Alpha 2.0

» Articles » PMID: 37159580

Correlation of Atherosclerotic Dyslipidemia with Long-Term Stroke Recurrence in Patients Undergoing Intravenous Thrombolysis for Acute Ischemic Stroke

Overview

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2023 May 9

PMID 37159580

Authors

Authors

Yuan Cheng

Qingqing Wang

Guihong Niu

Chun Luo

Affiliations

Affiliations

Soon will be listed here.

Abstract

Background: Atherosclerotic dyslipidemia (AD) is associated with an increased risk of cardiovascular diseases and stroke events, but the effect of AD among acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis is unclear. This study aimed to investigate the relationship between AD and long-term stroke recurrence in AIS patients undergoing intravenous thrombolysis.

Methods: This prospective cohort study included 499 AIS patients treated with intravenous thrombolysis. Stroke subtype was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, patients' clinical characteristics, and results from multiple diagnostic tests. The primary endpoint event was ischemic stroke recurrence; the time to first AIS recurrence was estimated using Kaplan‒Meier analysis and compared using the two-sided Log rank test. Cox univariate and multivariate regression analyses were used to assess the association between AD and long-term stroke recurrence.

Results: Of the 499 patients with AIS treated with rt-PA intravenous thrombolysis, 80 (16.0%) had AD, and 60 (12.0%) had a stroke recurrence event. Kaplan‒Meier analysis showed that the stroke recurrence rate was significantly higher in patients with AD than in those without AD (p = 0.035, log rank test) and in the large-artery disease (LAD) subtype (p = 0.006, log rank test). Multivariate Cox regression analysis showed that AD (HR = 2.363, 95% CI: 1.294-4.314, P = 0.005) and atrial fibrillation (HR = 2.325, 95% CI: 1.007-5.366, P = 0.048) were associated with an increased risk of long-term stroke recurrence in AIS patients who underwent intravenous thrombolysis. Furthermore, AD was associated with an increased risk of stroke recurrence in patients undergoing intravenous thrombolysis in the LAD subtype (HR = 3.122, 95% CI: 1.304-7.437, P = 0.011).

Conclusion: We found that AD increases the risk of long-term stroke recurrence in AIS patients undergoing intravenous thrombolysis. This association may be stronger in the LAD subtype.

Citing Articles

Association between dietary intake of niacin and stroke in the US residents: evidence from national health and nutrition examination survey (NHANES) 1999-2018.

Qiu J, Zhang W, Zhu X, Wu L, Huang J, Zhang J Front Nutr. 2024; 11:1391023.

PMID: 39101008 PMC: 11294223. DOI: 10.3389/fnut.2024.1391023.

References

1.

Diener H, Ringleb P, Savi P . Clopidogrel for the secondary prevention of stroke. Expert Opin Pharmacother. 2005; 6(5):755-64. DOI: 10.1517/14656566.6.5.755. View

2.

Barkas F, Elisaf M, Liberopoulos E, Liontos A, Rizos E . High triglyceride levels alter the correlation of apolipoprotein B with low- and non-high-density lipoprotein cholesterol mostly in individuals with diabetes or metabolic syndrome. Atherosclerosis. 2016; 247:58-63. DOI: 10.1016/j.atherosclerosis.2016.02.001. View

3.

Hu Y, Ji C . Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis. BMC Neurol. 2021; 21(1):66. PMC: 7877096. DOI: 10.1186/s12883-021-02095-x. View

4.

Kumral E, Evyapan D, Gokcay F, Karaman B, Orman M . Association of baseline dyslipidemia with stroke recurrence within five-years after ischemic stroke. Int J Stroke. 2014; 9 Suppl A100:119-26. DOI: 10.1111/ijs.12341. View

5.

Turan T, Makki A, Tsappidi S, Cotsonis G, Lynn M, Cloft H . Risk factors associated with severity and location of intracranial arterial stenosis. Stroke. 2010; 41(8):1636-40. PMC: 2927377. DOI: 10.1161/STROKEAHA.110.584672. View

6.

Tu W, Zhao Z, Yin P, Cao L, Zeng J, Chen H . Estimated Burden of Stroke in China in 2020. JAMA Netw Open. 2023; 6(3):e231455. PMC: 9982699. DOI: 10.1001/jamanetworkopen.2023.1455. View

7.

Horenstein R, Smith D, Mosca L . Cholesterol predicts stroke mortality in the Women's Pooling Project. Stroke. 2002; 33(7):1863-8. DOI: 10.1161/01.str.0000020093.67593.0b. View

8.

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K . Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American.... Stroke. 2019; 50(12):e344-e418. DOI: 10.1161/STR.0000000000000211. View

9.

Varbo A, Benn M, Tybjaerg-Hansen A, Nordestgaard B . Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation. Circulation. 2013; 128(12):1298-309. DOI: 10.1161/CIRCULATIONAHA.113.003008. View

10.

. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106(25):3143-421. View

11.

Lopez-Montoya P, Cerqueda-Garcia D, Rodriguez-Flores M, Lopez-Contreras B, Villamil-Ramirez H, Moran-Ramos S . Association of Gut Microbiota with Atherogenic Dyslipidemia, and Its Impact on Serum Lipid Levels after Bariatric Surgery. Nutrients. 2022; 14(17). PMC: 9460232. DOI: 10.3390/nu14173545. View

12.

Manninen V, Tenkanen L, Koskinen P, HUTTUNEN J, Manttari M, Heinonen O . Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation. 1992; 85(1):37-45. DOI: 10.1161/01.cir.85.1.37. View

13.

Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L . Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults. Circulation. 2017; 135(8):759-771. DOI: 10.1161/CIRCULATIONAHA.116.025250. View

14.

Kutkiene S, Petrulioniene Z, Laucevicius A, Matuzeviciene G, Kasiulevicius V, Petrulionyte E . Cardiovascular risk profile of patients with atherogenic dyslipidemia in middle age Lithuanian population. Lipids Health Dis. 2018; 17(1):208. PMC: 6123979. DOI: 10.1186/s12944-018-0851-0. View

15.

Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson C . Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019; 18(4):394-405. DOI: 10.1016/S1474-4422(18)30500-3. View

16.

Stahel P, Xiao C, Hegele R, Lewis G . The Atherogenic Dyslipidemia Complex and Novel Approaches to Cardiovascular Disease Prevention in Diabetes. Can J Cardiol. 2018; 34(5):595-604. DOI: 10.1016/j.cjca.2017.12.007. View

17.

Zhao L, Wang R, Song B, Tan S, Gao Y, Fang H . Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke. Int J Stroke. 2015; 10(5):752-8. DOI: 10.1111/ijs.12471. View

18.

Sacco R, Benson R, Kargman D, Boden-Albala B, Tuck C, Lin I . High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study. JAMA. 2001; 285(21):2729-35. DOI: 10.1001/jama.285.21.2729. View

19.

Findler M, Molad J, Bornstein N, Auriel E . Worse Outcome in Patients with Acute Stroke and Atrial Fibrillation Following Thrombolysis. Isr Med Assoc J. 2017; 19(5):293-295. View

20.

Julian M, Pera G, Soldevila B, Caballeria L, Julve J, Puig-Jove C . Atherogenic dyslipidemia, but not hyperglycemia, is an independent factor associated with liver fibrosis in subjects with type 2 diabetes and NAFLD: a population-based study. Eur J Endocrinol. 2021; 184(4):587-596. DOI: 10.1530/EJE-20-1240. View