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Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee K, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Lee J, Park KY, Bae HJ. Admission LDL-cholesterol, statin pretreatment and early outcomes in acute ischemic stroke. J Clin Lipidol 2023; 17:612-621. [PMID: 37574400 DOI: 10.1016/j.jacl.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission. OBJECTIVE This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes. PATIENTS AND METHODS This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored. RESULTS A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (Pnon-linearity<0.001), with substantial relationships in the no pretreatment subgroup. CONCLUSIONS The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Ji Sung Lee
- Clinical Research Center (Dr Lee), Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jihoon Kang
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keon-Joo Lee
- Department of Neurology (Dr Lee), Korea University Guro Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology (Dr Park), Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Korea
| | - Kyusik Kang
- Department of Neurology (Dr Kang), Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology (Drs Lee, Kim), Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae Guk Kim
- Department of Neurology (Drs Lee, Kim), Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae-Kwan Cha
- Department of Neurology (Drs Cha, Kim), Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology (Drs Cha, Kim), Dong-A University Hospital, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology (Dr Park), Seoul Medical Center, Seoul, Korea
| | - Kyungbok Lee
- Department of Neurology (Dr Lee), Soonchunhyang University Hospital, Seoul, Korea
| | - Jun Lee
- Department of Neurology (Dr Lee), Yeungnam University Hospital, Daegu, Korea
| | - Keun-Sik Hong
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Sun Oh
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong-Eog Kim
- Department of Neurology (Drs Kim, Ryu), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Wi-Sun Ryu
- Department of Neurology (Drs Kim, Ryu), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology (Dr Choi), Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jee-Hyun Kwon
- Department of Neurology (Drs Kwon, Kim), Ulsan University College of Medicine, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology (Drs Kwon, Kim), Ulsan University College of Medicine, Ulsan, Korea
| | - Dong-Ick Shin
- Department of Neurology (Drs Shin, Yum), Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Sun Yum
- Department of Neurology (Drs Shin, Yum), Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Il Sohn
- Department of Neurology (Drs Sohn, Hong), Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology (Drs Sohn, Hong), Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang-Hwa Lee
- Department of Neurology (Dr Lee), Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Man-Seok Park
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Juneyoung Lee
- Department of Biostatistics (Dr Lee), Korea University College of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology (Dr Park), Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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2
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Licari C, Tenori L, Di Cesare F, Luchinat C, Giusti B, Kura A, De Cario R, Inzitari D, Piccardi B, Nesi M, Sarti C, Arba F, Palumbo V, Nencini P, Marcucci R, Gori AM, Sticchi E. Nuclear Magnetic Resonance-Based Metabolomics to Predict Early and Late Adverse Outcomes in Ischemic Stroke Treated with Intravenous Thrombolysis. J Proteome Res 2023; 22:16-25. [PMID: 36469426 PMCID: PMC9830637 DOI: 10.1021/acs.jproteome.2c00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Metabolic perturbations and inflammatory mediators play a fundamental role in both early and late adverse post-acute ischemic stroke outcomes. Using data from the observational MAGIC (MArker bioloGici nell'Ictus Cerebrale) study, we evaluated the effect of 130 serum metabolic features, using a nuclear magnetic spectroscopy approach, on the following outcomes: hemorrhagic transformation at 24 h after stroke, non-response to intravenous thrombolytic treatment with the recombinant tissue plasminogen activator (rt-PA), and the 3 month functional outcome. Blood circulating metabolites, lipoproteins, and inflammatory markers were assessed at the baseline and 24 h after rt-PA treatment. Adjusting for the major determinants for unfavorable outcomes (i.e., age, sex, time onset-to-treatment, etc.), we found that acetone and 3-hydroxybutyrate were associated with symptomatic hemorrhagic transformation and with non-response to rt-PA; while 24 h after rt-PA, levels of triglycerides high-density lipoprotein (HDL) and triglycerides low-density lipoprotein (LDL) were associated with 3 month mortality. Cholesterol and phospholipids levels, mainly related to smaller and denser very low-density lipoprotein (VLDL) and LDL subfractions were associated with 3 month poor functional outcomes. We also reported associations between baseline 24 h relative variation (Δ) in VLDL subfractions and ΔC-reactive protein, Δinterleukin-10 levels with hemorrhagic transformation. All observed metabolic changes reflect a general condition of energy failure, oxidative stress, and systemic inflammation that characterize the development of adverse outcomes.
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Affiliation(s)
- Cristina Licari
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy
| | - Leonardo Tenori
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy,Department
of Chemistry “Ugo Schiff”, University of Florence, Via della Lastruccia 3-13, Sesto Fiorentino, Florence 50019, Italy
| | - Francesca Di Cesare
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy
| | - Claudio Luchinat
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy,Department
of Chemistry “Ugo Schiff”, University of Florence, Via della Lastruccia 3-13, Sesto Fiorentino, Florence 50019, Italy,CIRMMP, Via Luigi Sacconi
6, Sesto Fiorentino, Florence 50019, Italy
| | - Betti Giusti
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy,Excellence
Centre for Research, Transfer and High Education for the Development
of DE NOVO Therapies (DENOTHE), University
of Florence, Viale Pieraccini
6, Firenze 50139, Italy
| | - Ada Kura
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Rosina De Cario
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy
| | - Domenico Inzitari
- Stroke
Unit, Careggi University Hospital, Florence 50134, Italy,Institute
of Neuroscience, Italian National Research
Council (CNR), Via Madonna
del Piano, 10, Sesto Fiorentino, Florence 50019, Italy
| | | | - Mascia Nesi
- Stroke
Unit, Careggi University Hospital, Florence 50134, Italy
| | - Cristina Sarti
- NEUROFARBA
Department, Neuroscience Section, University
of Florence, Largo Brambilla
3, Florence 50134, Italy
| | - Francesco Arba
- Department
of Neurology, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Vanessa Palumbo
- Stroke
Unit, Careggi University Hospital, Florence 50134, Italy
| | | | - Rossella Marcucci
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy,Excellence
Centre for Research, Transfer and High Education for the Development
of DE NOVO Therapies (DENOTHE), University
of Florence, Viale Pieraccini
6, Firenze 50139, Italy
| | - Anna Maria Gori
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy,Excellence
Centre for Research, Transfer and High Education for the Development
of DE NOVO Therapies (DENOTHE), University
of Florence, Viale Pieraccini
6, Firenze 50139, Italy
| | - Elena Sticchi
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,
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3
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Licari C, Tenori L, Giusti B, Sticchi E, Kura A, De Cario R, Inzitari D, Piccardi B, Nesi M, Sarti C, Arba F, Palumbo V, Nencini P, Marcucci R, Gori AM, Luchinat C, Saccenti E. Analysis of Metabolite and Lipid Association Networks Reveals Molecular Mechanisms Associated with 3-Month Mortality and Poor Functional Outcomes in Patients with Acute Ischemic Stroke after Thrombolytic Treatment with Recombinant Tissue Plasminogen Activator. J Proteome Res 2021; 20:4758-4770. [PMID: 34473513 PMCID: PMC8491161 DOI: 10.1021/acs.jproteome.1c00406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
![]()
Here, we present
an integrated multivariate, univariate, network
reconstruction and differential analysis of metabolite–metabolite
and metabolite–lipid association networks built from an array
of 18 serum metabolites and 110 lipids identified and quantified through
nuclear magnetic resonance spectroscopy in a cohort of 248 patients,
of which 22 died and 82 developed a poor functional outcome within
3 months from acute ischemic stroke (AIS) treated with intravenous
recombinant tissue plasminogen activator. We explored differences
in metabolite and lipid connectivity of patients who did not develop
a poor outcome and who survived the ischemic stroke from the related
opposite conditions. We report statistically significant differences
in the connectivity patterns of both low- and high-molecular-weight
metabolites, implying underlying variations in the metabolic pathway
involving leucine, glycine, glutamine, tyrosine, phenylalanine, citric,
lactic, and acetic acids, ketone bodies, and different lipids, thus
characterizing patients’ outcomes. Our results evidence the
promising and powerful role of the metabolite–metabolite and
metabolite–lipid association networks in investigating molecular
mechanisms underlying AIS patient’s outcome.
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Affiliation(s)
- Cristina Licari
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy
| | - Leonardo Tenori
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (C.I.R.M.M.P.), Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Department of Chemistry, University of Florence, Via della Lastruccia, 3, Sesto Fiorentino, Florence 50019, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy.,Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies (DENOTHE), University of Florence, Viale Pieraccini 6, Firenze 50139, Italy
| | - Elena Sticchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Ada Kura
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Rosina De Cario
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Domenico Inzitari
- Stroke Unit, Careggi University Hospital, Florence 50134, Italy.,Institute of Neuroscience, Italian National Research Council (CNR), Via Madonna del Piano, 10, Sesto Fiorentino, Florence 50019, Italy
| | | | - Mascia Nesi
- Stroke Unit, Careggi University Hospital, Florence 50134, Italy
| | - Cristina Sarti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Francesco Arba
- Department of Neurology, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Vanessa Palumbo
- Stroke Unit, Careggi University Hospital, Florence 50134, Italy
| | | | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy.,Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies (DENOTHE), University of Florence, Viale Pieraccini 6, Firenze 50139, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy.,Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies (DENOTHE), University of Florence, Viale Pieraccini 6, Firenze 50139, Italy
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (C.I.R.M.M.P.), Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Department of Chemistry, University of Florence, Via della Lastruccia, 3, Sesto Fiorentino, Florence 50019, Italy
| | - Edoardo Saccenti
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Stippeneng 4, Wageningen 6708 WE, the Netherlands
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4
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Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients. Sci Rep 2021; 11:15258. [PMID: 34315990 PMCID: PMC8316573 DOI: 10.1038/s41598-021-94757-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/13/2021] [Indexed: 12/21/2022] Open
Abstract
Aspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.
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5
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Deng Q, Li S, Zhang H, Wang H, Gu Z, Zuo L, Wang L, Yan F. Association of serum lipids with clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis. J Clin Neurosci 2018; 59:236-244. [PMID: 30243601 DOI: 10.1016/j.jocn.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/28/2018] [Accepted: 09/10/2018] [Indexed: 12/31/2022]
Abstract
Serum lipid levels have been investigated as prognostic markers in patients with acute ischaemic stroke. However, these results remain inconsistent. This study aimed at assessing the association between serum lipid and clinical outcomes in acute ischaemic stroke. Relevant data were obtained from Cochrane Library, PubMed and Web of Science databases. The heterogeneity of pooled results was determined by the Cochran's Q test and Higgins I-squared statistic. The random-effect model was performed to calculate the pooled results if PH < 0.05 for Q-test, otherwise the fixed-effect model was applied. The primary results were death, and the secondary were recurrence, dependency, mRS score ≥3, and early neurological deterioration. A total of 21 full-text studies was included in the present study. For primary results, the pooled results from 5 studies with 4119 patients showed that triglyceride (TG) was a significant predictor for death (OR = 0.65, 95%CI = 0.43-0.98, PH = 0.028). The pooled data from 11 studies with 12,486 patients for total cholesterol (TC), 4 studies with 7593 patients for low-density lipoprotein cholesterol (LDL-C), and 5 studies with 6933 patients for high-density lipoprotein cholesterol (HDL-C) suggested that TC (OR = 0.79, 95%CI = 0.56-1.13, PH < 0.001), LDL-C (OR = 1.02, 95%CI = 0.66-1.57, PH = 0.042), and HDL-C (OR = 1.18, 95%CI = 0.75-1.86, PH = 0.003) were not associated with death in acute ischaemic stroke. For secondary results, the pooled results of 2 studies with 867 patients indicated that TG was positively associated with early neurological deterioration. This study suggested that serum TG was associated with death and early neurological deterioration in acute ischaemic stroke.
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Affiliation(s)
- Qiwen Deng
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China; Department of Neurology, Nanjing First Hospital, Nanjing Medical University. Nanjing, China
| | - Shuo Li
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Hanqing Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Huan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Zhengtian Gu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China
| | - Lei Zuo
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Lvyue Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Fuling Yan
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
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6
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Deng QW, Li S, Wang H, Lei L, Zhang HQ, Gu ZT, Xing FL, Yan FL. The Short-term Prognostic Value of the Triglyceride-to-high-density Lipoprotein Cholesterol Ratio in Acute Ischemic Stroke. Aging Dis 2018; 9:498-506. [PMID: 29896437 PMCID: PMC5988604 DOI: 10.14336/ad.2017.0629] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/29/2017] [Indexed: 12/26/2022] Open
Abstract
The triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) is a simple approach to predicting unfavorable outcomes in cardiovascular disease. The influence of TG/HDL-C on acute ischemic stroke remains elusive. The purpose of this study was to investigate the precise effect of TG/HDL-C on 3-month mortality after acute ischemic stroke (AIS). Patients with AIS were enrolled in the present study from 2011 to 2017. A total of 1459 participants from a single city in China were divided into retrospective training and prospective test cohorts. Medical records were collected periodically to determine the incidence of fatal events. All participants were followed for 3 months. Optimal cutoff values were determined using X-tile software to separate the training cohort patients into higher and lower survival groups based on their lipid levels. A survival analysis was conducted using Kaplan-Meier curves and a Cox proportional hazards regression model. A total of 1459 patients with AIS (median age 68.5 years, 58.5% male) were analyzed. Univariate Cox regression analysis confirmed that TG/HDL-C was a significant prognostic factor for 3-month survival. X-tile identified 0.9 as an optimal cutoff for TG/HDL-C. In the univariate analysis, the prognosis of the TG/HDL-C >0.9 group was markedly superior to that of TG/HDL-C ≤0.9 group (P<0.001). A multivariate Cox regression analysis showed that TG/HDL-C was independently correlated with a reduced risk of mortality (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.24-0.62; P<0.001). These results were confirmed in the 453 patients in the test cohort. A nomogram was constructed to predict 3-month case-fatality, and the c-indexes of predictive accuracy were 0.684 and 0.670 in the training and test cohorts, respectively (P<0.01). The serum TG/HDL-C ratio may be useful for predicting short-term mortality after AIS.
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Affiliation(s)
- Qi-Wen Deng
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Shuo Li
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Huan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Leix Lei
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Han-Qing Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zheng-Tian Gu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Fang-Lan Xing
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Fu-Ling Yan
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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7
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Winovich DT, Longstreth WT, Arnold AM, Varadhan R, Zeki Al Hazzouri A, Cushman M, Newman AB, Odden MC. Factors Associated With Ischemic Stroke Survival and Recovery in Older Adults. Stroke 2017; 48:1818-1826. [PMID: 28526765 DOI: 10.1161/strokeaha.117.016726] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 03/28/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about factors that predispose older adults to poor recovery after a stroke. In this study, we sought to evaluate prestroke measures of frailty and related factors as markers of vulnerability to poor outcomes after ischemic stroke. METHODS In participants aged 65 to 99 years with incident ischemic strokes from the Cardiovascular Health Study, we evaluated the association of several risk factors (frailty, frailty components, C-reactive protein, interleukin-6, and cystatin C) assessed before stroke with stroke outcomes of survival, cognitive decline (≥5 points on Modified Mini-Mental State Examination), and activities of daily living decline (increase in limitations). RESULTS Among 717 participants with incident ischemic stroke with survival data, slow walking speed, low grip strength, and cystatin C were independently associated with shorter survival. Among participants <80 years of age, frailty and interleukin-6 were also associated with shorter survival. Among 509 participants with recovery data, slow walking speed, and low grip strength were associated with both cognitive and activities of daily living decline poststroke. C-reactive protein and interleukin-6 were associated with poststroke cognitive decline among men only. Frailty status was associated with activities of daily living decline among women only. CONCLUSIONS Markers of physical function-walking speed and grip strength-were consistently associated with survival and recovery after ischemic stroke. Inflammation, kidney function, and frailty also seemed to be determinants of survival and recovery after an ischemic stroke. These markers of vulnerability may identify targets for differing pre and poststroke medical management and rehabilitation among older adults at risk of poor stroke outcomes.
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Affiliation(s)
- Divya Thekkethala Winovich
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - William T Longstreth
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Alice M Arnold
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Ravi Varadhan
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Adina Zeki Al Hazzouri
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Mary Cushman
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Anne B Newman
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Michelle C Odden
- From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.).
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8
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Zhou G, An Z, Zhao W, Hong Y, Xin H, Ning X, Wang J. Sex differences in outcomes after stroke among patients with low total cholesterol levels: a large hospital-based prospective study. Biol Sex Differ 2016; 7:62. [PMID: 27904745 PMCID: PMC5122199 DOI: 10.1186/s13293-016-0109-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/17/2016] [Indexed: 12/02/2022] Open
Abstract
Background Previous studies have shown that total cholesterol (TC) levels are associated with stroke outcomes, but sex differences in the association between TC levels, especially a low TC level, and ischemic stroke outcomes are unknown. We aimed to assess the sex differences in stroke outcomes among patients with atherothrombotic infarctions and low TC levels in China. Methods This study recruited patients with atherothrombotic infarctions from Tianjin, China, between May 2005 and September 2014. Patients with low TC levels (defined as TC <4.22 mmol/L) were analyzed in this study. Sex differences in stroke subtypes, severity, risk factors, and outcomes at 3 and 12 months after stroke were compared. Results Overall, 1587 patients with low TC levels were recruited to this study from among 6407 patients with atherothrombotic infarctions listed in a stroke registry. Women were more likely than men to have posterior circulation infarcts, severe stroke, hypertension, and obesity but less likely to be current smokers or to consume alcohol. There were no sex differences in stroke outcomes. Older age and severe stroke were common risk factors for poor outcomes after stroke in this study. The presence of diabetes mellitus was an independent predictor of low mortality at 12 months after stroke, possibly because a drug commonly used to treat diabetes, metformin, enhances angiogenesis. Obesity was the determinant of the recurrence and dependency rates at 12 months after stroke. Conclusions These findings suggest that patients (both men and women) with atherothrombotic infarction who have low TC levels would not benefit from receiving statin treatment. Therefore, it is crucial to explore the impact of statin treatment on outcomes in Asian patients, especially Chinese patients with atherothrombotic and low TC levels, in order to improve outcomes after stroke and reduce the disease burden.
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Affiliation(s)
- Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin 300350 China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350 China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin 300350 China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350 China
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin 300350 China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350 China
| | - Yan Hong
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin 300350 China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350 China
| | - Haolin Xin
- Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin 300350 China ; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350 China
| | - Xianjia Ning
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052 China ; Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052 China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052 China ; Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052 China
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9
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Deng QW, Wang H, Sun CZ, Xing FL, Zhang HQ, Zuo L, Gu ZT, Yan FL. Triglyceride to high-density lipoprotein cholesterol ratio predicts worse outcomes after acute ischaemic stroke. Eur J Neurol 2016; 24:283-291. [PMID: 27862659 DOI: 10.1111/ene.13198] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/16/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE The effect of the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) on clinical outcomes of acute ischaemic stroke (AIS) patients is unclear. This study sought to determine whether the TG/HDL-C ratio in AIS patients is associated with worse outcomes at 3 months. METHODS Acute ischaemic stroke patients who were admitted from 2011 to 2014 were enrolled in this study. TG, total cholesterol (TC), HDL-C and low-density lipoprotein cholesterol (LDL-C) were collected on admission. Three end-points were defined according to the modified Rankin scale (mRS) score at 3 months after symptom onset (excellent outcome, mRS 0-1; good outcome, mRS 0-2; and death, mRS 6). RESULTS In all, 1006 patients were included (median age 68.5 years; 58.2% male). Higher TG, non-HDL-C and TG/HDL-C were strongly associated with the three end-points after adjustments: excellent [odds ratio (OR) = 1.39, OR 1.89 and OR 2.34, respectively] and good (OR 1.48, OR 2.90 and OR 4.12) outcomes, and death (OR 0.59, OR 0.29 and OR 0.26). According to receiver operating characteristic (ROC) analysis, the best discriminating factor was a TG/HDL-C ≥ 0.87 for excellent outcomes [area under the ROC curve (AUC) 0.596; sensitivity 73.3%; specificity 42.7%] and non-death (AUC 0.674; sensitivity 67.8%; specificity 60.6%) as well as a TG/HDL-C ≥ 1.01 for a good outcome (AUC 0.652; sensitivity 61.6%; specificity 63.2%). Patients with a TG/HDL-C < 0.87 had a 2.94-fold increased risk of death (95% confidence interval 1.89-4.55) compared with patients with a TG/HDL-C ≥ 0.87. CONCLUSIONS A lower TG/HDL-C was independently associated with death and worse outcome at 3 months in AIS.
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Affiliation(s)
- Q-W Deng
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - H Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - C-Z Sun
- Department of Emergency, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - F-L Xing
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - H-Q Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - L Zuo
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Z-T Gu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - F-L Yan
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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10
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Yeramaneni S, Kleindorfer DO, Sucharew H, Alwell K, Moomaw CJ, Flaherty ML, Woo D, Adeoye O, Ferioli S, de Los Rios La Rosa F, Martini S, Mackey J, Khatri P, Kissela BM, Khoury JC. Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use: A population-based study. Int J Stroke 2016; 12:152-160. [PMID: 27649737 DOI: 10.1177/1747493016670175] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Although statin therapy is associated with reduced stroke and mortality risk, some studies report that higher lipid levels are associated with improved outcomes following ischemic stroke. Aims We examined the association of hyperlipidemia (HLD) combined with statin therapy on all-cause mortality in stroke patients. Methods All stroke patients in the Greater Cincinnati Northern Kentucky region of ∼1.3 million were identified using ICD-9 discharge codes in 2005 and 2010. Stroke patients with and without HLD were categorized based on their reported statin use at baseline or discharge into three groups: no-HLD/no-statins, HLD/no-statins, and HLD/on-statins. Cox proportional hazards model was used to estimate the risk of mortality at 30 days, 1 year, and 3 years poststroke. Results Overall, 77% (2953) of the 3813 ischemic stroke patients were diagnosed with HLD and 72% ( n = 2123) of those patients were on statin medications. The mean age was 70.0 ± 14.6 years, 56% were women, and 21% were black. In adjusted analyses, the HLD/no-statins group showed 35% (adjusted hazard ratio (aHR) = 0.65, 95% CI: 0.46-0.92), 27% (aHR = 0.73, 95% CI: 0.59-0.90), and 17% (aHR = 0.83, 95% CI: 0.70-0.97) reduced risk of mortality at 30 days, 1 year, and 3 years, respectively, poststroke, compared with no-HLD/no-statins group. The HLD/on-statins group showed an additional 17% significant survival benefit at 3 years poststroke compared with HLD/no-statins group. Conclusions A diagnosis of HLD in ischemic stroke patients is associated with reduced short- and long-term mortality, irrespective of statin use. Statin therapy is associated with significant, additional long-term survival benefit.
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Affiliation(s)
- Samrat Yeramaneni
- 1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,2 Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas, USA
| | - Dawn O Kleindorfer
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Heidi Sucharew
- 1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathleen Alwell
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Charles J Moomaw
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Matthew L Flaherty
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Daniel Woo
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Opeolu Adeoye
- 4 Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Simona Ferioli
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Felipe de Los Rios La Rosa
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,5 Baptist Health Neuroscience Center, Miami, Florida, USA
| | - Sharyl Martini
- 6 Michael E. DeBakey VA Medical Center, and Department of Neurology, Baylor College of Medicine, Houston Texas, USA
| | - Jason Mackey
- 7 Department of Neurology, Indiana University, Indianapolis, Indiana, USA
| | - Pooja Khatri
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Brett M Kissela
- 3 Department of Neurology and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Jane C Khoury
- 1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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11
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Zhao W, An Z, Hong Y, Zhou G, Guo J, Zhang Y, Yang Y, Ning X, Wang J. Low total cholesterol level is the independent predictor of poor outcomes in patients with acute ischemic stroke: a hospital-based prospective study. BMC Neurol 2016; 16:36. [PMID: 26980573 PMCID: PMC4793701 DOI: 10.1186/s12883-016-0561-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/10/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Total cholesterol is a well-documented risk factor for coronary disease. Previous studies have shown that high total cholesterol level is associated with better stroke outcomes, but the association of low total cholesterol levels and ischemic stroke outcomes is rare. Therefore, we aimed to assess the association of low total cholesterol levels and stroke outcomes among acute ischemic stroke patients in China. METHODS This study recruited 6407 atherothrombotic infarction patients from Tianjin, China, between May 2005 and September 2014. All patients were categorized into five groups according to TC level quintiles at admission. Differences in subtypes, severity, risk factors, and outcomes at 3, 12, and 36 months after stroke were compared between these groups. RESULTS In total, 1256 (19.6%) patients had low cholesterol levels, with a higher prevalence in men than in women (23.7% vs. 11.2%, P < 0.001). Compared with higher cholesterol levels, the lowest cholesterol level quintile (TC, <4.07 mmol/L) was associated with older age (64.7 years, P = 0.033), anterior circulation infarct (22.8%), atrial fibrillation (4.9%), current smoking (41.1%), and alcohol consumption (21.1%) and lower frequencies of hypertension (72.9%), diabetes (30.7%), and obesity (9.9%). Dependency and recurrence rates were significantly higher at 36 months in patients in the lowest TC level quintile than in those with higher cholesterol levels (dependency rates, 51.2% vs 45.2%; P = 0.007 and recurrence rates, 46.3% vs 37.3%, P = 0.001). Moreover, these differences remained after adjustment for age, sex, stroke severity, and Oxfordshire Community Stroke Project classification (odds ratios [ORs] for dependency rate, 1.41; 95% confidence interval [CI], 1.11, 1.79; P = 0.005 and recurrence rate, 1.50; 95% CI, 1.19, 1.89; P = 0.001). However, mortality rates after stroke were not significantly different between the groups. CONCLUSIONS These findings suggest that statin treatment for patients with atherothrombotic infarction and low cholesterol levels increase long-term dependency and recurrence rates, but do not increase mortality rates. It is crucial to highlight the different impact of statin treatment on patients with atherothrombotic infarction and lower cholesterol levels for secondary stroke prevention in China.
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Affiliation(s)
- Wenjuan Zhao
- />Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, Tianjin, 300060 China
- />Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Zhongping An
- />Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, Tianjin, 300060 China
- />Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Yan Hong
- />Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, Tianjin, 300060 China
- />Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Guanen Zhou
- />Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, Tianjin, 300060 China
- />Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Jingjing Guo
- />Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
- />Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yongli Zhang
- />Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
- />Department of Clinical Pharmacy, Tianjin Huanhu Hospital, Tianjin, China
| | - Yuanju Yang
- />Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, Tianjin, 300060 China
- />Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xianjia Ning
- />Department of Epidemiology, Tianjin Neurological Institute & Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghua Wang
- />Department of Epidemiology, Tianjin Neurological Institute & Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
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12
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Shibasaki K, Ogawa S, Yamada S, Iijima K, Eto M, Kozaki K, Toba K, Ouchi Y, Akishita M. Favorable effect of sympathetic nervous activity on rehabilitation outcomes in frail elderly. J Am Med Dir Assoc 2015; 16:799.e7-799.e12. [PMID: 26170032 DOI: 10.1016/j.jamda.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Previous studies have suggested the relationship between physical function, mortality, and autonomic nervous activity in frail elderly and that maintaining sympathetic nervous activity might lead to improved physical function and mortality in the elderly population. The aim of this study was to investigate the utility of sympathetic nervous activity measured by heart rate variability in frail elderly patients undergoing inpatient rehabilitation, further focusing the nervous activity on the effect of rehabilitation therapy. DESIGN Prospective cohort study. PARTICIPANTS Sixty-one subjects aged 75 years or older were recruited after treatment of acute phase illness. MEASUREMENTS Before undergoing rehabilitation, data of 24-hour Holter monitoring and a blood venous sample were obtained. From RR intervals in the electrocardiogram, heart rate and SDs of all NN intervals in all 5-minute segments of the entire recording, power spectral density, low frequency (LF), high frequency (HF), and low frequency/high frequency (LF/HF) were calculated. Functional Independence Measure (FIM) and Barthel index were used to measure physical function. RESULTS FIM score and Barthel index were 46.8 ± 25.4 and 32.8 ± 31.7, respectively. Serum total protein, albumin, hemoglobin, and total cholesterol were all significantly related to FIM score and Barthel index before rehabilitation. Heart rate variability indices did not show a significant relationship with physical function, whereas the high LH/HF group showed significant improvement in physical function compared with the low LH/HF group. Moreover, LF/HF frequency was a predictive factor for improvement of physical function after 2 months of rehabilitation. CONCLUSION A favorable effect of preserved LF/HF on rehabilitation outcome was observed in elderly undergoing rehabilitation. Preservation of sympathetic nervous activity may lead to improved physical function in the elderly.
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Affiliation(s)
- Koji Shibasaki
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Shizuru Yamada
- Komagane-kogen Ladies Clinic, Komagane City, Nagano, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masato Eto
- General Educational Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
| | - Kenji Toba
- National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Yasuyoshi Ouchi
- Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Cha JK, Lim JH, Kim DH, Nah HW, Park HS, Choi JH, Suh HK, Huh JT. Prognostic factors for long-term poor outcomes after acute ischemic stroke in very old age (>80 years) patients: Total cholesterol level might differently influence long-term outcomes after acute ischemic stroke at ages above 80 years. Geriatr Gerontol Int 2014; 15:1227-33. [PMID: 25496005 DOI: 10.1111/ggi.12419] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Abstract
AIM We investigated the differences in determinant factors for functional outcomes between patients aged >80 years and those aged <80 years after acute ischemic stroke (AIS). In particular, we would like to know the differential impacts of initial total cholesterol (TC) levels between the two groups. METHODS We defined a poor outcome as 3-6 modified Rankin Scale 90 days after AIS. RESULTS In the present study, 2772 participants were enrolled. Among them, 374 patients (13.5%) were aged >80 years, and 1061 patients had a poor outcome 90 days after AIS. The proportion was significantly higher in patients aged >80 years than in those aged <80 years after AIS. Regarding factors relating to poor outcomes, previous history of stroke, stroke severity and stroke subtypes of ischemic stroke were independent factors in patients aged <80 years, and the stroke severity and initial TC level independently influenced the outcome for patients aged >80 years. In particular, risk of poor outcome adjusted for age, stroke severity and subtypes of ischemic stroke for patients (OR [95% CI]) in the first quartile range (≤157 mg%) were 2.21 (1.06-4.62), in the third quartile range (184-210 mg%) 2.76 (1.27-6.01) and in the fourth quartile range (≥211 mg%) 2.75 (1.21-6.24) compared with those in the second quartile range (158-183 mg%) in patients aged >80 years. CONCLUSIONS There were also some differences in related factors regarding occurrences of poor outcome between the two groups. In particular, the initial TC level might play a crucial role for the outcome after AIS in the very old population.
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Affiliation(s)
- Jae-Kwan Cha
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Jun-Ho Lim
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Hyun-Wook Nah
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | | | | | - Hyun-Kyung Suh
- Department of Visual Optics, KyungWoon University, Gumi, Korea
| | - Jae-Taeck Huh
- Stroke Center, Dong-A University Hospital, Busan, Korea
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14
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ABCD2 Score May Discriminate Minor Stroke from TIA on Patient Admission. Transl Stroke Res 2013; 5:128-35. [DOI: 10.1007/s12975-013-0286-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/12/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
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Weng WC, Huang WY, Su FC, Chien YY, Wu CL, Lee TH, Peng TI. Less favorable neurological recovery after acute stroke in patients with hypercholesterolemia. Clin Neurol Neurosurg 2013; 115:1446-50. [DOI: 10.1016/j.clineuro.2013.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/15/2013] [Accepted: 01/23/2013] [Indexed: 11/24/2022]
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Rist PM, Buring JE, Kase CS, Ridker PM, Kurth T. Biomarkers and functional outcomes from ischaemic cerebral events in women: a prospective cohort study. Eur J Neurol 2012; 20:375-81. [PMID: 23034002 DOI: 10.1111/j.1468-1331.2012.03874.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 08/17/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Several biomarkers have been associated with an increased risk of ischaemic stroke. However, the association between these biomarkers and functional outcome from cerebral ischaemic events is unclear. We aimed to assess the patterns of association between cardiovascular disease biomarkers and functional outcomes after incident ischaemic cerebral events in women. METHODS Prospective cohort study of 27,728 women enrolled in the Women's Health Study who provided information on blood samples and were free of stroke or transient ischaemic attack (TIA) at baseline. Multinomial logistic regression was used to determine the association between elevated biomarker levels and functional outcomes from ischaemic cerebral events. Possible functional outcomes included TIA and ischaemic stroke with modified Rankin Scale (mRS) score of 0-1, 2-3, or 4-6. RESULTS After a mean follow-up of 15.1 years, 461 TIAs and 380 ischaemic strokes occurred. Elevated levels of total cholesterol were associated with the highest risk of poor functional outcome (mRS 4-6) after incident cerebral ischaemic events (relative risk = 2.02, 95% CI = 1.18-3.46). We observed significant associations between elevated levels of total cholesterol, Lp(a), C-reactive protein, and triglycerides, and mild or moderate functional outcomes after ischaemic cerebral events. Elevations in all other biomarkers were not significantly associated with functional outcomes. CONCLUSIONS Whilst total cholesterol level was associated with highest risks of poor functional outcome after stroke, we overall observed an inconsistent pattern of association between biomarkers linked with an increased risk of vascular events and more impaired functional outcomes from stroke.
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Affiliation(s)
- P M Rist
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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Cataldo MC, Calcara ML, Caputo G, Mammina C. Association of total serum cholesterol with functional outcome following home care rehabilitation in Italian patients with stroke. Disabil Health J 2012; 5:111-6. [PMID: 22429545 DOI: 10.1016/j.dhjo.2011.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 11/04/2011] [Accepted: 11/17/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stroke is a disabling disease. In elderly populations, stroke is the third leading cause of death and the primary cause of reduction in or loss of functional ability and personal autonomy. Possible associations between levels of total serum cholesterol (TC) and both incidence of stroke and functional outcomes after rehabilitation are still under study. OBJECTIVE To detect positive and negative prognostic factors associated with functional outcomes in first-time stroke patients admitted to an integrated home care rehabilitative program. METHODS This study enrolled 141 patients with a first-time stroke who were admitted to a home care rehabilitation program. Primary outcome measures were the Barthel activities of daily living (ADL) and mobility indices at the beginning and end of the rehabilitative treatment. The impact of TC and other demographic and clinical variables was analyzed using bivariate and multivariate logistic regression analyses. RESULTS Age and Short Portable Mental Status Questionnaire (SPMSQ) score were negatively associated with functional outcome. In contrast, elevated TC was positively associated with a better home rehabilitative treatment outcome. Barthel index score at admission was negatively associated with outcomes assessed by the Barthel ADL index and age with outcomes assessed by the Barthel mobility index. In a multivariate logistic regression analysis, SPMSQ score and elevated TC were significantly associated with outcome. Specifically, higher SPMSQ scores were negatively associated with better rehabilitative treatment outcomes, whereas elevated TC was positively associated. CONCLUSIONS Elevated TC seems to be associated with better functional outcomes in patients with first-time stroke.
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Affiliation(s)
- Maria Concetta Cataldo
- Geriatric Assessment and Integrated Home Care Unit, District 10, Regional Health Agency 6, Palermo, Italy
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Hsu WC, Chiu SYH, Yen AMF, Chen LS, Fann CY, Liao CS, Chen HH. Somatic neuropathy is an independent predictor of all- and diabetes-related mortality in type 2 diabetic patients: a population-based 5-year follow-up study (KCIS No. 29). Eur J Neurol 2012; 19:1192-8. [DOI: 10.1111/j.1468-1331.2011.03659.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koton S, Molshatzki N, Bornstein NM, Tanne D. Low Cholesterol, Statins and Outcomes in Patients with First-Ever Acute Ischemic Stroke. Cerebrovasc Dis 2012; 34:213-20. [DOI: 10.1159/000342302] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 08/01/2012] [Indexed: 11/19/2022] Open
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