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Gou L, Li H, Jiang Y, Liu Y, Gu H, Xu Z, Jin W, Li L, Shi Y, Zhang J, Fang Z, Meng X, Jiang Y, Li H, Wang Y, Cheng S. Non-O blood types are associated with a greater risk of large artery atherosclerosis stroke and dysregulation of cholesterol metabolism: an observational study. Lipids Health Dis 2024; 23:211. [PMID: 38965603 PMCID: PMC11223365 DOI: 10.1186/s12944-024-02199-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Previous research on ABO blood types and stroke has been controversial, predominantly suggesting heightened risk of stroke in non-O blood types. Nonetheless, investigations into the correlation and underlying mechanisms between ABO blood groups and stroke subtypes, especially within Chinese cohorts, remain limited. METHODS The ABO blood types of 9,542 ischaemic stroke (IS) patients were inferred using two ABO gene loci (c.261G > del; c.802G > A). The healthy population was derived from the 1000 Genomes Project. Patients were classified by the causative classification system (CCS). Volcano plot and gene ontology (GO) analysis were employed to explore protein differential expression among blood types. Additionally, HT29 and SW480 cell lines with downregulated ABO expression were generated to evaluate its impact on cholesterol uptake and efflux. RESULTS A greater proportion of stroke patients had non-O blood types (70.46%) than did healthy individuals (61.54%). Notable differences in blood type distributions were observed among stroke subtypes, with non-O blood type patients mainly classified as having large artery atherosclerosis (LAA). Clinical baseline characteristics, such as the low-density lipoprotein cholesterol level, activated partial thromboplastin time and thrombin time, varied significantly among blood types. A volcano plot revealed 17 upregulated and 42 downregulated proteins in the O blood type. GO term analysis indicated that downregulated proteins were primarily associated with lipid metabolism pathways. In vitro experiments revealed that reducing ABO gene expression decreased cholesterol uptake and increased cholesterol efflux. CONCLUSIONS This study revealed that the non-O blood type increased the risk of LAA stroke through cholesterol metabolism.
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Affiliation(s)
- Lan Gou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haowen Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhe Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weina Jin
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lanxin Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanfeng Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Changping Laboratory, Beijing, China.
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China.
| | - Si Cheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Center of excellence for Omics Research (CORe), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Changping Laboratory, Beijing, China.
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China.
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Sterenstein A, Garg R. The impact of sex on epidemiology, management, and outcome of spontaneous intracerebral hemorrhage (sICH). J Stroke Cerebrovasc Dis 2024; 33:107755. [PMID: 38705497 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107755] [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: 10/30/2023] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE Data on sex differences in spontaneous intracerebral hemorrhages are limited. METHODS An automated comprehensive scoping literature review was performed using PubMed and Scopus. Articles written in English about spontaneous intracerebral hemorrhage and sex were reviewed. RESULTS Males experience spontaneous intracerebral hemorrhage more frequently than females, at younger ages, and have a higher prevalence of deep bleeds compared to females. Risk factors between sexes vary and may contribute to differing incidences and locations of spontaneous intracranial hemorrhage. Globally, females receive less aggressive care than males, likely impacting survival. CONCLUSIONS Epidemiology, risk factors, and treatment of spontaneous intracranial hemorrhage vary by sex, with limited and oftentimes conflicting data available. Further research into the sex-based differences of spontaneous intracranial hemorrhage is necessary for clinicians to better understand how to evaluate and guide treatment in the future.
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Affiliation(s)
- Andrea Sterenstein
- Rush University Medical Center, Division of Critical Care Neurology, Department of Neurological Sciences.
| | - Rajeev Garg
- Rush University Medical Center, Division of Critical Care Neurology, Department of Neurological Sciences
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Winardi W, Moi SH, Winardi T, Cheng YW, Chen PY, Lin CK. Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:939. [PMID: 38929556 PMCID: PMC11205390 DOI: 10.3390/medicina60060939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Although statins are recommended for secondary prevention of acute ischemic stroke, some population-based studies and clinical evidence suggest that they might be used with an increased risk of intracranial hemorrhage. In this nested case-control study, we used Taiwan's nationwide universal health insurance database to investigate the possible association between statin therapy prescribed to acute ischemic stroke patients and their risk of subsequent intracerebral hemorrhage and all-cause mortality in Taiwan. Materials and Methods: All data were retrospectively obtained from Taiwan's National Health Insurance Research Database. Acute ischemic stroke patients were divided into a cohort receiving statin pharmacotherapy and a control cohort not receiving statin pharmacotherapy. A 1:1 matching for age, gender, and index day, and propensity score matching was conducted, producing 39,366 cases and 39,366 controls. The primary outcomes were long-term subsequent intracerebral hemorrhage and all-cause mortality. The competing risk between subsequent intracerebral hemorrhage and all-cause mortality was estimated using the Fine and Gray regression hazards model. Results: Patients receiving statin pharmacotherapy after an acute ischemic stroke had a significantly lower risk of subsequent intracerebral hemorrhage (p < 0.0001) and lower all-cause mortality rates (p < 0.0001). Low, moderate, and high dosages of statin were associated with significantly decreased risks for subsequent intracerebral hemorrhage (adjusted sHRs 0.82, 0.74, 0.53) and all-cause mortality (adjusted sHRs 0.75, 0.74, 0.74), respectively. Conclusions: Statin pharmacotherapy was found to safely and effectively reduce the risk of subsequent intracerebral hemorrhage and all-cause mortality in acute ischemic stroke patients in Taiwan.
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Affiliation(s)
- William Winardi
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan;
- Department of Neurosurgery, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Sin-Hua Moi
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Medical Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | | | - Yu-Wen Cheng
- Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - Po-Yuan Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan;
- Department of Neurosurgery, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Cheng-Kai Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan;
- Department of Neurosurgery, E-Da Hospital, Kaohsiung 82445, Taiwan
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4
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Mhaimeed O, Burney ZA, Schott SL, Kohli P, Marvel FA, Martin SS. The importance of LDL-C lowering in atherosclerotic cardiovascular disease prevention: Lower for longer is better. Am J Prev Cardiol 2024; 18:100649. [PMID: 38576462 PMCID: PMC10992711 DOI: 10.1016/j.ajpc.2024.100649] [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] [Received: 11/15/2023] [Revised: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 04/06/2024] Open
Abstract
Cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cardiovascular disease (ASCVD) risk. An armamentarium of therapies to achieve robust and sustained reduction in LDL-C can reduce ASCVD risk. The gold standard for LDL-C assessment is ultracentrifugation but in routine clinical practice LDL-C is usually calculated and the most accurate calculation is the Martin/Hopkins equation. For primary prevention, consideration of estimated ASCVD risk frames decision making regarding use of statins and other therapies, and tools such as risk enhancing factors and coronary artery calcium enable tailoring of risk assessment and decision making. In patients with diabetes, lipid lowering therapy is recommended in most patients to reduce ASCVD risk with an opportunity to tailor therapy based on other risk factors. Patients with primary hypercholesterolemia and familial hypercholesterolemia (FH) with baseline LDL-C greater than or equal to 190 mg/dL are at elevated risk, and LDL-C lowering with high-intensity statin therapy is often combined with non-statin therapies to prevent ASCVD. Secondary prevention of ASCVD, including in patients with prior myocardial infarction or stroke, requires intensive lipid lowering therapy and lifestyle modification approaches. There is no established LDL-C level below which benefit ceases or safety concerns arise. When further LDL-C lowering is required beyond lifestyle modifications and statin therapy, additional medications include oral ezetimibe and bempedoic acid, or injectables such as PCSK9 monoclonal antibodies or siRNA therapy. A novel agent that acts independently of hepatic LDL receptors is evinacumab, which is approved for patients with homozygous FH. Other emerging agents are targeted at Lp(a) and CETP. In light of the expanding lipid treatment landscape, this manuscript reviews the importance of early, intensive, and sustained LDL-C-lowering for primary and secondary prevention of ASCVD.
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Affiliation(s)
- Omar Mhaimeed
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Zain A Burney
- Department of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Stacey L Schott
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Payal Kohli
- Department of Cardiology, University of Colorado Anschutz, Aurora, CO, United States
- Department of Cardiology, Veterans Affairs Hospital, Aurora, CO, United States
- Cherry Creek Heart, Aurora, CO, United States
- Tegna Broadcasting, MD, United States
| | - Francoise A Marvel
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Seth S Martin
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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5
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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6
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Nasso G, Vignaroli W, Amodeo V, Bartolomucci F, Larosa C, Contegiacomo G, Demola MA, Girasoli C, Valenzano A, Fiore F, Bonifazi R, Triggiani V, Vitobello V, Errico G, Lamanna A, Hila D, Loizzo T, Franchino R, Sechi S, Valenti G, Diaferia G, Brigiani MS, Arima S, Angelelli M, Curcio A, Greco F, Greco E, Speziale G, Santarpino G. Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results. J Clin Med 2024; 13:2987. [PMID: 38792527 PMCID: PMC11121999 DOI: 10.3390/jcm13102987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study. Until December 2019, 100 patients optimized therapy with statin ± ezetimibe (SG). Since January 2020, 80 matched patients added treatment with Evolocumab every 2 weeks (EG). All 180 patients were followed-up at 3 and 12 months, comparing outcomes. Results: The two groups are homogenous. At 3 months and 1 year, a significant decrease in the parameter mean levels of LDL cholesterol and total cholesterol is detected in the Evolocumab group compared to the standard group. No mortality was detected in either group. No complications or drug discontinuation were recorded. In the SG group, five patients (5%) suffered a myocardial infarction during the 1-year follow-up. In the EG group, two patients (2.5%) underwent PTCA due to myocardial infarction. There is no significant difference in overall survival according to the new treatment (p-value = 0.9), and the hazard ratio is equal to 0.94 (95% C.I.: [0.16-5.43]; p-value = 0.9397). Conclusions: The use of Evolocumab, which was started immediately after coronary artery bypass graft surgery, significantly reduced LDL cholesterol and total cholesterol levels compared to statin treatment alone and is completely safe. However, at one year of follow-up, this result did not have impact on the reduction in major clinical events.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Walter Vignaroli
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Vincenzo Amodeo
- Department of Cardiology, “Santa Maria degli Ungheresi” Hospital, 89024 Polistena, Italy;
| | - Francesco Bartolomucci
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Claudio Larosa
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Gaetano Contegiacomo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Maria Antonietta Demola
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Cataldo Girasoli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Antongiulio Valenzano
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Flavio Fiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Raffaele Bonifazi
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Vera Triggiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Vincenza Vitobello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Giacomo Errico
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Angela Lamanna
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Dritan Hila
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Tommaso Loizzo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Rosalba Franchino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Stefano Sechi
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Giovanni Valenti
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Giuseppe Diaferia
- Department of Cardiology, “M. Di Miccoli” Hospital, 70051 Barletta, Italy;
| | - Mario Siro Brigiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Serena Arima
- Department of Human and Social Sciences Unisalento, University of Salento, 73100 Lecce, Italy; (S.A.); (M.A.)
| | - Mario Angelelli
- Department of Human and Social Sciences Unisalento, University of Salento, 73100 Lecce, Italy; (S.A.); (M.A.)
| | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Science, University of Calabria, 87036 Rende, Italy;
| | - Francesco Greco
- Department of Cardiology, “Santissima Annunziata” Hospital, 87100 Cosenza, Italy;
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany
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7
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Lee TC, Leung WC, Ho C, Chiu MW, Leung IY, Wong YK, Roxanna LK, Sum CH, Lui DT, Cheung RT, Leung GK, Chan KH, Teo KC, Lau KK. Association of LDL-cholesterol <1.8 mmol/L and statin use with the recurrence of intracerebral hemorrhage. Int J Stroke 2024:17474930241239523. [PMID: 38429252 DOI: 10.1177/17474930241239523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND Recent intensive low-density lipoprotein cholesterol (LDL-C) lowering trials, including FOURIER, ODYSSEY OUTCOMES, and Treat Stroke to Target (TST) trials, have mostly refuted the concern surrounding statin use, LDL-C lowering, and intracerebral hemorrhage (ICH) risk. However, the results from these trials may not be fully applied to ICH survivors, as the populations studied were mainly patients without prior ICH, in whom the inherent ICH risk is more than 10 times lower than that of ICH survivors. Although available literature on statin use after ICH has demonstrated no excess risk of recurrent ICH, other potential factors that may modify ICH risk, especially hypertension control and ICH etiology, have not generally been considered. Notably, data on LDL-C levels following ICH are lacking. AIMS We aim to investigate the association between LDL-C levels and statin use with ICH risk among ICH survivors, and to determine whether the risk differed with patients' characteristics, especially ICH etiology. METHODS Follow-up data of consecutive spontaneous ICH survivors enrolled in the University of Hong Kong prospective stroke registry from 2011 to 2019 were retrospectively analyzed. ICH etiology was classified as cerebral amyloid angiopathy (CAA) using the modified Boston criteria or hypertensive arteriopathy, while the mean follow-up LDL-C value was categorized as <1.8 or ⩾1.8 mmol/L. The primary endpoint was recurrent ICH. The association of LDL-C level and statin use with recurrent ICH was determined using multivariable Cox regression. Pre-specified subgroup analyses were performed, including based on ICH etiology and statin prescription. Follow-up blood pressure was included in all the regression models. RESULTS In 502 ICH survivors (mean age = 64.2 ± 13.5 years, mean follow-up LDL-C = 2.2 ± 0.6 mmol/L, 28% with LDL-C <1.8 mmol/L), 44 had ICH recurrence during a mean follow-up of 5.9 ± 2.8 years. Statin use after ICH was not associated with recurrent ICH (adjusted hazard ratio (AHR) = 1.07, 95% confidence interval (CI) = 0.57-2.00). The risk of ICH recurrence was increased for follow-up LDL-C <1.8 mmol/L (AHR = 1.99, 95% CI = 1.06-3.73). This association was predominantly observed in ICH attributable to CAA (AHR = 2.52, 95% CI = 1.06-5.99) and non-statin users (AHR = 2.91, 95% CI = 1.08-7.86). CONCLUSION The association between post-ICH LDL-C <1.8 mmol/L and recurrent ICH was predominantly observed in CAA patients and those with intrinsically low LDL-C (non-statin users). While statins can be safely prescribed in ICH survivors, LDL-C targets should be individualized and caution must be exercised in CAA patients.
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Affiliation(s)
- Tsz-Ching Lee
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - William Cy Leung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chun Ho
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Megan Wl Chiu
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ian Yh Leung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Liu Kc Roxanna
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christopher Hf Sum
- Division of Neurosurgery, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - David Tw Lui
- Division of Endocrinology & Metabolism, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Raymond Tf Cheung
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gilberto Kk Leung
- Division of Neurosurgery, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kay-Cheong Teo
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kui-Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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8
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Zeinalabedini M, Ladaninezhad M, Mobarakeh KA, Hoshiar-Rad A, Shekari S, Askarpour SA, Ardekanizadeh NH, Esmaeili M, Abdollahi M, Doaei S, Khoshdooz S, Ajami M, Gholamalizadeh M. Association of dietary fats with ischemic heart disease (IHD): a case-control study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:19. [PMID: 38303014 PMCID: PMC10832209 DOI: 10.1186/s41043-023-00489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study aimed to investigate the association between different types of dietary fats with ischemic heart disease (IHD). METHODS This case-control study was conducted on 443 cases and 453 controls aged 40-80 years in Tehran, Iran. The semi-quantitative 237-item food frequency questionnaire (FFQ) was used to assess the amount of food intake. Nutritionist IV was applied to test the amount of consumption of dietary fats. RESULTS The case group had a lower intake of docosahexaenoic acid (DHA) (11.36 ± 12.58 vs. 14.19 ± 19.57, P = 0.01) than the control group. A negative association was found between IHD and DHA (OR 0.98, CI 95% 0.97-0.99, P = 0.01). No significant association was observed between IHD with the intake of cholesterol, trans fatty acids (TFA), saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), eicosatetraenoic acid (EPA), and α-Linolenic acid (ALA). CONCLUSION It was found that DHA may reduce the risk of IHD, whereas there was no significant association between other types of dietary fats with the odds of IHD. If the results of this study are confirmed in future research, a higher intake of DHA in diet can be recommended as a strategy to prevent IHD events.
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Affiliation(s)
- Mobina Zeinalabedini
- Department of Community Nutrition, School of Nutritional Sciences and dietetic, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ladaninezhad
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Abbasi Mobarakeh
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan, Iran
| | - Anahita Hoshiar-Rad
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Shekari
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Ali Askarpour
- Division of Food Safety and Hygiene, Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mina Esmaeili
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Abdollahi
- Social Determinants of Health Research Center, and National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Doaei
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Marjan Ajami
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Gholamalizadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Helven C, Burel J, Vannier M, Maltête D, Ozkul-Wermester O, Hermary C, Wallon D, Grangeon L. Impact of previous statin use on first intracerebral hemorrhage in cerebral amyloid angiopathy. Rev Neurol (Paris) 2023; 179:1074-1080. [PMID: 37598087 DOI: 10.1016/j.neurol.2023.02.071] [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: 10/23/2022] [Revised: 01/29/2023] [Accepted: 02/25/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES Statins have been associated with an increased risk of spontaneous intracerebral hemorrhage (ICH), but without dedicated study in cerebral amyloid angiopathy (CAA). We aimed to evaluate the association between previous statin treatment and radiological hemorrhagic lesions in a CAA population during a first lobar ICH event. MATERIALS AND METHODS We retrospectively included all patients meeting the modified Boston criteria for probable CAA and admitted for a first lobar ICH between 2010 and 2021 at Rouen University Hospital. Patients were classified as having previous statin treatment or not. We compared the ICH volume, the number of associated cerebral microbleeds (CMBs), and cortical superficial siderosis (CSS) according to previous statin treatment or not. We also compared functional outcomes and ICH recurrence during the follow-up period between the two groups. RESULTS We included 99 patients, 27 of whom had statin treatment prior to their ICH. The ICH volume and the number of CMBs did not differ between groups. Disseminated CSS was initially more frequent in the statin group (88% versus 57%; P=0.019), but this was no longer significant after adjustment for antiplatelet treatment (P=0.13). The long-term outcome was similar between the two groups with no increased risk of ICH recurrence in the statin-treated group (29.63% versus 23.61%, P=0.54). CONCLUSIONS Previous statin treatment was not associated with more severe hemorrhagic lesions in CAA in terms of ICH volume or number of microbleeds, but a trend for increased disseminated CSS was highlighted, which will require further larger studies.
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Affiliation(s)
- C Helven
- Department of Neurology, Rouen University Hospital, 76000 Rouen, France.
| | - J Burel
- Department of Radiology, Rouen University Hospital, 76000 Rouen, France
| | - M Vannier
- Department of Biostatistics, University of Rouen, Rouen University Hospital, 76000 Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, 76000 Rouen, France
| | - O Ozkul-Wermester
- Department of Neurology, Rouen University Hospital, 76000 Rouen, France
| | - C Hermary
- Department of Radiology, Rouen University Hospital, 76000 Rouen, France
| | - D Wallon
- Department of Neurology, Rouen University Hospital, 76000 Rouen, France; Inserm U1245, CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Department of Neurology, CHU of Rouen, University of Rouen Normandie, 76000 Rouen, France
| | - L Grangeon
- Department of Neurology, Rouen University Hospital, 76000 Rouen, France; Inserm U1245, CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Department of Neurology, CHU of Rouen, University of Rouen Normandie, 76000 Rouen, France
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10
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Zaryczańska K, Pawlukowska W, Nowacki P, Zwarzany Ł, Bagińska E, Kot M, Masztalewicz M. Statins and 90-Day Functional Performance and Survival in Patients with Spontaneous Intracerebral Hemorrhage. J Clin Med 2023; 12:6608. [PMID: 37892746 PMCID: PMC10607334 DOI: 10.3390/jcm12206608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The neuroprotective effect of statins has become a focus of interest in spontaneous intracerebral hemorrhage (sICH). The purpose of this study was: (1) to evaluate the effect of statin use by the analyzed patients with sICH in the period preceding the onset of hemorrhage on their baseline neurological status and baseline neuroimaging of the head; (2) to evaluate the effect of statin use in the acute period of hemorrhage on the course and prognosis in the in-hospital period, taking into account whether the statin was taken before the hemorrhage or only after its onset; (3) to evaluate the effect of continuing statin treatment after in-hospital treatment on the functional performance and survival of patients up to 90 days after the onset of sICH symptoms, taking into account whether the statin was taken before the onset of sICH. MATERIAL AND METHODS A total of 153 patients diagnosed with sICH were analyzed, where group I were not previously taking a statin and group II were taking a statin before sICH onset. After lipidogram assessment, group I was divided into patients without dyslipidemia and without statin treatment (Ia) and patients with dyslipidemia who received de novo statin treatment during hospitalization (Ib). Group II patients continued taking statin therapy. We evaluated the effect of prior statin use on the severity of hemorrhage; the effect of statin use during the acute period of sICH on its in-hospital course; and the effect of statin treatment on the severity of neurological deficit, functional capacity and survival of patients up to 90 days after the onset of sICH symptoms. RESULTS There was no effect of prior statin use on the severity of hemorrhage as assessed clinically and by neuroimaging of the head. At in-hospital follow-up, subgroup Ia was the least favorable in terms of National Institutes of Health Stroke Scale (NIHSS) score. This subgroup had the highest percentage of deaths during hospitalization. In the post-hospital period, the greatest number of patients with improvement in the NIHSS, modified Rankin Scale (mRS) and Barthel scales were among those taking statins, especially group II patients. At 90-day follow-up, survival analysis fell significantly in favor of subgroup Ib and group II. CONCLUSIONS 1. The use of statins in the pre-sICH period did not adversely affect the patients' baseline neurological status or the results of baseline neuroimaging studies. 2. Continued statin therapy prior to the onset of sICH or the inclusion of statins in acute treatment in patients with sICH and dyslipidemia does not worsen the course of the disease and the in-hospital prognosis. Statin therapy should not be discontinued during the acute phase of sICH. 3. To conclude the eventual beneficial effect on the functional performance and survival of patients after sICH onset, comparability of the analyzed groups in terms of clinical, radiological and other prognostic factors in spontaneous intracerebral hemorrhage would be needed. Future studies are needed to confirm these findings.
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Affiliation(s)
- Karolina Zaryczańska
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (W.P.); (P.N.); (M.M.)
| | - Wioletta Pawlukowska
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (W.P.); (P.N.); (M.M.)
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (W.P.); (P.N.); (M.M.)
| | - Łukasz Zwarzany
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, 71-252 Szczecin, Poland;
| | - Ewelina Bagińska
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (W.P.); (P.N.); (M.M.)
| | - Monika Kot
- Independent Researcher, 71-004 Szczecin, Poland;
| | - Marta Masztalewicz
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland; (W.P.); (P.N.); (M.M.)
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11
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Wretlind A, Curovic VR, Suvitaival T, Theilade S, Tofte N, Winther SA, Vilsbøll T, Vestergaard H, Rossing P, Legido-Quigley C. Ceramides as Risk Markers for Future Cardiovascular Events and All-Cause Mortality in Long-standing Type 1 Diabetes. Diabetes 2023; 72:1493-1501. [PMID: 37478203 PMCID: PMC10545556 DOI: 10.2337/db23-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Ceramides are lipid molecules involved in inflammation-related signaling. Recent studies have shown that higher amounts of specific circulating ceramides and their ratios are associated with future development of cardiovascular (CV) disease (CVD). We examined the associations between serum ceramide levels with CVD, kidney failure, and all-cause mortality in individuals with long-standing type 1 diabetes (T1D). We included 662 participants with T1D and 6-year follow-up, with a mean age of 55 years and mean diabetes duration of 33 years. Baseline serum samples were analyzed using liquid chromatography-mass spectrometry. Six predefined ceramide levels were measured, and predefined ratios were calculated. Adjusted Cox regression analyses on ceramide levels in relation to future CV events (CVE), kidney failure, and all-cause mortality were performed, with and without adjustment for age, sex, BMI, LDL, triglycerides, systolic blood pressure, HbA1c, history of CVD, smoking status, statin use, estimated glomerular filtration rate (eGFR), and urinary albumin excretion rate (UAER). The ceramide ratio cer(d18:1/18:0)/cer(d18:1/24:0) was significantly associated with risk of CVE (hazard ratio [HR] = 1.33, P = 0.01) and all-cause mortality (HR = 1.48, P = 0.01) before and after adjustments. All five investigated ceramide ratios were associated with kidney failure, before adjusting for the kidney markers eGFR and UAER. In this study, we demonstrate specific ceramides and ratios associated with 6-year cardiovascular risk and all-cause mortality in a T1D cohort. This highlights the strength of ceramide association with vascular complications and presents a new potential tool for early risk assessment if validated in other cohorts. ARTICLE HIGHLIGHTS Improved tools for assessing risk for diabetes complication before onset will help in complication prevention. We investigated a set of six predefined ceramides and their ratios versus 6-year outcomes of cardiovascular events, kidney failure, and all-cause mortality in people with long-standing type 1 diabetes, using Cox regression with and without adjustment for potential confounders. We found that several ceramides and ceramide ratios associated with cardiovascular events and all-cause mortality. The ratio of cer(d18:1/18:0)/cer(d18:1/24:0) was an especially robust marker. These finding show that ceramides can be biomarkers of cardiovascular disease and all-cause mortality in individuals with long-standing type 1 diabetes.
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Affiliation(s)
- Asger Wretlind
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | | | - Simone Theilade
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Herlev-Gentofte Hospital, Herlev, Denmark
| | | | | | | | - Henrik Vestergaard
- University of Copenhagen, Copenhagen, Denmark
- Bornholms Hospital, Rønne, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- University of Copenhagen, Copenhagen, Denmark
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12
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Goldstein LB, Toth PP, Dearborn-Tomazos JL, Giugliano RP, Hirsh BJ, Peña JM, Selim MH, Woo D. Aggressive LDL-C Lowering and the Brain: Impact on Risk for Dementia and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol 2023; 43:e404-e442. [PMID: 37706297 DOI: 10.1161/atv.0000000000000164] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The objective of this scientific statement is to evaluate contemporary evidence that either supports or refutes the conclusion that aggressive low-density lipoprotein cholesterol lowering or lipid lowering exerts toxic effects on the brain, leading to cognitive impairment or dementia or hemorrhagic stroke. The writing group used literature reviews, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion to summarize existing evidence and to identify gaps in current knowledge. Although some retrospective, case control, and prospective longitudinal studies suggest that statins and low-density lipoprotein cholesterol lowering are associated with cognitive impairment or dementia, the preponderance of observational studies and data from randomized trials do not support this conclusion. The risk of a hemorrhagic stroke associated with statin therapy in patients without a history of cerebrovascular disease is nonsignificant, and achieving very low levels of low-density lipoprotein cholesterol does not increase that risk. Data reflecting the risk of hemorrhagic stroke with lipid-lowering treatment among patients with a history of hemorrhagic stroke are not robust and require additional focused study.
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13
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Tian Z, Liu M, Zhang Z, Yan T, Guo S, Miao Y, Wang J, Zhang R, Bi Y, Zhang N, Zhang X. Association between intracerebral hemorrhage and cholesterol levels, and molecular mechanism underlying low cholesterol inhibiting autophagy in cerebral arterial smooth muscle cells leading to cell necrosis. Int J Cardiol 2023; 387:131134. [PMID: 37355236 DOI: 10.1016/j.ijcard.2023.131134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND An association between cholesterol and intracerebral hemorrhage (ICH) has been reported, but the mechanism is unclear. METHODS In this cross-sectional study, participants aged 50-75 years were selected using multistage stratified cluster sampling. All samples completed a questionnaire (age, gender, medication, etc.) and were examined (blood lipid, height, blood pressure, etc.) for risk factors. Multivariable logistic regression was used to analyze the association between cholesterol levels and ICH risk, after adjusting for age, smoking, hypertension, and other factors. We cultured rat cerebral artery smooth muscle cells at different cholesterol concentrations. The autophagy pathway was identified by transcriptome sequencing. The results were then validated using real-time polymerase chain reaction and western blot. RESULTS We included 39,595 patients, among whom 286 had ICH. The study showed that a low level of low-density lipoprotein cholesterol (LDL-C) was a risk factor of ICH (odds ratio 2.912, 95% confidence interval 1.460-5.806; P = 0.002). Cell experiments showed that lower cholesterol levels could significantly induce rat cerebral artery smooth muscle cell necrosis. In low-cholesterol groups, expression of the autophagy marker LC3 protein was significantly decreased and p62 protein was significantly increased. In western blot and comparison with the control group, the low cholesterol PI3K/Akt/mTOR signaling pathway was significantly activated in the autophagy pathway, resulting in its inhibition, which in turn led to smooth muscle cell death. CONCLUSION Low cholesterol levels may inhibit autophagy through PI3K/Akt/mTOR signaling and induce arterial smooth muscle cell necrosis, thereby increasing the risk of ICH.
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Affiliation(s)
- Zixuan Tian
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Min Liu
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Ziying Zhang
- School of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Tao Yan
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Shuyi Guo
- People's Hospital of Inner Mongolia Autonomous Region, Hohhot, China
| | - Yu Miao
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Jingyu Wang
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Ru Zhang
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Yanqing Bi
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Nan Zhang
- School of Public Health, Inner Mongolia Medical University, Hohhot, China.
| | - Xingguang Zhang
- School of Public Health, Inner Mongolia Medical University, Hohhot, China.
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14
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Shridharan P, Nair R, Gorthi SP, Prakashini K, Chatterjee A. Effects of Serum Cholesterol on Severity of Stroke and Dosage of Statins on Functional Outcome in Acute Ischemic Stroke. Neurol India 2023; 71:923-927. [PMID: 37929428 DOI: 10.4103/0028-3886.388115] [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] [Indexed: 11/07/2023]
Abstract
Background A high dose of statin is used to obtain an intensive lipid-lowering in stroke patients, even in patients with normal lipid levels. There are limited data on effect of dosage of statins and functional outcome in stroke patients. Objectives To compare serum cholesterol levels with severity of stroke measured by infarct volume. To compare functional outcome measured by mRS at day 90 with the dose of statin. Materials and Methods This retrospective observational study was conducted in KMC Hospital Manipal, India between 2016 and 2018. Result A total of 100 consecutive patients were included in the study, out of which 60 (60.0%) were males. Hyperlipidemia was present in 65 (65.0%) patients. On comparing the serum cholesterol levels with infarct volume using MRI, patients with low volume of ≤70 ml had higher mean serum total cholesterol concentration (223.83 mg/dl), whereas patients with high volume of >70 ml had low mean cholesterol level (218.70 mg/dl). The patients were divided into those who received low dose (≤20 mg) versus high dose (≥40 mg equivalent) of Atorvastatin. On comparing the mRS values at baseline and on day 90 with the dose of statins, patients who received a higher dosage had a statistically significant fall in mRS (p-0.045) at day 90. Conclusion It was found that serum cholesterol levels were inversely related to the stroke severity. However, a higher the dose of statins resulted in better functional outcome and survival in post-stroke patients, possibly due to its neuroprotective effect.
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Affiliation(s)
| | - Radhika Nair
- Department of Neurology, KMC, Manipal, Karnataka, India; Clinical Fellow, Stroke and Cerebrovascular Diseases, University of Alberta, Edmonton, AB, Canada
| | - Sankar P Gorthi
- Department of Neurology, Bharati Vidhya Peeth (DTU), Medical College and Hospital, Pune, Maharashtra, India
| | - K Prakashini
- Department of Radiodiagnosis, KMC, Manipal, Karnataka, India
| | - Aparajita Chatterjee
- Department of Neurology, Fortis Hospital, Anandapur, Kolkata, West Bengal, India
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15
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Dopler B. Stroke Prevention. Dela J Public Health 2023; 9:6-10. [PMID: 37701472 PMCID: PMC10494800 DOI: 10.32481/djph.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Stroke has three main subtypes - ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The most common stroke subtype is ischemic stroke, making up about 88% of strokes. Many of these strokes may be prevented by lifestyle modifications. These lifestyle modifications include engaging in physical activity, dietary changes such as the Mediterranean diet, smoking cessation, and avoiding substance abuse. Addressing medical conditions such as diabetes, hypertension, lipid management, sleep apnea, and atrial fibrillation will also have a major impact on stroke prevention. In addition to stroke prevention, these strategies help with overall brain health, which may also have an impact on neurological degenerative diseases such as Alzheimer's disease.
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Affiliation(s)
- Bruce Dopler
- Neurologist, Neurology Center of South Delaware; Tidal Health Nanticoke
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Qin H, Yang F, Zhao H, Zhao J, Lin S, Shang Y, Zhang C, Hao P, Zhang X. Associations of lipids and lipid-lowering drugs with risk of stroke: a Mendelian randomization study. Front Neurol 2023; 14:1185986. [PMID: 37528862 PMCID: PMC10390065 DOI: 10.3389/fneur.2023.1185986] [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] [Received: 03/14/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Background Stroke is a leading cause of death worldwide, but it is unclear whether circulating lipids and lipid-lowering drugs are causally associated with stroke and its subtypes. Methods We used two-sample Mendelian randomization (MR) to examine the effects of blood lipids and lipid-lowering drugs on stroke and its subtypes. Results The inverse variance weighted Mendelian randomization (IVW-MR) revealed the low-density lipoprotein cholesterol (LDL-C) (OR, 1.46; 95% CI, 1.17-1.83; p = 0.0008) and apolipoprotein B (apoB) (OR, 1.46; 95% CI, 1.21-1.77; p = 0.0001) was positively correlated with large artery stroke (LAS). However, no causal effect was found in LDL-C and apoB on LAS risk when we conducted mvMR. The IVW-MR also found a suggestive evidence that decreased LDL-C levels mediated by the PCSK9 (proprotein convertase subtilisin-kexin type 9) gene were associated with a reduced risk of any stroke (AS) (OR, 1.31; 95% CI, 1.13-1.52; p = 0.0003), any ischemic stroke (AIS) (OR, 1.29; 95% CI, 1.10-1.51; p = 0.001), and LAS (OR, 1.73; 95% CI, 1.15-2.59; p = 0.008), while NPC1L1 (Niemann-Pick C1-like protein)-mediated LDL-C levels were associated with a higher risk of small vessel stroke (SVS) (OR, 6.10; 95% CI, 2.13-17.43; p = 0.0008). The SMR revealed that expression of PCSK9 was associated with risk of AS (OR, 1.15; 95% CI, 1.03-1.28; p = 0.01), AIS (OR, 1.02; 95% CI, 1.14-1.29; p = 0.03), cardioembolic stroke (CES) (OR, 1.28; 95% CI, 1.01-1.61; p = 0.04). And, a significant association was found between the expression of NPC1L1 and the risk of SVS (OR, 1.15; 95% CI, 1.00-1.32; p = 0.04). Conclusion We cautiously find that LDL-C and apoB was positively correlated with LAS. These findings suggest that the reducing LDL-C levels could be an effective prevention strategy for reducing the risk of stroke.
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Affiliation(s)
- Hao Qin
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Fan Yang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, China
| | - Haitao Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinchuan Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Siyuan Lin
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yinshuai Shang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Chaoling Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Pengfei Hao
- Department of Neurosurgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Xianfeng Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Menon G, Macharla A, Srinivasan S, Santosh S, Pai A, Nair R, Hegde A. Spontaneous Intracerebral Hemorrhage in the Young: An Institutional Registry Analysis. Ann Indian Acad Neurol 2023; 26:502-506. [PMID: 37970280 PMCID: PMC10645210 DOI: 10.4103/aian.aian_76_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 11/17/2023] Open
Abstract
Background Spontaneous intracerebral hemorrhage (SICH) accounts for about 10-15% of all strokes. Generally, it is a disease of the elderly; worldwide, the incidence of SICH in the young is showing an increasing trend, especially in India and the Asian continent. An attempt is also made to analyze the presence of factors, which may predict the risk of SICH among young hypertensives. Methods A six-year retrospective review of patients aged below 50 years who presented with SICH was included in the study. Patients with bleeds secondary to an identifiable cause such as tumor, trauma, vascular malformations, and coagulopathy-induced bleeds were excluded from the study. The outcome was measured at 90 days using the modified ranking scale, and predictors of outcome (good outcome modified ranking score (mRS): 0-3; poor outcome mRS: 4-6) were analyzed. Results SICH in the young accounted for 28.4% of all intracerebral hemorrhage (ICH) patients admitted during the study period (344/1210). The mean age of our male-dominant (78.5%) cohort was 42.9 ± 6.24 years, and the median Glasgow coma score (GCS) on presentation was 11 (IQR: 8-14). A prior history of hypertension (HTN) was obtained in 51.2% (176), and left ventricular hypertrophy (LVH) was documented in 237 (68.9%) patients. The basal ganglia was the most common location of the bleed (62.2%). At 90 days, 200 patients (58.1%) had good outcome and 144 (41.9%) had poor outcome with an overall mortality of 75 (21.8%). Independent predictors of poor outcome were poor GCS, larger volume, and high serum creatinine values. Conclusion The incidence of SICH among the young accounts for nearly 30% of admitted ICH. Poor outcome and mortality are high with HTN being the single most important modifiable risk factor in the cohort.
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Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Aparna Macharla
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sonin Santosh
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Iwasa K, Onoda K, Takamura M, Takayoshi H, Mitaki S, Yamaguchi S, Nagai A. Development of a stroke risk score with MRI asymptomatic brain lesions attributes to evaluate prognostic vascular events. J Neurol Sci 2023; 448:120642. [PMID: 37030186 DOI: 10.1016/j.jns.2023.120642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The use of a combination of stroke predictors, such as clinical factors and asymptomatic lesions on brain magnetic resonance imaging (MRI), may improve the accuracy of stroke risk prediction. Therefore, we attempted to develop a stroke risk score for healthy individuals. METHODS We investigated the presence of cerebral stroke in 2365 healthy individuals who underwent brain dock screening at the Health Science Center in Shimane. We examined the factors that contributed to stroke and attempted to determine the risk of stroke by comparing background factors and MRI findings. RESULTS The following items were found to be significant risk factors for stroke: age (≥60 years), hypertension, subclinical cerebral infarction, deep white matter lesion, and microbleeds. Each item was scored with 1 point, and the hazard ratios for the risk of developing stroke based on the group with 0 points were 17.2 (95% confidence interval [CI] 2.31-128) for 3 points, 18.1 (95% CI 2.03-162) for 4 points, and 102 (95% CI 12.6-836) for 5 points. CONCLUSIONS A precise stroke prediction score biomarker can be obtained by combining MRI findings and clinical factors.
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Affiliation(s)
- Kenichi Iwasa
- Department of Neurology, Faculty of Medicine, Shimane University, Japan.
| | - Keiichi Onoda
- Department of Psychology, Faculty of Psychology, Otemon Gakuin University, Japan
| | - Masahiro Takamura
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
| | | | - Shingo Mitaki
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
| | - Shuhei Yamaguchi
- Department of Neurology, Shimane Prefectural Central Hospital, Japan
| | - Atsushi Nagai
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
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KOCATÜRK İ, GÜLTEN S. Immature granulocyte and other markers in prediction of mortality in spontaneous intracerebral hemorrhage. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1225428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: This study aims to evaluate immature granulocyte count (IG#) and percentage (IG%) in the prediction of mortality in spontaneous intracerebral hemorrhage (SICH).
Material and Method: Demographic characteristics and laboratory test results of patients diagnosed with SICH and admitted to the neurology clinic in a tertiary hospital between January 1, 2020, and January 1, 2022, were recorded. One hundred ten patients were included in the study. While 80 of these patients constituted the group that recovered after treatment, 30 of them formed the group that died despite treatment. IG and other laboratory and clinic parameters were statistically compared in both groups.
Results: Of 110 patients, 45 (42.7%) were female, and 65 (57.3%) were male. IG counts were higher in the non-survival group than in the survival group (p=0.001). When the patients were divided according to low IG% (=0.6), 30 patients were in the high IG# group, and 80 patients were in the low IG% group. White blood cell (WBC), neutrophil count (NEUT#), monocyte count (MONO#), IG#, neutrophil-lymphocyte ratio (NLR), and hemorrhage volume (HV) values were statistically significantly higher in the high IG% group than in the low IG% group; Glasgow coma score (GCS) and percentage of lymphocytes (LYMPH%) values were significantly lower too. In addition, the mortality rate in the high IG# group was significantly higher than the mortality rate in the low IG% group (53.23% vs. 17.5%).
Conclusion: IG is a new, easily accessible, inexpensive, and promising marker for predicting in-hospital mortality in patients with SICH.
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Efremova D, Ciolac D, Zota E, Glavan D, Ciobanu N, Aulitzky W, Nics AM, Trinka E, Yamada C, Movila A, Groppa SA. Dissecting the Spectrum of Stroke Risk Factors in an Apparently Healthy Population: Paving the Roadmap to Primary Stroke Prevention. J Cardiovasc Dev Dis 2023; 10:35. [PMID: 36826531 PMCID: PMC9965290 DOI: 10.3390/jcdd10020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
We aimed to investigate, for the first time, the spectrum of stroke risk factors specific to the population of the Republic of Moldova. The subjects were examined according to a pre-established protocol of risk factor estimation. The study involved 300 subjects, including 60% women and 40% men, with a mean age of 49.9 ± 14.5 years. The most common risk factor was abdominal obesity, identified in 75% of subjects; general obesity was detected in 48%, while 32% of subjects were overweight and 20% were normally weighted. Hypertension was observed in 44%; 8% of those examined had atrial fibrillation, and 9% had diabetes mellitus. Left myocardial hypertrophy on ECG was present in 53% of subjects, and acute ischemic changes in 2%. Laboratory observations detected that glycosylated hemoglobin increased by 7%, and >50% had dyslipidemia. Total cholesterol was significantly elevated by 58%, LDL-cholesterol was increased by 32%, and HDL-cholesterol was decreased by 9%. Homocysteine was increased in 55% and high-sensitivity C-reactive protein in 28% of subjects. These results indicate the presence of modifiable risk factors and the necessity to elaborate on the primary prevention strategies aimed at minimizing the burden of stroke in the population of the Republic of Moldova.
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Affiliation(s)
- Daniela Efremova
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Eremei Zota
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Danu Glavan
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Natalia Ciobanu
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Wolfgang Aulitzky
- Open Medical Institute, American Austrian Foundation, 5020 Salzburg, Austria
| | - Anna Maria Nics
- Open Medical Institute, American Austrian Foundation, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria
| | - Chiaki Yamada
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Alexandru Movila
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Stanislav A. Groppa
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
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Cheng Y, Wang Q, Niu G, Luo C. Correlation of Atherosclerotic Dyslipidemia with Long-Term Stroke Recurrence in Patients Undergoing Intravenous Thrombolysis for Acute Ischemic Stroke. Int J Gen Med 2023; 16:1621-1629. [PMID: 37159580 PMCID: PMC10163887 DOI: 10.2147/ijgm.s407971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023] Open
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.
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Affiliation(s)
- Yuan Cheng
- Medical School, Fuyang Normal University, Fuyang, Anhui, People’s Republic of China
| | - Qingqing Wang
- Department of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, People’s Republic of China
| | - Guihong Niu
- Medical School, Fuyang Normal University, Fuyang, Anhui, People’s Republic of China
- Correspondence: Guihong Niu, Medical School, Fuyang Normal University, Fuyang, Anhui, 236300, People’s Republic of China, Email
| | - Chun Luo
- Department of Pediatric Surgery, Fuyang Women and Children’s Hospital, Fuyang, People’s Republic of China
- Chun Luo, Department of Pediatric Surgery, Fuyang Women and Children’s Hospital, Fuyang, Anhui, 236300, People’s Republic of China, Email
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22
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Li Z, Hui Y, Sha Z, Liu B, Wang C, Yang F, Zhang W, Gao C, Jiang R. Association between preadmission low‐density lipoprotein cholesterol concentration and risk of large intracerebral hemorrhage: Results from the Kailuan study. J Clin Lab Anal 2022; 36:e24787. [DOI: 10.1002/jcla.24787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/24/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Zhanying Li
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Tianjin Neurological Institute, Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System Tianjin Medical University General Hospital, Ministry of Education Tianjin China
- Department of Neurosurgery Kailuan General Hospital Tangshan China
| | - Ying Hui
- Department of Radiology, Beijing Friendship Hospital Capital Medical University Beijing China
| | - Zhuang Sha
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Tianjin Neurological Institute, Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System Tianjin Medical University General Hospital, Ministry of Education Tianjin China
| | - Bailu Liu
- Department of Rheumatology Kailuan General Hospital Tangshan China
| | - Chengbo Wang
- Department of Medical Imaging Kailuan General Hospital Linxi Hospital Tangshan China
| | - Feng Yang
- Department of neurosurgery North China University of Science and Technology Affiliated Hospital Tangshan China
| | - Wenfei Zhang
- Department of Medical Imaging Kailuan General Hospital Tangshan China
| | - Chuang Gao
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Tianjin Neurological Institute, Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System Tianjin Medical University General Hospital, Ministry of Education Tianjin China
| | - Rongcai Jiang
- Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China
- Tianjin Neurological Institute, Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous System Tianjin Medical University General Hospital, Ministry of Education Tianjin China
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O'Donoghue ML, Giugliano RP, Wiviott SD, Atar D, Keech A, Kuder JF, Im K, Murphy SA, Flores-Arredondo JH, López JAG, Elliott-Davey M, Wang B, Monsalvo ML, Abbasi S, Sabatine MS. Long-Term Evolocumab in Patients With Established Atherosclerotic Cardiovascular Disease. Circulation 2022; 146:1109-1119. [PMID: 36031810 DOI: 10.1161/circulationaha.122.061620] [Citation(s) in RCA: 118] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND In FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk), the proprotein convertase subtilisin-kexin type 9 inhibitor evolocumab reduced low-density lipoprotein cholesterol (LDL-C) and risk of cardiovascular events and was safe and well tolerated over a median of 2.2 years of follow-up. However, large-scale, long-term data are lacking. METHODS The parent FOURIER trial randomized 27 564 patients with atherosclerotic cardiovascular disease and LDL-C ≥70 mg/dL on statin to evolocumab versus placebo. Patients completing FOURIER at participating sites were eligible to receive evolocumab in 2 open-label extension studies (FOURIER-OLE [FOURIER Open-Label Extension]) in the United States and Europe; primary analyses were pooled across studies. The primary end point was the incidence of adverse events. Lipid values and major adverse cardiovascular events were prospectively collected. RESULTS A total of 6635 patients were enrolled in FOURIER-OLE (3355 randomized to evolocumab and 3280 to placebo in the parent study). Median follow-up in FOURIER-OLE was 5.0 years; maximum exposure to evolocumab in parent plus FOURIER-OLE was 8.4 years. At 12 weeks in FOURIER-OLE, median LDL-C was 30 mg/dL, and 63.2% of patients achieved LDL-C <40 mg/dL on evolocumab. Incidences of serious adverse events, muscle-related events, new-onset diabetes, hemorrhagic stroke, and neurocognitive events with evolocumab long term did not exceed those for placebo-treated patients during the parent study and did not increase over time. During the FOURIER-OLE follow-up period, patients originally randomized in the parent trial to evolocumab versus placebo had a 15% lower risk of cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina or coronary revascularization (hazard ratio, 0.85 [95% CI, 0.75-0.96]; P=0.008); a 20% lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80 [95% CI, 0.68-0.93]; P=0.003); and a 23% lower risk of cardiovascular death (hazard ratio, 0.77 [95% CI, 0.60-0.99]; P=0.04). CONCLUSIONS Long-term LDL-C lowering with evolocumab was associated with persistently low rates of adverse events for >8 years that did not exceed those observed in the original placebo arm during the parent study and led to further reductions in cardiovascular events compared with delayed treatment initiation. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT02867813 and NCT03080935.
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Affiliation(s)
- Michelle L O'Donoghue
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Stephen D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, Norway (D.A.)
- Institute of Clinical Medicine, University of Oslo, Norway (D.A.)
| | - Anthony Keech
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Julia F Kuder
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - KyungAh Im
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Sabina A Murphy
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | | | - J Antonio G López
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | | | - Bei Wang
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | - Maria Laura Monsalvo
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | - Siddique Abbasi
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
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Mayerhofer E, Malik R, Parodi L, Burgess S, Harloff A, Dichgans M, Rosand J, Anderson CD, Georgakis MK. Genetically predicted on-statin LDL response is associated with higher intracerebral haemorrhage risk. Brain 2022; 145:2677-2686. [PMID: 35598204 PMCID: PMC9612789 DOI: 10.1093/brain/awac186] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/30/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
Statins lower low-density lipoprotein cholesterol and are widely used for the prevention of atherosclerotic cardiovascular disease. Whether statin-induced low-density lipoprotein reduction increases risk of intracerebral haemorrhage has been debated for almost two decades. Here, we explored whether genetically predicted on-statin low-density lipoprotein response is associated with intracerebral haemorrhage risk using Mendelian randomization. Using genomic data from randomized trials, we derived a polygenic score from 35 single nucleotide polymorphisms of on-statin low-density lipoprotein response and tested it in the population-based UK Biobank. We extracted statin drug and dose information from primary care data on a subset of 225 195 UK Biobank participants covering a period of 29 years. We validated the effects of the genetic score on longitudinal low-density lipoprotein measurements with generalized mixed models and explored associations with incident intracerebral haemorrhage using Cox regression analysis. Statins were prescribed at least once to 75 973 (31%) of the study participants (mean 57 years, 55% females). Among statin users, mean low-density lipoprotein decreased by 3.45 mg/dl per year [95% confidence interval (CI): (-3.47, -3.42)] over follow-up. A higher genetic score of statin response [1 standard deviation (SD) increment] was associated with significant additional reductions in low-density lipoprotein levels [-0.05 mg/dl per year, (-0.07, -0.02)], showed concordant lipidomic effects on other lipid traits as statin use and was associated with a lower risk for incident myocardial infarction [hazard ratio per SD increment 0.98 95% CI (0.96, 0.99)] and peripheral artery disease [hazard ratio per SD increment 0.93 95% CI (0.87, 0.99)]. Over a 11-year follow-up period, a higher genetically predicted statin response among statin users was associated with higher intracerebral haemorrhage risk in a model adjusting for statin dose [hazard ratio per SD increment 1.16, 95% CI (1.05, 1.28)]. On the contrary, there was no association with intracerebral haemorrhage risk among statin non-users (P = 0.89). These results provide further support for the hypothesis that statin-induced low-density lipoprotein reduction may be causally associated with intracerebral haemorrhage risk. While the net benefit of statins for preventing vascular disease is well-established, these results provide insights about the personalized response to statin intake and the role of pharmacological low-density lipoprotein lowering in the pathogenesis of intracerebral haemorrhage.
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Affiliation(s)
- Ernst Mayerhofer
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Livia Parodi
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen Burgess
- University of Cambridge, MRC Biostatistics Unit, Cambridge, UK
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher D Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Marios K Georgakis
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and the Massachusetts Institute of Technology, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
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Molecular mechanisms underlying some major common risk factors of stroke. Heliyon 2022; 8:e10218. [PMID: 36060992 PMCID: PMC9433609 DOI: 10.1016/j.heliyon.2022.e10218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Ischemic and hemorrhagic strokes are the most common known cerebrovascular disease which can be induced by modifiable and non-modifiable risk factors. Age and race are the most common non-modifiable risk factors of stroke. However, hypertension, diabetes, obesity, dyslipidemia, physical inactivity, and cardiovascular disorders are major modifiable risk factors. Understanding the molecular mechanism mediating each of these risk factors is expected to contribute significantly to reducing the risk of stroke, preventing neural damage, enhancing rehabilitation, and designing suitable treatments. Abnormalities in the structure of the blood-brain barrier and blood vessels, thrombosis, vasoconstriction, atherosclerosis, reduced cerebral blood flow, neural oxidative stress, inflammation, and apoptosis, impaired synaptic transmission, excitotoxicity, altered expression/activities of many channels and signaling proteins are the most knows mechanisms responsible for stroke induction. However, the molecular role of risk factors in each of these mechanisms is not well understood and requires a lot of search and reading. This review was designed to provide the reader with a single source of information that discusses the current update of the prevalence, pathophysiology, and all possible molecular mechanisms underlying some major risk factors of stroke namely, hypertension, diabetes mellitus, dyslipidemia, and lipid fraction, and physical inactivity. This provides a full resource for understanding the molecular effect of each of these risk factors in stroke.
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Sabouret P, Angoulvant D, Cannon CP, Banach M. Low levels of low-density lipoprotein cholesterol, intracerebral haemorrhage, and other safety issues: is there still a matter of debate? EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac038. [PMID: 36117951 PMCID: PMC9472780 DOI: 10.1093/ehjopen/oeac038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/07/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Although some observational studies suggest a potential association of low levels of low-density lipoprotein cholesterol (LDL-C) with intracerebral haemorrhage (ICH), these analyses have issues of confounding where other factors (e.g. older age, frailty) that likely explain the findings, and the number of events was very low. More recent results from randomized clinical trials have not found an increased risk in ICH, most notably trials using PCSK9 inhibitors that achieve very low levels of LDL-C, but also in the long-term follow-up of the IMPROVE-IT trial. Also, other statin-associated safety issues, including new onset diabetes and the cancer risk should not be the reason of statin discontinuation, especially for the former, the benefits highly outweigh the risk (even 5×), and for the latter, there is no confirmed link suggesting any increased risk, in opposite, data exist suggesting benefits of statin therapy in cancer prevention. Furthermore, use of intensive lipid-lowering strategies with statins and non-statin drugs leads to decrease of ischaemic major adverse cardiac events, without safety concern, in a large population of patients with atherosclerotic cardiovascular disease (ASCVD). These data should promote the concept ‘the earlier, the lower, the longer, the better’ for the lipid management of patients with ASCVD. While few uncertainties remain in several populations that have been underrepresented in clinical trials (African American and Asian patients, low weight individuals), the most recent data with intensive LDL-C lowering with PCSK9 inhibitors are reassuring that the benefit outweighs any possible risk.
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Affiliation(s)
| | - Denis Angoulvant
- Cardiology Department - Loire Valley Cardiovascular Collaboration and EA4245, CHRU de Tours and Tours University, Tours, France
| | - Christopher P Cannon
- Cardiovascular Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
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Mori T, Yoshioka K, Tanno Y, Kasakura S. Independent factors affecting hemorrhagic and ischemic stroke in patients aged 40-69 years: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:189. [PMID: 35448966 PMCID: PMC9027078 DOI: 10.1186/s12872-022-02625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) have common vascular risk factors; however, ICH often occurs in adults aged < 70 years. Intracerebral hemorrhage and AIS in adults aged < 70 years should be preventable; however, it is unclear why different subtypes of ICH or AIS occur among adults aged < 70 years with vascular risk factors. This study aimed to identify independent variables for ICH or AIS onset in patients aged < 70 years. Methods We included patients aged 40–69 years who experienced ICH or AIS between August 2016 and July 2019. Patients aged < 40 years were excluded because other diseases, rather than vascular risk factors, are often associated with stroke etiology in this age group. Data on age, systolic blood pressure (SBP), serum lipids, and serum fatty acid levels were compared between patients with ICH and those with AIS. In addition, we conducted multivariable logistic regression analyses to identify independent factors among the variables, such as blood pressure or biomarkers, with significant differences between the two groups. Results Of the 1252 acute stroke patients screened, 74 patients with ICH and 149 patients with AIS met the inclusion criteria. After excluding variables with multicollinearity, SBP, glycated hemoglobin (HbA1c), and eicosapentaenoic acid (EPA) proportion (%) of total fatty acids were identified as independent factors affecting ICH and AIS. The SBP and EPA% threshold values for ICH compared to AIS were ≥ 158 mmHg and ≤ 2.3%, respectively. The HbA1c threshold value for AIS compared to ICH was ≥ 6.1%. Conclusions Systolic blood pressure, HbA1c, and EPA%, were independent factors between ICH and AIS. Patients aged 40–69 years with high SBP and low EPA% were at a higher risk of ICH than AIS, and those with a high HbA1c were at a higher risk of AIS than ICH. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02625-6.
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Affiliation(s)
- Takahisa Mori
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan.
| | - Kazuhiro Yoshioka
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Yuhei Tanno
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
| | - Shigen Kasakura
- Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan
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ADIGÜZEL A, ÇIPLAK S, ÖZTÜRK Ü. Evaluation of lipid levels and LDL-C/HDL-C ratio as possible risk markers of intracerebral hemorrhage. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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29
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Bershad EM, Suarez JI. Aneurysmal Subarachnoid Hemorrhage. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Iso H. Cardiovascular disease, a major global burden: Epidemiology of stroke and ischemic heart disease in Japan. Glob Health Med 2021; 3:358-364. [PMID: 35036616 DOI: 10.35772/ghm.2020.01113] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022]
Abstract
Japan ranks the highest globally, in terms of longevity. The average life expectancy was 81.4 years for men and 87.5 years for women in 2019. Such success in health is attributable to the substantial reduction in age-standardized mortality from cardiovascular diseases, especially stroke (136 per 105 in 1980 and 24 per 105 in 2015), when stroke mortality was the highest in the world between the 1960s and the 1990s. On the other hand, ischemic heart disease mortality was the lowest in the world between the 1960s and the 1980s and has continued to decline (40 per 105 in 1980 and 17 per 105 in 2015). Such a disease profile (larger burden of stroke compared to ischemic heart disease) was observed not only in Japan but also in some countries in central Asia and Africa, where small vessel disease (arteriolosclerosis) is assumed to be more common than large vessel disease (atherosclerosis). Between 1970 and 2015, a large decline in the population with high blood pressure levels was observed for both men and women. Meanwhile, there was a moderate decline in the smoking rate among men, and an increasing trend in serum cholesterol levels in both men and women. The sharp and extensive socioeconomic development between the 1960s and 1990s contributed to these health outcomes, while preventive measures and improved emergency medical care also contributed to the reduction of risk factors, disease incidence, case-fatality, and mortality. However, there is a threat of increasing incidence of ischemic heart disease in urban male employees and middle-aged male residents. Japan, with a super-aging society, needs to develop a new model for the prevention and control of cardiovascular disease and related health issues, with emphasis on efforts towards the early (primordial) prevention of cardiovascular disease as well as the attenuation of their progress towards chronic heart failure, chronic kidney disease, and vascular dementia.
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Affiliation(s)
- Hiroyasu Iso
- Institute of Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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31
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The Role of Lipid-Lowering Treatment in the Secondary Prevention of Ischemic Stroke. Diseases 2021; 10:diseases10010003. [PMID: 35076490 PMCID: PMC8788422 DOI: 10.3390/diseases10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 01/03/2023] Open
Abstract
Dyslipidemia is a major modifiable risk factor for ischemic stroke. Treatment with statins reduces the incidence of recurrent ischemic stroke and also reduces coronary events in patients with a history of ischemic stroke. Therefore, statins represent an important component of secondary prevention of ischemic stroke. In patients who do not achieve low-density lipoprotein cholesterol (LDL-C) targets despite treatment with the maximal tolerated dose of a potent statin, ezetimibe should be added to their lipid-lowering treatment and also appears to reduce the risk of cardiovascular events. Selected patients who do not achieve LDL-C targets despite statin/ezetimibe combination are candidates for receiving proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Finally, it appears that adding icosapent ethyl might also reduce cardiovascular morbidity in patients who have achieved LDL-C targets but have persistently elevated triglyceride levels.
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Saba L, Brinjikji W, Spence JD, Wintermark M, Castillo M, Borst GJD, Yang Q, Yuan C, Buckler A, Edjlali M, Saam T, Saloner D, Lal BK, Capodanno D, Sun J, Balu N, Naylor R, Lugt AVD, Wasserman BA, Kooi ME, Wardlaw J, Gillard J, Lanzino G, Hedin U, Mikulis D, Gupta A, DeMarco JK, Hess C, Goethem JV, Hatsukami T, Rothwell P, Brown MM, Moody AR. Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement. AJNR Am J Neuroradiol 2021; 42:1566-1575. [PMID: 34326105 DOI: 10.3174/ajnr.a7223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/26/2021] [Indexed: 12/19/2022]
Abstract
Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.
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Affiliation(s)
- L Saba
- From the Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy
| | | | - J D Spence
- Stroke Prevention and Atherosclerosis Research Centre (J.D.S.), Robarts Research Institute, Western University, London, Ontario, Canada
| | - M Wintermark
- Department of Neuroradiology (M.W.), Stanford University and Healthcare System, Stanford, California
| | - M Castillo
- Department of Radiology (M.C.), University of North Carolina, Chapel Hill, North Carolina
| | - G J D Borst
- Department of Vascular Surgery (G.J.D.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Q Yang
- Department of Radiology (Q.Y.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - C Yuan
- Departments of Radiology (C.Y., J.S., N.B.)
| | - A Buckler
- Elucid Bioimaging (A.B.), Boston, Massachusetts
| | - M Edjlali
- Department of Neuroradiology (M.E.), Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - T Saam
- Department of Radiology (T.S.), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Radiologisches Zentrum (T.S.), Rosenheim, Germany
| | - D Saloner
- Departments of Radiology and Biomedical Imaging (D.S., C.H.), University of California San Francisco, San Francisco, California
| | - B K Lal
- Department of Vascular Surgery (B.K.L.), University of Maryland School of Medicine, Baltimore, Maryland
| | - D Capodanno
- Division of Cardiology (D.C.), A.O.U. Policlinico "G. Rodolico-San Marco," University of Catania, Italy
| | - J Sun
- Departments of Radiology (C.Y., J.S., N.B.)
| | - N Balu
- Departments of Radiology (C.Y., J.S., N.B.)
| | - R Naylor
- The Leicester Vascular Institute (R.N.), Glenfield Hospital, Leicester, UK
| | - A V D Lugt
- Department of Radiology and Nuclear Medicine (A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science (B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - M E Kooi
- Department of Radiology and Nuclear Medicine (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Wardlaw
- Centre for Clinical Brain Sciences (J.W.), United Kingdom Dementia Research Institute and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - J Gillard
- Christ's College (J.G.), Cambridge, UK
| | - G Lanzino
- Neurosurgery (G.L.) Mayo Clinic, Rochester, Minnesota
| | - U Hedin
- Department of Molecular Medicine and Surgery (U.H.), Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery (U.H.), Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - D Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory (D.M.), University Health Network, Toronto, Ontario, Canada
| | - A Gupta
- Department of Radiology (A.G.), Weill Cornell Medical College, New York, New York
| | - J K DeMarco
- Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences (J.K.D.), Bethesda, Maryland
| | - C Hess
- Departments of Radiology and Biomedical Imaging (D.S., C.H.), University of California San Francisco, San Francisco, California
| | - J V Goethem
- Faculty of Biomedical Sciences (J.V.G.), University of Antwerp, Antwerp, Belgium
| | - T Hatsukami
- Surgery (T.H.), University of Washington, Seattle, Washington
| | - P Rothwell
- Centre for Prevention of Stroke and Dementia (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - M M Brown
- Stroke Research Centre (M.M.B.), Department of Brain Repair and Rehabilitation, University College of London Queen Square Institute of Neurology, University College London, UK
| | - A R Moody
- Department of Medical Imaging (A.R.M.), University of Toronto, Toronto, Ontario, Canada
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Tanaka Y, Kamisako T. Regulation of the expression of cholesterol transporters by lipid-lowering drugs ezetimibe and pemafibrate in rat liver and intestine. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166215. [PMID: 34265370 DOI: 10.1016/j.bbadis.2021.166215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022]
Abstract
Ezetimibe and pemafibrate are lipid-lowering drugs and promote reverse cholesterol transport. However, it is unknown whether cholesterol is mainly excreted by hepatobiliary excretion or by non-biliary transintestinal cholesterol efflux (TICE). We evaluated the effects of ezetimibe and pemafibrate on hepatic and intestinal cholesterol transporter regulation in Sham-operated rats, and examined the effects of these drugs on TICE in bile duct-ligated rats. Seven-week-old male Sprague-Dawley rats were treated as follows for two weeks: 1) Sham, Sham operation; 2) BDL, bile duct ligation; 3) E-Sham, Sham + ezetimibe; 4) E-BDL, BDL + ezetimibe; 5) P-Sham, Sham + pemafibrate; and 6) P-BDL, BDL + pemafibrate. Blood, liver, jejunum, and feces were collected 72 h post-surgery. Hepatic cholesterol levels were decreased in P-Sham and E-Sham, and were lower in E-BDL and P-BDL than in BDL. Fecal cholesterol levels increased in E-Sham and P-Sham compared with Sham, and were higher in E-BDL and P-BDL than in BDL. In liver, Abcg5 mRNA showed induction in E-Sham, Abcg5 and Abca1 mRNA were induced in P-Sham, Abcg5 mRNA was reduced in E-BDL, and Abca1 mRNA was increased in P-BDL. In jejunum, Abcg5 mRNA was induced in E-Sham. Abcg8 mRNA was induced in E-Sham and P-Sham. NPC1L1 mRNA showed reduced expression in P-Sham and P-BDL. SR-B1 mRNA was reduced in P-Sham, and the expression decreased in P-BDL. LDL receptor mRNA was induced in BDL and P-BDL. Ezetimibe and pemafibrate may promote TICE by increasing Abcg5/g8, while pemafibrate may inhibit intestinal cholesterol absorption by decreasing SR-B1 and NPC1L1.
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Affiliation(s)
- Yuji Tanaka
- Department of Clinical Laboratory Medicine, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan.
| | - Toshinori Kamisako
- Department of Clinical Laboratory Medicine, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
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Yu Q, Wu Y, Jin Q, Chen Y, Lin Q, Liu X. Development and internal validation of a multivariable prediction model for 6-year risk of stroke: a cohort study in middle-aged and elderly Chinese population. BMJ Open 2021; 11:e048734. [PMID: 34233994 PMCID: PMC8264906 DOI: 10.1136/bmjopen-2021-048734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/10/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To develop and internally validate a prediction model for 6-year risk of stroke and its primary subtypes in middle-aged and elderly Chinese population. DESIGN This is a retrospective cohort study from a prospectively collected database. PARTICIPANTS We included a total 3124 adults aged 45-80 years, free of stroke or myocardial infarction at baseline in the 2009-2015 cohort of China Health and Nutrition Survey. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of the prediction model was stroke. Investigated predictors were: age, gender, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), hypertension (HBP), drinking status, smoking status, diabetes and site. Stepwise multiple Cox regression was applied to identify independent predictors. A nomogram was constructed to predict 6-year risk of stroke based on the multiple analysis results. Bootstraps with 1000 resamples were applied to both C-index and calibration curve. RESULT The overall incidence of overall stroke was 2.98%. Age, gender, HBP and TC were found as significant risk predictors for overall stroke; age, gender, HBP and LDL-C were found as significant risk predictors for ischaemic stroke; age, gender, HBP, BMI and HDL-C were found as significant risk predictors for haemorrhagic stroke. The nomogram was constructed using significant variables included in the model, with a C-index of 0.74 (95% CI: 0.72 to 0.76), 0.74 (95% CI: 0.71 to 0.77), and 0.81 (95% CI: 0.78 to 0.84) for overall stroke, ischaemic stroke, and haemorrhagic stroke model, respectively. The calibration curves demonstrated the good agreements between predicted and observed 6-year risk probability. CONCLUSION Our nomogram could be convenient, easy to use and effective prognoses for predicting 6-year risk of stroke in middle-aged and elderly Chinese population.
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Affiliation(s)
- Qi Yu
- Department of Scientific Research and Education, The First Hospital of Putian, Putian, Fujian, China
| | - Yuanzhe Wu
- Department of Scientific Research and Education, The First Hospital of Putian, Putian, Fujian, China
| | - Qingdong Jin
- Department of Neurosurgery, The First Hospital of Putian, Putian, Fujian, China
| | - Yanqing Chen
- Department of Scientific Research and Education, The First Hospital of Putian, Putian, Fujian, China
| | - Qingying Lin
- Department of Scientific Research and Education, The First Hospital of Putian, Putian, Fujian, China
| | - Xinru Liu
- Department of Scientific Research and Education, The First Hospital of Putian, Putian, Fujian, China
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35
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AbuRahma AF, Avgerinos ED, Chang RW, Darling RC, Duncan AA, Forbes TL, Malas MB, Perler BA, Powell RJ, Rockman CB, Zhou W. The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease. J Vasc Surg 2021; 75:26S-98S. [PMID: 34153349 DOI: 10.1016/j.jvs.2021.04.074] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University-Charleston Division, Charleston, WV.
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, UPMC Hearrt & Vascular Institute, Pittsburgh, Pa
| | - Robert W Chang
- Vascular Surgery, Permanente Medical Group, San Francisco, Calif
| | | | - Audra A Duncan
- Division of Vascular & Endovascular Surgery, University of Western Ontario, London, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular & Endovascular Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mahmoud B Malas
- Vascular & Endovascular Surgery, University of California San Diego, La Jolla, Calif
| | - Bruce Alan Perler
- Division of Vascular Surgery & Endovascular Therapy, Johns Hopkins, Baltimore, Md
| | | | - Caron B Rockman
- Division of Vascular Surgery, New York University Langone, New York, NY
| | - Wei Zhou
- Division of Vascular Surgery, University of Arizona, Tucson, Ariz
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Kim JS. Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines. J Stroke 2021; 23:149-161. [PMID: 34102752 PMCID: PMC8189863 DOI: 10.5853/jos.2021.01249] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023] Open
Abstract
Hyperlipidemia is an important risk factor for ischemic stroke; the Stroke Prevention by Aggressive Reduction in Cholesterol Level and Treat Stroke to Target studies have shown that statins are beneficial for patients with stroke and that a low target for low-density lipoprotein cholesterol (LDL-C) concentration may maximize this benefit. Based on these results, recent guidelines have emphasized the application of "high-intensity statins" and "low LDL-C target" strategies in patients with stroke. However, it should be kept in mind that the role of blood lipids as a risk factor and benefit of lipid-lowering therapy are different among patients with different levels of cerebral arterial diseases. Studies have suggested that hypolipidemia, but not hyperlipidemia, is a risk factor for small vessel diseases (SVDs) such as intracerebral hemorrhages, microbleeds, white matter hyperintensities, and perhaps, lacunar infarction. Although lipid-lowering agents might benefit certain patients with SVD, high-intensity statin and low LDL-C target strategies cannot be applied. In contrast, these strategies are important in patients with extracranial atherosclerosis, such as internal carotid disease, considering ample evidence of the benefits of lipid-lowering agents. Imaging studies have shown that statins stabilize vulnerable plaques in these patients. Although lipid-lowering agents are likely to benefit patients with intracranial atherosclerosis, the degree of their benefit and appropriate target LDL-C level for these patients remain unclear. More studies are needed to elucidate the appropriate lipid-modifying strategies in patients with stroke with different levels of cerebral artery disease.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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37
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Wang G, Jing J, Wang A, Zhang X, Zhao X, Li Z, Wang C, Li H, Liu L, Wang Y, Wang Y. Non-High-Density Lipoprotein Cholesterol Predicts Adverse Outcomes in Acute Ischemic Stroke. Stroke 2021; 52:2035-2042. [PMID: 34000828 DOI: 10.1161/strokeaha.120.030783] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Guangyao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Liping Liu
- China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
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38
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Liu Q, Zhao W, Zou X, Xing Y, Zhou G, Li X. Sex Differences in Outcomes After Spontaneous Intracerebral Hemorrhage Among Patients With Low Total Cholesterol Levels. Am J Med Sci 2021; 362:462-471. [PMID: 33992602 DOI: 10.1016/j.amjms.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/21/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low total cholesterol (TC) levels were shown to be an independent predictor of intracerebral hemorrhagic stroke in previous studies. However, the role of sex in risk and outcome of patients with ICH and low TC levels is unclear. Therefore, the objective of our study was to assess the sex differences in the risk factors and outcomes after spontaneous intracerebral hemorrhage (ICH) in patients with low TC levels in China. METHODS This study recruited consecutive patients diagnosed with ICH who were admitted to the Stroke Registry System in Tianjin between May 2005 and May 2018. Patients with low TC levels (defined as TC<200mg/dl) were analyzed in this study. Sex differences in clinical features, risk factors, and outcomes at hospital discharge, 3 months, and 12 months after ICH were evaluated. RESULTS Of the 824 patients with low TC levels, 610 men (74%) and 214 women (26%). The mean age at ICH onset was younger in men than in women (60.93±12.54 vs. 64.5±12.28, P<0.001), and men were more likely to have higher educational levels than women. There were higher prevalence rates of hypertension, current smoking status, and alcohol consumption in men. Urinary tract infections were more prevalent in women, and hepatic/renal dysfunctions were more prevalent in men. Women had significantly higher neurological function deficits. With lower Barthel indices (BIs) and higher modified Rankin scale (mRS) scores at admission; but there was no significant difference between men and women in National Institutes of Health Stroke Scale (NIHSS) scores. The study showed that there was no significant difference in mortality and dependency rates at hospital discharge, 3 months, and 12 months after ICH. CONCLUSIONS Our study showed that there were no sex differences in clinical outcomes of patients with ICH and low TC levels, which suggests that the effect of low cholesterol as a risk factor for cerebral hemorrhage is the same on patients of different sexs. The possible mechanisms need larger, prospective, multicenter studies to further research.
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Affiliation(s)
- Qian Liu
- The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China.
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xuan Zou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Yonghong Xing
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xin Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
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39
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Masson W, Lobo M, Siniawski D, Masson G, Lavalle-Cobo A, Molinero G. LDL-C Levels Below 55 mg/dl and Risk of Hemorrhagic Stroke: A Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 30:105655. [PMID: 33571878 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/17/2021] [Accepted: 01/30/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the effect of very low levels of LDL-C (< 55 mg/dl) achieved with lipid-lowering therapy on hemorrhagic stroke incidence. METHODS We performed a meta-analysis including randomized trials that achieved LDL-C levels under 55 mg/dl in more intensive lipid-lowering arms, regardless of the lipid-lowering drug used. A fixed-effects model was used. This meta-analysis was performed according to PRISMA guidelines. RESULTS Eight eligible trials including 122.802 patients, were identified and considered eligible for the analyses. A total of 62.526 subjects were allocated to receive more intensive lipid-lowering therapy while 60.276 subjects were allocated to the respective control arms. There were no differences in the incidence of hemorrhagic stroke between the group that received a more intensive lipid-lowering therapy (achieved LDL-C level <55 mg/dl), and the group that received a less intense scheme (OR, 1.05; 95%CI, 0.85-1.31). The statistical heterogeneity was low (I2 = 2%). The sensitivity analysis showed that the results were robust. CONCLUSIONS The use of more intensive lipid-lowering therapy that achieved an LDL-C level lower than 55 mg/dl in patients with high cardiovascular risk, is not associated with an increased risk of hemorrhagic stroke. Considering the cardiovascular benefit and safety observed with the achievement of very low LDL-C values, the challenging lipid goals recommended by the new guidelines seem consistent.
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Affiliation(s)
- Walter Masson
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD Buenos Aires, Argentina; Cardiology Department. Hospital Italiano de Buenos Aires. Tte. Gral. Juan Domingo Perón 4190 (C1199ABB), Buenos Aires, Argentina.
| | - Martín Lobo
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD Buenos Aires, Argentina; Cardiology Department. Hospital Militar Campo de Mayo. Tte. Gral. Ricchieri S/N (B1659AMA), Buenos Aires, Argentina
| | - Daniel Siniawski
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD Buenos Aires, Argentina; Cardiology Department. Hospital Italiano de Buenos Aires. Tte. Gral. Juan Domingo Perón 4190 (C1199ABB), Buenos Aires, Argentina.
| | - Gerardo Masson
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD Buenos Aires, Argentina; Cardiology Department. Sanatorio Las Lomas. Diego Carman 555 (B1642AKG), San Isidro, Buenos Aires, Argentina
| | - Augusto Lavalle-Cobo
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD Buenos Aires, Argentina; Cardiology Department. Sanatorio Finochietto. Av. Córdoba 2678 (C1187AAN), Buenos Aires, Argentina
| | - Graciela Molinero
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD Buenos Aires, Argentina
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40
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Robinson JG. Low LDL-C Levels: Likely No Short-Term Cognitive Harm. J Am Coll Cardiol 2020; 75:2294-2296. [PMID: 32381159 DOI: 10.1016/j.jacc.2020.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer G Robinson
- Departments of Epidemiology and Internal Medicine, Division of Cardiology, University of Iowa, Iowa City, Iowa.
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41
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Edes A, Brown J, Edwards K. Testing lipid markers as predictors of all-cause morbidity, cardiac disease, and mortality risk in captive western lowland gorillas ( Gorilla gorilla gorilla). Primate Biol 2020; 7:41-59. [PMID: 33553576 PMCID: PMC7852406 DOI: 10.5194/pb-7-41-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022] Open
Abstract
Great apes and humans develop many of the same health conditions, including cardiac disease as a leading cause of death. In humans, lipid markers are strong predictors of morbidity and mortality risk. To determine if they similarly predict risk in gorillas, we measured five serum lipid markers and calculated three lipoprotein ratios from zoo-housed western lowland gorillas (aged 6-52 years, n = 61 , subset with routine immobilizations only: n = 47 ): total cholesterol (TC), triglycerides (TGs), high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A1 (apoA1), TC / HDL , LDL / HDL , and TG / HDL . We examined each in relation to age and sex, then analyzed whether they predicted all-cause morbidity, cardiac disease, and mortality using generalized linear models (GLMs). Older age was significantly associated with higher TG, TC / HDL , LDL / HDL , and TG / HDL , and lower HDL and apoA1. With all ages combined, compared to females, males had significantly lower TG, TC / HDL , LDL / HDL , and TG / HDL , and higher HDL. Using GLMs, age, sex, and lower LDL / HDL were significant predictors of all-cause morbidity; this is consistent with research demonstrating lower LDL in humans with arthritis, which was the second most prevalent condition in this sample. In contrast to humans, lipid markers were not better predictors of cardiac disease and mortality risk in gorillas, with cardiac disease best predicted by age and sex alone, and mortality risk only by age. Similar results were observed when multimodel inference was used as an alternative analysis strategy, suggesting it can be used in place of or in addition to traditional methods for predicting risk.
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Affiliation(s)
- Ashley N. Edes
- Center for Species Survival, Smithsonian Conservation Biology
Institute, 1500 Remount Rd., Front Royal, VA 22630, USA
- currently at: Department of Reproductive and
Behavioral Sciences, Saint Louis Zoo, St. Louis, MO 63110, USA
| | - Janine L. Brown
- Center for Species Survival, Smithsonian Conservation Biology
Institute, 1500 Remount Rd., Front Royal, VA 22630, USA
| | - Katie L. Edwards
- Center for Species Survival, Smithsonian Conservation Biology
Institute, 1500 Remount Rd., Front Royal, VA 22630, USA
- North of England Zoological Society, Chester Zoo, Upton by Chester,
CH2 1LH, UK
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42
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Newman CB, Blaha MJ, Boord JB, Cariou B, Chait A, Fein HG, Ginsberg HN, Goldberg IJ, Murad MH, Subramanian S, Tannock LR. Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2020; 105:5909161. [PMID: 32951056 DOI: 10.1210/clinem/dgaa674] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This guideline will provide the practicing endocrinologist with an approach to the assessment and treatment of dyslipidemia in patients with endocrine diseases, with the objective of preventing cardiovascular (CV) events and triglyceride-induced pancreatitis. The guideline reviews data on dyslipidemia and atherosclerotic cardiovascular disease (ASCVD) risk in patients with endocrine disorders and discusses the evidence for the correction of dyslipidemia by treatment of the endocrine disease. The guideline also addresses whether treatment of the endocrine disease reduces ASCVD risk. CONCLUSION This guideline focuses on lipid and lipoprotein abnormalities associated with endocrine diseases, including diabetes mellitus, and whether treatment of the endocrine disorder improves not only the lipid abnormalities, but also CV outcomes. Based on the available evidence, recommendations are made for the assessment and management of dyslipidemia in patients with endocrine diseases.
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Affiliation(s)
- Connie B Newman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, New York
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Jeffrey B Boord
- Department of Administration and Parkview Physicians Group Endocrinology Section, Parkview Health System, Fort Wayne, Indiana
| | - Bertrand Cariou
- Department of Endocrinology, L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Alan Chait
- Department of Medicine, University of Washington, Seattle, Washington
| | - Henry G Fein
- Department of Medicine, Division of Endocrinology, Sinai Hospital, Baltimore, Maryland
| | - Henry N Ginsberg
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ira J Goldberg
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, New York
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
| | | | - Lisa R Tannock
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
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Khan SU, Khan MU, Virani SS, Khan MS, Khan MZ, Rashid M, Kalra A, Alkhouli M, Blaha MJ, Blumenthal RS, Michos ED. Efficacy and safety for the achievement of guideline-recommended lower low-density lipoprotein cholesterol levels: a systematic review and meta-analysis. Eur J Prev Cardiol 2020; 28:2001-2009. [DOI: 10.1093/eurjpc/zwaa093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/23/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Aim
The 2018 American Heart Association/American College of Cardiology/Multi-Society Cholesterol Guidelines recommended the addition of non-statins to statin therapy for high-risk secondary prevention patients above a low-density lipoprotein cholesterol (LDL-C) threshold of ≥70 mg/dL (1.8 mmol/L). We compared effectiveness and safety of treatment to achieve lower (<70) vs. higher (≥70 mg/dL) LDL-C among patients receiving intensive lipid-lowering therapy (statins alone or plus ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors).
Methods and results
Eleven randomized controlled trials (130 070 patients), comparing intensive vs. less-intensive lipid-lowering therapy, with follow-up ≥6 months and sample size ≥1000 patients were selected. Meta-analysis was reported as random effects risk ratios (RRs) [95% confidence intervals] and absolute risk differences (ARDs) as incident cases per 1000 person-years. The median LDL-C levels achieved in lower LDL-C vs. higher LDL-C groups were 62 and 103 mg/dL, respectively. At median follow-up of 2 years, the lower LDL-C vs. higher LDL-C group was associated with significant reduction in all-cause mortality [ARD −1.56; RR 0.94 (0.89–1.00)], cardiovascular mortality [ARD −1.49; RR 0.90 (0.81–1.00)], and reduced risk of myocardial infarction, cerebrovascular events, revascularization, and major adverse cardiovascular events (MACE). These benefits were achieved without increasing the risk of incident cancer, diabetes mellitus, or haemorrhagic stroke. All-cause mortality benefit in lower LDL-C group was limited to statin therapy and those with higher baseline LDL-C (≥100 mg/dL). However, the RR reduction in ischaemic and safety endpoints was independent of baseline LDL-C or drug therapy.
Conclusion
This meta-analysis showed that treatment to achieve LDL-C levels below 70 mg/dL using intensive lipid-lowering therapy can safely reduce the risk of mortality and MACE.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, 1969 Ogden Ave, Chicago, IL 60612, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Muhammad Rashid
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Michael J Blaha
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
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Kuriakose D, Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci 2020; 21:E7609. [PMID: 33076218 PMCID: PMC7589849 DOI: 10.3390/ijms21207609] [Citation(s) in RCA: 391] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Stroke is the second leading cause of death and a major contributor to disability worldwide. The prevalence of stroke is highest in developing countries, with ischemic stroke being the most common type. Considerable progress has been made in our understanding of the pathophysiology of stroke and the underlying mechanisms leading to ischemic insult. Stroke therapy primarily focuses on restoring blood flow to the brain and treating stroke-induced neurological damage. Lack of success in recent clinical trials has led to significant refinement of animal models, focus-driven study design and use of new technologies in stroke research. Simultaneously, despite progress in stroke management, post-stroke care exerts a substantial impact on families, the healthcare system and the economy. Improvements in pre-clinical and clinical care are likely to underpin successful stroke treatment, recovery, rehabilitation and prevention. In this review, we focus on the pathophysiology of stroke, major advances in the identification of therapeutic targets and recent trends in stroke research.
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Affiliation(s)
| | - Zhicheng Xiao
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC 3800, Australia;
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Noda H, Iso H. Reader response: Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study. Neurology 2020; 95:98-99. [DOI: 10.1212/wnl.0000000000009830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Low total cholesterol and high density lipoprotein are independent predictors of poor outcomes following aneurysmal subarachnoid hemorrhage: A preliminary report. Clin Neurol Neurosurg 2020; 197:106062. [PMID: 32688095 DOI: 10.1016/j.clineuro.2020.106062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH. METHODS We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed. RESULTS There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and Hunt & Hess score of 2.8 ± 0.1, included for analysis. Those with a low TC < 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL < 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm. CONCLUSIONS Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.
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Lipid-lowering treatment in secondary prevention of ischaemic cerebrovascular disease. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2020; 32:175-182. [PMID: 32035666 DOI: 10.1016/j.arteri.2019.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
Abstract
Stroke is the second cause of death after myocardial infarction, and the main cause of acquired disability. Patients with ischaemic stroke have a higher risk of future vascular events, including recurrent stroke, myocardial infarction, and death by vascular cause. The initial epidemiological studies demonstrated a weak or non-existent relationship between cholesterolaemia and stroke. Subsequently, statin intervention trials showed a reduction in the risk of recurrence of cerebrovascular events. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), the first clinical trial designed to assess effects of statin therapy in secondary stroke prevention, highlighted the reduction of stroke recurrence with atorvastatin 80mg/daily in patients with a recent ischaemic established or transient stroke, with a modest increase in the rate of haemorrhagic stroke. Successive studies have also reported the benefits of statin therapy combined with ezetimibe or PCSK9 inhibitors in primary and secondary ischaemic stroke prevention. Since 80% of recurrent cerebrovascular events could be prevented, it is considered of interest to carry out a narrative review of the benefits of lipid-lowering therapy in the secondary prevention of ischaemic cerebrovascular disease.
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Tan A, Fraser C, Khoo P, Watson S, Ooi K. Statins in Neuro-ophthalmology. Neuroophthalmology 2020; 45:219-237. [PMID: 34366510 PMCID: PMC8312600 DOI: 10.1080/01658107.2020.1755872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/05/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022] Open
Abstract
Statins are effective and well-tolerated hypolipidaemic agents which have been increasingly studied for their pleiotropic immunomodulatory and anti-inflammatory effects. Statins have potential therapeutic benefit in a range of neuro-ophthalmological conditions but may also induce or exacerbate certain neurological disorders. This literature review examines evidence from clinical and in vitro studies assessing the effects of statins in myasthenia gravis, myopathy, multiple sclerosis, neuromyelitis optica, idiopathic intracranial hypertension (pseudotumour cerebri), migraine, giant cell arteritis, Bell's palsy, ocular ischaemia, stroke, Alzheimer's disease and Parkinson's disease.
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Affiliation(s)
- Alvin Tan
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Clare Fraser
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Pauline Khoo
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Stephanie Watson
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
| | - Kenneth Ooi
- Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
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49
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Low triglyceride to high-density lipoprotein cholesterol ratio predicts hemorrhagic transformation in large atherosclerotic infarction of acute ischemic stroke. Aging (Albany NY) 2020; 11:1589-1601. [PMID: 30853665 PMCID: PMC6428094 DOI: 10.18632/aging.101859] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/06/2019] [Indexed: 12/21/2022]
Abstract
The ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) is an objective approach to predicting poor outcomes in acute ischemic stroke (AIS). The impact of TG/HDL-C on hemorrhagic transformation (HT) after AIS remains unknown. The aim of this study was to explore the accurate effect of TG/HDL-C on HT after AIS. We enrolled a total of 1423 patients with AIS in the training cohort from a prospective, consecutive hospital-based stroke registry. Of the 1423 patients, HT occurred in 155 (10.89%) patients. The incidence of HT after AIS was significantly increased when there were low levels of TG (P=0.016) and TG/HDL-C (P=0.006) in patients with AIS attributable to large artery atherosclerosis (LAA), but not in those who suffered from cardioembolic stroke. After adjustment for covariates, a lower TG/HDL-C (OR=0.53, 95%CI=0.20-0.93) that was more than TG alone (OR=0.61, 95%CI=0.27-0.98) independently increased the risk of HT in LAA. Furthermore, our established nomogram indicated that lower TG/HDL-C was an indicator of HT. These findings were further validated in the test cohort of 558 patients with AIS attributable to LAA. In summary, a low level of TG/HDL-C is correlated with greater risk of HT after AIS attributable to LAA.
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Edes AN, Edwards KL, Wolfe BA, Brown JL, Crews DE. Allostatic Load Indices With Cholesterol and Triglycerides Predict Disease and Mortality Risk in Zoo-Housed Western Lowland Gorillas ( Gorilla gorilla gorilla). Biomark Insights 2020; 15:1177271920914585. [PMID: 32425494 PMCID: PMC7218307 DOI: 10.1177/1177271920914585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
Abstract
Allostatic load, or the physiological dysregulation accumulated due to senescence and stress, is an established predictor of human morbidity and mortality and has been proposed as a tool for monitoring health and welfare in captive wildlife. It is estimated by combining biomarkers from multiple somatic systems into allostatic load indices (ALIs), providing a score representing overall physiological dysregulation. Such ALIs have been shown to predict disease and mortality risk in western lowland gorillas. In these prior analyses, we were unable to include lipid markers, a potential limitation as they are key biomarkers in human models. Recently, we were able to assay serum cholesterol and triglycerides and add them to our previous ALI. We then re-examined associations with health outcomes using binomial generalized linear models. We constructed ALIs using 2 pooling strategies and 2 methods. By itself, a 1-unit increase in allostatic load was associated with higher odds of all-cause morbidity and mortality, but results were mixed for cardiac disease. However, the best fit models for all-cause morbidity and cardiac disease included only age and sex. Allostatic load was retained alongside age in the best fit models for mortality, with a 1-unit increase associated with 23% to 45% higher odds of death. Compared with previous results, ALIs containing cholesterol and triglycerides better predict disease risk in zoo-housed western lowland gorillas, as evidenced by larger effect sizes for some models and better goodness of fit for all ALIs. Based on these results, we address methodology for future allostatic load research on wildlife.
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Affiliation(s)
- Ashley N Edes
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
| | - Katie L Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | - Barbara A Wolfe
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | - Douglas E Crews
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
- College of Public Health, The Ohio State University, Columbus, OH, USA
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