of vascular disease more than the sum of accompanying single risk factors, MetS has significant effects on development of atherosclerosis. Proinflammatory state and oxidative stress induced by MetS play a pivotal role in the carotid artery wall damage. MetS is an independent determinant of cIMT in both sexes, and predicts cIMT progression in large cohorts comprised of different race-ethnicities. Moreover, MetS has been demonstrated to significantly increase STIFF and to be a significant predictor of CP in multi-ethnic populations. Controversially, presence of MetS was not associated with cIMT and CP independent of other cardiovascular risk factors in individuals with optimal, normal, or high-normal blood pressure. Recently, a major issue has been whether MetS is a valid indicator of vascular risk, although from a clinical perspective, it serves a useful purpose to focus on individuals at high risk for developing vascular disease and type 2 diabetes. The development of non-invasive ultrasound methods capable of quantitatively evaluating atherosclerosis has provided an opportunity to understand the early determinants of atherosclerosis and has improved our ability to detect individuals at high risk for stroke including individuals with MetS. Therefore, exploring and understanding the link between MetS and subclinical atherosclerosis could help further risk-stratify individuals with MetS, design new strategies to prevent stroke, and to determine the predominant components of MetS associated with carotid atherosclerosis in order to develop new and effective antiatherosclerotic therapies.

Original languageEnglish
Title of host publicationHandbook on Metabolic Syndrome: Classification, Risk Factors and Health Impact
PublisherNova Science Publishers, Inc.
Number of pages24
ISBN (Print)9781622570256
Publication statusPublished - Nov 2012

ASJC Scopus subject areas

  • Medicine(all)


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