Metabolic Syndrome and Risk of Moyamoya Vasculopathy and Subsequent Stroke in Young Adults

BACKGROUND: Moyamoya vasculopathy (MMV) is a rare cerebrovascular disease of unclear cause. In this study, we aimed to determine whether metabolic syndrome (MetS) is associated with the development of MMV and subsequent stroke risk in young adults. METHODS: Using a nationwide database, we retrospectively analyzed the data of 6 891 400 Korean adults aged 20 to 40 years who underwent health screening between 2009 and 2012. Participants were monitored until December 31, 2021, to identify patients newly diagnosed with MMV. We further examined the risk of ischemic and hemorrhagic stroke in patients newly diagnosed with MMV without prior stroke. Hazard ratios (HR) were calculated using multivariable Cox regression models adjusted for relevant confounders. RESULTS: Over a median follow-up of 9.65 years, 1754 individuals developed MMV. These participants exhibited significantly poorer baseline metabolic profiles, including a higher body mass index and a higher prevalence of diabetes, hypertension, and dyslipidemia (all P < 0.0001). Metabolic syndrome was associated with a significantly increased risk of MMV development (adjusted HR, 2.94 [95% CI, 2.60–3.33]). The association between metabolic derangements and MMV risk was stronger in women. Among newly diagnosed patients with MMV, metabolic syndrome was associated with an increased risk of subsequent stroke (adjusted HR, 2.05 [95% CI, 1.25–3.37]), primarily ischemic stroke. CONCLUSIONS: Metabolic syndrome could substantially increase the risk of MMV development and subsequent stroke events in young adults. These findings emphasize the importance of managing metabolic health to prevent MMV and related neurological outcomes.