Dual Antiplatelet Therapy in Patients With Metabolic Syndrome After Mild Ischemic Stroke or Transient Ischemic Attack

Abstract

Background Metabolic syndrome (MetS) attenuates antiplatelet agent effects. This study investigated the efficacy and safety of clopidogrel–aspirin therapy for secondary stroke prevention in patients with MetS. Methods Data were obtained from the INSPIRES (Intensive Statin and Antiplatelet Therapy for Acute High‐Risk Intracranial or Extracranial Atherosclerosis) trial. Patients with mild ischemic stroke or high‐risk transient ischemic attack were randomized to treatment with clopidogrel–aspirin or aspirin alone within 72 hours after symptom onset. MetS was defined according to the Adult Treatment Panel‐III. The primary efficacy outcome was new stroke, and the primary safety outcome was moderate ‐ to ‐ severe bleeding within 90‐day follow‐up. Differences between groups were estimated with Cox proportional hazards models, with hazard ratio (HR) and 95% CI presented. Results This study included 4715 patients, with a mean age of 63.7±9.6 years, 35.8% of women, and 75.8% of patients having MetS. After adjustment for potential confounders, patients with MetS were at higher risk of recurrent stroke (HR, 1.39 [95% CI, 1.06–1.82]; P=0.02) but not moderate ‐ to ‐ severe bleeding events (HR, 1.02 [95% CI, 0.47–2.21]; P=0.97) as compared with patients without MetS. However, MetS state did not impact the efficacy of clopidogrel–aspirin therapy for recurrent stroke (P for interaction=0.44) and the safety for moderate‐to‐severe bleeding events (P for interaction=0.54). Conclusions MetS was associated with higher risk of recurrent stroke at 90 days. There was no difference in the effect of clopidogrel–aspirin therapy on reducing new stroke and increasing moderate‐to‐severe bleeding events between patients with and without MetS. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03635749.

Keywords

• dual antiplatelet therapy
• ischemic stroke
• metabolic syndrome
• secondary prevention