{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T12:40:16Z","timestamp":1756298416868,"version":"3.44.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Metabolic syndrome (MetS) attenuates antiplatelet agent effects. This study investigated the efficacy and safety of clopidogrel\u2013aspirin therapy for secondary stroke prevention in patients with MetS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">Data were obtained from the INSPIRES (Intensive Statin and Antiplatelet Therapy for Acute High\u2010Risk Intracranial or Extracranial Atherosclerosis) trial. Patients with mild ischemic stroke or high\u2010risk transient ischemic attack were randomized to treatment with clopidogrel\u2013aspirin or aspirin alone within 72\u2009hours after symptom onset. MetS was defined according to the Adult Treatment Panel\u2010III. The primary efficacy outcome was new stroke, and the primary safety outcome was moderate \u2010 to \u2010 severe bleeding within 90\u2010day follow\u2010up. Differences between groups were estimated with Cox proportional hazards models, with hazard ratio (HR) and 95% CI presented.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This study included 4715 patients, with a mean age of 63.7\u00b19.6\u2009years, 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\u20131.82];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.02) but not moderate \u2010 to \u2010 severe bleeding events (HR, 1.02 [95% CI, 0.47\u20132.21];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.97) as compared with patients without MetS. However, MetS state did not impact the efficacy of clopidogrel\u2013aspirin therapy for recurrent stroke (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              for interaction=0.44) and the safety for moderate\u2010to\u2010severe bleeding events (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              for interaction=0.54).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">MetS was associated with higher risk of recurrent stroke at 90\u2009days. There was no difference in the effect of clopidogrel\u2013aspirin therapy on reducing new stroke and increasing moderate\u2010to\u2010severe bleeding events between patients with and without MetS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT03635749.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.125.041449","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T12:05:22Z","timestamp":1752753922000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Dual Antiplatelet Therapy in Patients With Metabolic Syndrome After Mild Ischemic Stroke or Transient Ischemic Attack"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8833-773X","authenticated-orcid":false,"given":"Zhang","family":"Xia","sequence":"first","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Gao","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2551-9314","authenticated-orcid":false,"given":"Weiqi","family":"Chen","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2912-0714","authenticated-orcid":false,"given":"S. Claiborne","family":"Johnston","sequence":"additional","affiliation":[{"name":"University of California","place":["San Francisco, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3842-1236","authenticated-orcid":false,"given":"Pierre","family":"Amarenco","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2010H\u00f4pitaux de Paris (APHP), Bichat Hospital, INSERM LVTS\u2010U1148, University of Paris","place":["France"]},{"name":"Population Health Research Institute, McMaster University","place":["Hamilton, Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2734-5132","authenticated-orcid":false,"given":"Philip M.","family":"Bath","sequence":"additional","affiliation":[{"name":"University of Nottingham","place":["United 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