Abstract Body (Do not enter title and authors here):
Background
Patients with metabolic syndrome (MetS) are at an increased risk of cerebrovascular disease. Given the limited data available, this study aims to explore contemporary cerebrovascular disease-related mortality trends among patients aged 25 years and older in the United States with underlying MetS from 2000 to 2019.

Methods
We analyzed the death data using the CDC WONDER database, extracting age-adjusted mortality rates (AAMR) per 100,000 population between 2000 and 2019. Cerebrovascular disease was identified using ICD-10 codes I60–I69, and MetS was identified using ICD-10 codes E10–E14, E66, E78, E88, and I10. We identified fatalities where cerebrovascular disease was the underlying cause, while MetS was the contributing cause of death. We comprehended the trends by year, sex, race and ethnicity, census region, state, and metropolitan status. Joinpoint regression was used to calculate the annual percent change (APC) in AAMR with 95% confidence intervals.

Results
From 2000 to 2019, a total of 855,391 cerebrovascular disease-related deaths occurred among individuals with comorbid MetS, with an overall AAMR of 19.81/100,000. The overall AAMR decreased from 24.80 in 2000 to 16.92 in 2019, remaining stable from 2000 to 2003 (APC: –0.30, p = 0.543), followed by a significant decline from 2003 to 2009 (APC: –3.69, p < 0.001), and from 2009 to 2014 (APC: –2.60, p = 0.031). This was followed by another stable trend between 2014 and 2019 (APC: –0.23, p = 0.552). Women had a slightly higher AAMR (19.66) than men (19.32). Black or African American population had the highest AAMR (33.20), followed by Asian or Pacific Islanders (21.60), Hispanics/Latinos (19.88), American Indian/Alaska Natives (19.11), and Whites (17.92). Significant geographical variations were observed, with the West region (23.64) and the state of Mississippi (27.74) having the highest AAMR. Non-metropolitan areas had a higher AAMR (21.48) than metropolitan areas (19.46).

Conclusion
Despite the decline in the mortality trend earlier in the study period, we demonstrate a plateau in mortality trend between 2014 and 2019. Notable sociodemographic disparities are also highlighted in this study. These findings warrant further investigation to address these trends to prevent potentially avoidable mortality.