Non-High-Density Lipoprotein Cholesterol Levels on the Risk of Asymptomatic Intracranial Arterial Stenosis: A Result from the APAC Study

Association between atherogenic index of plasma and asymptomatic intracranial arterial stenosis in middle-aged and elderly women: A cross-sectional study in Shandong, China

BACKGROUND AND AIMS

The atherogenic index of plasma (AIP) is associated with progression of atherosclerosis and used to describe how pro- or anti-atherogenic components are balanced. However, the association of AIP with asymptomatic intracranial arterial stenosis (aICAS) is uncertain. The purpose of this study is to investigate the association between AIP and aICAS in rural China.

METHODS AND RESULTS

A total of 1990 participants aged ≥40 years free of stroke or transient ischemic attack were enrolled in this study. The presence of aICAS was examined by Transcranial Doppler ultrasound and confirmed by magnetic resonance angiography. The adjusted AIP (aAIP) was calculated according to the ratio of TG and HDL-C and further separated into 4 quartiles. Multiple logistic regression was used to investigate the association between aAIP and aICAS, and the dose-response relationship was explored by restricted cubic spline. After adjusting for conventional confounders, aAIP was significantly higher in the aICAS group than that in the non-aICAS group. Furthermore, the common odds ratios for aICAS risk increased with increasing aAIP quartiles. Multivariate logistic regression revealed that aAIP was independently associated with aICAS in female or middle-aged and elderly (age ≥50 years), and superior to other lipid profiles. Multiple-adjusted spline regression showed the dose-response association between aAIP levels and aICAS prevalence.

CONCLUSIONS

AIP might be independently and positively associated with the prevalence of aICAS in middle-aged and elderly women, which might be superior to traditional and nontraditional lipid profiles in rural China.

Carotid intima-media and epicardial adipose tissue thickness in adult patients with epilepsy taking anti-seizure medication and its long-term significance

OBJECTIVES

We investigated epicardial adipose tissue thickness (EATT), carotid intima-media thickness (CIMT), and lipid profile in adult patients with epilepsy (PWE) taking anti-seizure medication(s) (ASM) and compared with those of the healthy population. We also investigated whether duration of follow-up and number of ASM(s) (mono- vs. polytherapy) affect these risk factors.

METHODS

Twenty PWE older than 18 years of age were recruited at the outpatient epilepsy clinic and compared to twenty controls. Patients who were 18 years old and younger, those with cardiovascular risk factors, and patients with follow-up duration less than 2 years were excluded from the study.

RESULTS

Epicardial adipose tissue thickness and CIMT were thicker compared to controls. While patients' low-density lipoprotein (LDL) levels were higher than controls, and high-density lipoprotein (HDL) levels were lower, the levels were in normal ranges. Those patients with duration of follow-up more than five years had thicker EATT. The 5-year LDL was in normal ranges while HDL was abnormally low. Number of ASM(s) was not associated with increased risks of atherosclerosis. Increased CIMT in patients taking ASM(s) was independent of their lipid profile.

CONCLUSION

Anti-seizure medications contribute to accelerated atherosclerosis in people with epilepsy. Chronic use of ASMs may increase this chance. It is appropriate to use ASM(s) with lower chances of atherosclerosis in people with epilepsy and encourage them to change their lifestyle in order to modify cardiovascular risk factors. Meantime, it is reasonable to assess the risk of atherosclerosis periodically in these patients by noninvasive methods including lipid profile, CIMT, and EATT.

Association between the ABCA1 (R219K) polymorphism and lipid profiles: a meta-analysis

Conflicting evidence was found about the relationship between lipid profiles and R219K polymorphism in adenosine triphosphate-binding cassette exporter A1 (ABCA1) gene. In this study, four meta-analyses were conducted to assess the effect of R219K on lipid levels, including high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol, total cholesterol, and triglycerides (TG). A total of 125 samples of 87 studies (about 60,262 subjects) were included. The effect of each study was expressed using the standard mean difference (SMD) and 95% confidence interval (95% CI) and pooled by meta-analysis in the random-effects model. Subgroup and meta-regression analyses were conducted to explore potential heterogeneity sources. The overall pooled effect showed the following results. (1) The R219K was significantly associated with HDLC level (SMD = - 0.25 mmol/L, 95%CI - 0.32 to - 0.18, z = - 6.96, P < 0.01, recessive genetic model). People with different genotypes had significantly different HDLC levels under the recessive, codominant and dominant genetic models (all Ps < 0.01). (2) A weak and indeterminate relationship between R219K and TG level was observed (SMD = 0.18 mmol/L, 95%CI 0.06-0.30, z = 3.01, P < 0.01, recessive genetic model). These findings suggested that R219K was associated with HDLC and TG levels, which might implicate a promising clinical application for lipid-related disorders, though the influences of race, health status, BMI, and other heterogeneity sources should be considered when interpreting current findings. The protocol was registered at PROSPERO (registration number: CRD42021231178).

Non-traditional Lipid Parameters as Potential Predictors of Asymptomatic Intracranial Arterial Stenosis

Background: Intracranial arterial stenosis (ICAS) is a common cause of stroke. Identifying effective predictors of ICAS that could be easily obtained in clinical practice is important. The predictive values of serum individual lipid parameters have been well-established. In recent years, several non-traditional lipid parameters demonstrated greater predictive values for cardiovascular disease and ischemic stroke than traditional individual lipid parameters. However, their effects on asymptomatic ICAS (aICAS) are less clear. Therefore, we sought to observe the effects of non-traditional lipid parameters on aICAS. Methods: We enrolled 5,314 participants from the Asymptomatic Polyvascular Abnormalities in Community study. Asymptomatic ICAS was detected by transcranial Doppler ultrasonography (TCD). Non-traditional lipid parameters, including non-high-density lipoprotein cholesterol (non-HDL-C), the triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic coefficient (AC), atherogenic index of plasma, and Castelli's risk index (CRI) were measured. We used multivariable logistic analysis to assess the association of different lipid parameters with aICAS; a trend test and subgroup analyses were also performed. Results: In total, 695 of 5,314 participants had aICAS in this study. For the comparison of the highest to the lowest tertile, the multivariable-adjusted odds ratios (ORs) (95% CIs) were 1.78 (1.39-2.27) (p trend < 0.001) for non-HDL-C, 1.48 (1.18-1.85) (p trend = 0.004) for the AC, 1.48 (1.18-1.85) (p trend = 0.004) for CRI-I, and 1.34 (1.09-1.66) (p trend = 0.032) for CRI-II. Subgroup analyses showed significant interactions between the AC, CRI-I, and diabetes. Conclusions: This large community-based study showed that non-HDL-C, AC, CRI-I, and CRI-II were significantly associated with increased prevalence of aICAS.

Association between serum non-high-density lipoprotein cholesterol and cognitive dysfunction after acute ischemic stroke: a cross-sectional study

This study aimed to explore the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) and cognitive dysfunction risk in patients with acute ischemic stroke (AIS). This cross-sectional study enrolled 583 AIS patients. Biochemical markers and lipid profile were collected after admission. AIS patients were classified into high group (non-HDL-C ≥3.4 mM) and normal group (non-HDL-C <3.4 mM). Mini-Mental State Examination scale (MMSE), Montreal Cognitive Assessment scale (MoCA), Activities of Daily Living (ADL) scale, Neuropsychiatric Inventory (NPI), and Hamilton Depression scale 21 version (HAMD-21) were applied on the third day after admission. Compared with the control group, patients of the high group had higher body mass index and higher frequency of intracranial artery stenosis, and exhibited higher levels of non-HDL-C, total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, fasting blood glucose, and glycosylated hemoglobin (HbA1c), and lower levels of high-density lipoprotein cholesterol (all P<0.05). Compared with the control group, patients of the high group had significantly lower MMSE and MoCA scores (MMSE: 26.01±4.17 vs 23.12±4.73, P<0.001; MoCA: 22.28±5.28 vs 20.25±5.87, P<0.001) and higher scores on the NPI and HAMD-21 (both P<0.001). MMSE (r=-0.306, P<0.001) and MoCA scores (r=-0.251, P<0.001) were negatively associated with non-HDL-C level. Multivariate regression analysis revealed that non-HDL-C level (OR=1.361, 95%CI: 1.059-1.729, P=0.016) was independently associated with the presence of cognitive dysfunction after adjusting for confounding factors. High serum non-HDL-C level might significantly increase the risk of cognitive dysfunction after AIS.

Relationship between non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and coronary heart disease

OBJECTIVE

To investigate the association between non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and degree of coronary artery stenosis proven by coronary angiography.

METHODS

A total of 1867 patients were enrolled into this study and analyzed retrospectively. Three hundred eighty-five non-coronary artery disease hospitalized patients were selected as control group, 1482 patients diagnosed as coronary artery disease were classified into three subgroups according to the tertiles of their SYNTAX score. We compared the level of non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio among the three subgroups. The Spearman correlation was used to analyze the correlation between non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and SYNTAX, logistic regression was used for analyzing independent predictors of coronary artery disease.

RESULTS

The level of non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio was higher in coronary artery disease group compared with non-coronary artery disease group (P < 0.01). The Spearman correlation analysis showed that non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were significantly correlated with SYNTAX score (r = 0.081, P < 0.001; r = 0.216, P < 0.001). In multivariate logistic regression analysis showed that non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were independent predictors of coronary artery disease (odds ratio = 3.645, 95% confidence interval, 1.267-10.486; OR = 2.096, 95% confidence interval, 1.438-3.054).

CONCLUSION

Non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were associated with the severity of coronary artery lesions, which can be used as a biomarker for the evaluation of severity of coronary artery disease.

What Proportion of Patients Admitted with Stroke or Transient Ischemic Attack May Be Suitable for Newer Cholesterol-Lowering Treatment?

BACKGROUND

Protein convertase subtilisin-kexin type 9 (PCSK9) inhibitors effectively clear low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). We evaluated stroke admissions potentially eligible for more intensive cholesterol treatment.

METHODS

Retrospective analysis of consecutive admissions to a hyperacute stroke unit over 5 months in 2017. Records were individually searched. Data were collected on diagnosis, risk factors, and stroke work-up. European Society of Cardiology and European Atherosclerosis Society guidelines for the management of dyslipidaemias were used for screening patients eligible for PCSK9 inhibitors.

RESULTS

Of 650 patient admissions: 351 (54%) had acute ischemic stroke or transient ischemic attack (TIA), 80 (12%) hemorrhage, and 219 (34%) mimic syndromes. Patients with hemorrhage (n = 80), mimic syndromes (n = 219), and absent LDL-C, or non-HDL-C testing (n = 27) were subsequently excluded. 324 patients with acute ischemic stroke and TIA were further screened for PCSK9-inhibitor treatment eligibility. Forty-one (13%) patients with LDL-C greater than or equal to 1.8mmol/L (≥70 mg/dL) on maximal tolerated statin dose and with concomitant "very high vascular risk" were identified. "Very high vascular risk" was defined as a documented history of cardiovascular disease and/or peripheral arterial disease. Of 41 patients eligible for PCSK9 inhibitors, median age was 82 years (range 53-96); median vascular risk factors were 2 (range 1-5); 7 (17%) had TIA; 13 (31%) had history of preceding cerebrovascular events, 13 (31%) diabetes mellitus, 17 (42%) cardioembolic events, 9 (22%) lacunar syndrome, 11 (22%) symptomatic internal carotid artery stenosis (n = 9 were >70%), and 4 (10%) undetermined aetiology. Eighty-three percent patients eligible for PCSK9 inhibitors also had non-HDL-C values greater than or equal to 2.6 mmol/L.

CONCLUSIONS

Up to 13% of unselected acute ischemic stroke or TIA patients admitted to a hyper-acute stroke unit were potentially suitable for more intensive cholesterol treatment. Our data may act as a useful guide for sample size selection in future stroke trials testing PCSK9 inhibitors.

Risk factors for intracranial atherosclerosis: A systematic review and meta-analysis

BACKGROUND AND AIMS

Intracranial atherosclerosis (ICAS) is a predictable and preventable condition, but existing evidence concerning its risk factors has not been quantitatively assessed. The aim of this meta-analysis is to identify the non-modifiable and modifiable risk factors for ICAS.

METHODS

PubMed and EMBASE were searched (1995-May 15, 2018) for cross-sectional and longitudinal studies exploring risk factors for ICAS. The risk estimates and 95% confidence intervals (CIs) in multivariate analysis were aggregated using random-effect models.

RESULTS

Thirty-four studies comprising 59,736 subjects met the inclusion criteria for the systematic review involving thirty-one risk or protective factors. Seven factors were associated with ICAS, as suggested by the meta-analysis, including advanced age (odds ratio (OR) 1.05, 95% CI 1.03-1.08), metabolic syndrome (OR 2.13, 95% CI 1.35-3.37), diabetes mellitus (OR 1.98, 95% CI 1.69-2.31), hypertension (OR 1.97, 95% CI 1.69-2.31), dyslipidemia (OR 1.29, 95% CI 1.04-1.59), high levels of low-density lipoprotein cholesterol (OR 1.06, 95% CI 1.00-1.12) and high levels of apolipoprotein A1 (OR 0.34, 95% CI 0.15-0.75). The subgroup analysis for study populations indicated advanced age, metabolic syndrome, diabetes mellitus and hypertension as an elevated risk of ICAS among community subjects and stroke patients; according to the subgroup analysis for ethnicity, similar associations remained in Asians, but only metabolic syndrome and diabetes mellitus were correlated with ICAS in Caucasians.

CONCLUSIONS

Individuals with advanced age, metabolic syndrome, diabetes mellitus, hypertension and dyslipidemia might have a higher risk of ICAS, whereas high levels of apolipoprotein A1 might protect against ICAS.