Prognostic Significance of Major Lipids in Patients with Acute Ischemic Stroke

Overview

Journal Metab Brain Dis

Publisher Springer

Specialties Endocrinology
Neurology

Date 2016 Oct 25

PMID 27771869

Citations 17

Authors

Konstantinos Tziomalos

Vasilios Giampatzis

Stella D Bouziana

Marianna Spanou

Stavroula Kostaki

Maria Papadopoulou

Stella-Maria Angelopoulou

Maria Tsopozidi

Christos Savopoulos

Apostolos I Hatzitolios

Affiliations

Soon will be listed here.

Abstract

Although dyslipidemia increases the risk for ischemic stroke, previous studies reported conflicting data regarding the association between lipid levels and stroke severity and outcome. To evaluate the predictive value of major lipids in patients with acute ischemic stroke. We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0 % males, age 79.4 ± 6.8 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Moderate/severe stroke was defined as NIHSS ≥5. The outcome was assessed with dependency rates at discharge (modified Rankin scale between 2 and 5) and with in-hospital mortality. Independent predictors of moderate/severe stroke were age (relative risk (RR) 1.05, 95 % confidence interval (CI) 1.02-1.08, p < 0.001), atrial fibrillation (RR 1.71, 95 % CI 1.19-2.47, p < 0.005), heart rate (RR 1.02, 95 % CI 1.01-1.04, p < 0.001), log-triglyceride (TG) levels (RR 0.24, 95 % CI 0.08-0.68, p < 0.01) and high-density lipoprotein cholesterol (HDL-C) levels (RR 0.97, 95 % CI 0.95-0.98, p < 0.001). Major lipids did not predict dependency at discharge. Independent predictors of in-hospital mortality were atrial fibrillation (RR 2.35, 95 % CI 1.09-5.04, p < 0.05), diastolic blood pressure (RR 1.05, 95 % CI 1.02-1.08, p < 0.001), log-TG levels (RR 0.09, 95 % CI 0.01-0.87, p < 0.05) and NIHSS at admission (RR 1.19, 95 % CI 1.14-1.24, p < 0.001). Low-density lipoprotein cholesterol levels were not associated with stroke severity or outcome. Lower TG and HDL-C levels are associated with more severe stroke. Lower TG levels also appear to predict in-hospital mortality in patients with acute ischemic stroke.

Citing Articles

Association between blood triglycerides and stroke-associated pneumonia: a prospective cohort study.

Yuan X, Huang S, Ni J, Dong W BMC Neurol. 2025; 25(1):83.

PMID: 40038569 PMC: 11877716. DOI: 10.1186/s12883-025-04060-4.

Prognostic Implications of the Acute Lipid Levels in Stroke Patients.

Hoshino T J Atheroscler Thromb. 2024; 31(8):1133-1134.

PMID: 38658326 PMC: 11300718. DOI: 10.5551/jat.ED261.

Association between serum triglycerides and stroke type, severity, and prognosis. Analysis in 6558 patients.

Akhtar N, Singh R, Kamran S, Joseph S, Morgan D, Uy R BMC Neurol. 2024; 24(1):88.

PMID: 38443844 PMC: 10913234. DOI: 10.1186/s12883-024-03572-9.

Exosomal circCNOT6L Regulates Astrocyte Apoptotic Signals Induced by Hypoxia Exposure Through miR99a-5p/SERPINE1 and Alleviates Ischemic Stroke Injury.

He W, Gu L, Yang J, Zhang R, Long J, Peng W Mol Neurobiol. 2023; 60(12):7118-7135.

PMID: 37531026 DOI: 10.1007/s12035-023-03518-1.

The Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio as a Risk Marker for Metabolic Syndrome and Cardiovascular Disease.

Kosmas C, Rodriguez Polanco S, Bousvarou M, Papakonstantinou E, Pena Genao E, Guzman E Diagnostics (Basel). 2023; 13(5).

PMID: 36900073 PMC: 10001260. DOI: 10.3390/diagnostics13050929.

References

FRIEDEWALD W, Levy R, Fredrickson D . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18(6):499-502. View

Listenberger L, Han X, Lewis S, Cases S, Farese Jr R, Ory D . Triglyceride accumulation protects against fatty acid-induced lipotoxicity. Proc Natl Acad Sci U S A. 2003; 100(6):3077-82. PMC: 152249. DOI: 10.1073/pnas.0630588100. View

Tziomalos K, Athyros V, Karagiannis A, Mikhailidis D . Dyslipidemia as a risk factor for ischemic stroke. Curr Top Med Chem. 2009; 9(14):1291-7. DOI: 10.2174/156802609789869628. View

Amarenco P, Bogousslavsky J, Callahan 3rd A, Goldstein L, Hennerici M, Rudolph A . High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355(6):549-59. DOI: 10.1056/NEJMoa061894. View

Townsend N, Nichols M, Scarborough P, Rayner M . Cardiovascular disease in Europe--epidemiological update 2015. Eur Heart J. 2015; 36(40):2696-705. DOI: 10.1093/eurheartj/ehv428. View

Amarenco P, Labreuche J, Touboul P . High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review. Atherosclerosis. 2007; 196(2):489-96. DOI: 10.1016/j.atherosclerosis.2007.07.033. View

Jun M, Foote C, Lv J, Neal B, Patel A, Nicholls S . Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet. 2010; 375(9729):1875-84. DOI: 10.1016/S0140-6736(10)60656-3. View

Dziedzic T, Slowik A, Gryz E, Szczudlik A . Lower serum triglyceride level is associated with increased stroke severity. Stroke. 2004; 35(6):e151-2. DOI: 10.1161/01.STR.0000128705.63891.67. View

Weir C, Sattar N, Walters M, Lees K . Low triglyceride, not low cholesterol concentration, independently predicts poor outcome following acute stroke. Cerebrovasc Dis. 2003; 16(1):76-82. DOI: 10.1159/000070119. View

10.

Levey A, Bosch J, Lewis J, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6):461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. View

11.

Baigent C, Blackwell L, Emberson J, Holland L, Reith C, Bhala N . Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010; 376(9753):1670-81. PMC: 2988224. DOI: 10.1016/S0140-6736(10)61350-5. View

12.

Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J . Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007; 370(9602):1829-39. DOI: 10.1016/S0140-6736(07)61778-4. View

13.

Miller E, Murray L, Richards L, Zorowitz R, Bakas T, Clark P . Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010; 41(10):2402-48. DOI: 10.1161/STR.0b013e3181e7512b. View

14.

Olsen T, Christensen R, Kammersgaard L, Andersen K . Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study. Stroke. 2007; 38(10):2646-51. DOI: 10.1161/STROKEAHA.107.490292. View

15.

Sanossian N, Saver J, Kim D, Razinia T, Ovbiagele B . Do high-density lipoprotein cholesterol levels influence stroke severity?. J Stroke Cerebrovasc Dis. 2007; 15(5):187-9. DOI: 10.1016/j.jstrokecerebrovasdis.2006.05.003. View

16.

Vauthey C, R de Freitas G, van Melle G, Devuyst G, Bogousslavsky J . Better outcome after stroke with higher serum cholesterol levels. Neurology. 2000; 54(10):1944-9. DOI: 10.1212/wnl.54.10.1944. View

17.

Jain M, Jain A, Yerragondu N, Brown R, Rabinstein A, Jahromi B . The Triglyceride Paradox in Stroke Survivors: A Prospective Study. Neurosci J. 2015; 2013:870608. PMC: 4437270. DOI: 10.1155/2013/870608. View

18.

Rader D, Hovingh G . HDL and cardiovascular disease. Lancet. 2014; 384(9943):618-625. DOI: 10.1016/S0140-6736(14)61217-4. View

19.

Kisialiou A, Pelone G, Carrizzo A, Grillea G, Trimarco V, Marino M . Blood biomarkers role in acute ischemic stroke patients: higher is worse or better?. Immun Ageing. 2012; 9(1):22. PMC: 3533725. DOI: 10.1186/1742-4933-9-22. View

20.

Koton S, Molshatzki N, Bornstein N, Tanne D . Low cholesterol, statins and outcomes in patients with first-ever acute ischemic stroke. Cerebrovasc Dis. 2012; 34(3):213-20. DOI: 10.1159/000342302. View