The relationship between cholesterol and stroke: implications for antihyperlipidaemic therapy in older patients

Dyslipidemia among Patients with Ischemic Stroke Admitted to the Department of Medicine of a Tertiary Care Centre

Introduction

Sudden neurological deficits due to an acute focal vascular injury of the central nervous system is stroke. It is a major cause of morbidity and mortality. Dyslipidemia is any abnormality in the parameter of the lipid profile which has been associated with stroke. The aim of this study was to find out the prevalence of dyslipidemia among patients with ischemic stroke in the Department of Medicine of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted in a tertiary care centre among admitted ischemic stroke patients from 5 August 2022 to 14 March 2023 after obtaining ethical approval from the Institutional Review Committee. Overnight fasting blood samples were collected for lipid profile. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 79 ischemic stroke patients, 42 (53.16%) (42.09-64.23, at 95% Confidence Interval) had dyslipidemia where high cholesterol was seen in 21 (50%), high triglyceride in 22 (52.38%), high low-density lipoprotein 14 (33.33%) and low high-density lipoprotein in 20 (47.61%).

Conclusions

The prevalence of dyslipidemia among ischemic stroke patients was lower than the similar studies done in similar settings.

Keywords

cross-sectional studies; dyslipidemia; hyperlipidemias; ischemic stroke.

Matrix Metalloproteinase-9 Gene Polymorphism and Its Methylation in Stroke Patients

Background

Genetic and environmental factors, along with hypertension, diabetes mellitus and smoking cause accelerated atherosclerosis and, eventually, stroke. Matrix metalloproteinase-9 (MMP-9) are inflammatory mediators of the endoproteinase family, and their polymorphism and methylation are associated with the development of atherosclerosis and stroke. This study explores this association in the Indian population.

Objective

To study the association of MMP gene polymorphism and methylation with the risk of stroke.

Methods

A case-control study was conducted on 100 admitted patients (both genders) diagnosed with ischaemic stroke. Another 100 healthy subjects, not suffering from any chronic illness or stroke, were taken as controls. All participants were genotyped for rs3918242 (MMP-9) by polymerase chain reaction (PCR) and restriction fragment length polymorphism. Methylation of the MMP-9 gene-promoter region was assessed by methylation-specific PCR.

Results

The case (mean age = 61.3 ± 7.36 years old) and control (mean age = 60.68 ± 7.1 years old) groups were age-matched. Among cases, 61 patients were smokers, 55 were diabetic and 53 were hypertensive. A significant risk of ischaemic stroke was associated with the CT genotype (adjusted odds ratio [aOR] = 7.09; P < 0.001), TT genotype (aOR = 19.75; P < 0.001) and T allele (aOR = 10.71; P < 0.001). MMP-9 methylation decreased the risk of stroke (aOR = 0.23; P < 0.001).

Conclusion

MMP-9 gene-1562C/T polymorphism (SNP rs3918242) (single-nucleotide polymorphism [SNP] rs3918242) is a potential marker to predict ischaemic stroke and constitutes a significant proportion of the general population. Its polymorphism predisposes to ischaemic stroke, while its methylation is protective.

Characteristics and Risk Factors Associated with Stroke Subtypes among Adult Patients Admitted to the Stroke Unit of Jimma University Medical Center: A Retrospective Cross-sectional Study

BACKGROUND

Almost 80% of deaths due to non-communicable diseases occur in lowand middle-income countries. Stroke is a great public health problem in Ethiopia. Stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, researches done in Ethiopia on factors associated with stroke sub-types were inadequate.

OBJECTIVE

To assess the characteristics and risk factors associated with stroke subtypes among patients admitted to Jimma University Medical Center.

MATERIALS AND METHODS

A retrospective cross-sectional study was conducted from May 2017 to May 2018 in the stroke unit of the Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. A checklist comprising relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Pearson chi-square test was used to check the association of different parameters with stroke subtypes. A P-value <0.05 was used as a cutoff point to declare statistical significance. Data were presented using text, tables, and figures.

RESULTS

From a total of 106 patients, 67 (63.2%) were men. The mean ± SD of age was 52.67±12.46 Year's, and the difference was not significant among stroke subtypes. Among all patients, 59 (55.6%) had ischemic strokes and 47 (44.4%) had hemorrhagic strokes. The most prevalent risk factors significantly associated with stroke subtypes were being male 67 (63.2%) followed by dyslipidemia 43 (40.5%) and cigarette smoking 38 (35.8%).

CONCLUSION

The ischemic stroke was reported to be higher than hemorrhagic in this study. The overall mean (±SD) age of the patient was 52.67±(12.46) years. The mean age of hemorrhagic stroke patients was 55.98 (±13.77) years; while in ischemic stroke was 50.03 (±10.70) years. Being male, a history of cigarette smoking, and dyslipidemia were significantly associated with stroke subtypes.

Association between serum netrin-1 and prognosis of ischemic stroke: The role of lipid component levels

BACKGROUND AND AIMS

High serum netrin-1 levels decrease the risk of ischemic stroke and are negatively associated with outcomes after ischemic stroke. However, it remains unclear whether the association between netrin-1 and ischemic stroke prognosis is modified by lipid component levels.

METHODS AND RESULTS

We measured baseline serum netrin-1 levels in 3065 ischemic stroke patients from China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a combination of death and major disability (modified Rankin Scale score≥3) at 3 months after ischemic stroke. Total cholesterol (TC) levels could modify the association between netrin-1 and prognosis of ischemic stroke (P_interaction = 0.040). After multivariate adjustment, the odds ratios of the primary outcome associated with the highest quartile of netrin-1 were 0.39 (95%CI, 0.17-0.90; P_trend = 0.004) for the patients with high TC levels and 0.82 (95%CI, 0.61-1.11; P_trend = 0.149) for those with normal TC levels. Adding netrin-1 to conventional risk factors improved risk prediction for the primary outcome in the patients with high TC levels (net reclassification improvement: 26.8%, P = 0.015; integrated discrimination index: 1.6%, P = 0.028) but not in those with normal TC levels.

CONCLUSIONS

Elevated netrin-1 is associated with improved prognosis at 3 months after ischemic stroke in the patients with high TC levels but not in those with normal TC levels. Further prospective studies from other populations and randomized clinical trials are needed to verify our findings and clarify the potential mechanisms.

Prevalence of Stroke Risk Factors and Their Distribution Based on Stroke Subtypes in Gorgan: A Retrospective Hospital-Based Study-2015-2016

Background

Stroke is a leading cause of death and disability worldwide. According to the Iranian Ministry of Medical Health and Education, out of 100,000 stroke incidents in the country, 25,000 lead to death. Thus, identifying risk factors of stroke can help healthcare providers to establish prevention strategies. This study was conducted to investigate the prevalence of stroke risk factors and their distribution based on stroke subtypes in Sayad Shirazi Hospital, Gorgan, Northeastern Iran.

Material and Methods

A retrospective hospital-based study was conducted at Sayad Shirazi Hospital in Gorgan, the only referral university hospital for stroke patients in Gorgan city. All medical records with a diagnosis of stroke were identified based on the International Classification of Diseases, Revision 10, from August 23, 2015, to August 22, 2016. A valid and reliable data gathering form was used to capture data about demographics, diagnostics, lifestyle, risk factors, and medical history.

Results

Out of 375 cases, two-thirds were marked with ischemic stroke with mean ages (standard deviation) of 66.4 (14.2) for men and 64.6 (14.2) for women. The relationship between stroke subtypes and age groups (P=0.008) and hospital outcome (P=0.0001) was significant. Multiple regression analysis showed that hypertension (Exp. (B) =1.755, P=0.037), diabetes mellitus (Exp. (B) =0.532, P=0.021), and dyslipidemia (Exp. (B) =2.325, P=0.004) significantly increased the risk of ischemic stroke.

Conclusion

Overall, hypertension, diabetes mellitus, and dyslipidemia were the major risk factors of stroke in Gorgan. Establishment of stroke registry (population- or hospital-based) for the province is recommended.

Stroke prevention and management in older adults

Stroke is the third leading cause of death and a foremost cause of serious, long-term disability in the United States. As cardiovascular and metabolic disease incidence rises with age, older people are more likely to experience strokes. Age is the single most important risk factor for stroke. For each successive 10 years after age 55, the stroke rate more than doubles in both men and women. However, stroke is not an inevitable consequence of aging. By identifying and modifying risk factors in older people, nurses can partner with other providers to reduce the incidence, morbidity, and mortality associated with stroke in older adults. Control of hypertension, resolution of dyslipidemia, management of diabetes mellitus, anticoagulation for atrial fibrillation, promotion of exercise and healthy diet, and cessation of cigarette smoking are of particular importance in older adults. Recognition of stroke symptoms, access to emergency evaluation and treatments, and participation in comprehensive rehabilitation may determine stroke outcomes in aging. This article presents stroke risk factors and primary and secondary prevention in the context of aging, with special considerations in the identification and management of acute stroke, recovery, and rehabilitation for older adults who survive stroke.

Statin therapy in the elderly: does it make good clinical and economic sense?

HMG-CoA reductase inhibitors (statins) have been established as the dominant treatment for coronary heart disease (CHD). This dominance is based on an impressive body of clinical trial evidence showing significant benefits in primary prevention of cardiovascular events in individuals at risk for CHD and in secondary prevention of such events in patients with CHD and high or normal plasma cholesterol levels. There is, however, significant room for improvement in the treatment of CHD with respect both to drug efficacy and to the disparity between evidence-based medicine and actual clinical practice particularly in relation to treatment strategies for the elderly. Current statins fall short of requirements for 'ideal' lipid-lowering treatment in several respects; 'super' statins and other agents currently in development may satisfy more of these requirements. Moreover, available therapies are not applied optimally, because of physician nonacceptance and/or patient noncompliance; thus, the majority of patients with CHD or its risk factors still have cholesterol levels that exceed guideline targets. There is also evidence that older patients with CHD, or at high risk of CHD, are undertreated - possibly because of concerns regarding the increased likelihood of adverse events or drug interactions or doubts regarding the cost effectiveness of statin therapy in this population. This group is of particular clinical relevance, since it is showing a proportionate rapid expansion in most national populations. To address their potential healthcare needs, the ongoing Pravastatin in the Elderly at Risk (PROSPER) study is assessing the effects of pravastatin in elderly patients (5804 men and women aged 70-82 years) who either have pre-existing vascular disease or are at significant risk for developing it, with the central hypothesis that statin therapy (pravastatin 40 mg/day) will diminish the risk of subsequent major vascular events compared with placebo. After a 3.2-year treatment period, a primary assessment will be made of the influence of statin treatment on major cardiovascular events (a combination of CHD death, nonfatal myocardial infarction, and fatal or nonfatal stroke). Optimal deployment of the currently available agents and of newer agents (no matter how well they satisfy requirements for ideal treatment) ultimately depends on the establishment of an evidence base and may require far-reaching educational programmes that change the way risk factor management is viewed by caregivers and patients alike.

Hypertension and hypercholesterolaemia as risk factors for Alzheimer's disease: potential for pharmacological intervention

This paper focuses on hypertension and hypercholesterolaemia as risk factors for Alzheimer's disease and, as such, subjects for prevention. The long-term, prospective, population-based studies regarding the relationship between hypertension or hypercholesterolaemia and Alzheimer's disease, and the clinical studies regarding the association between antihypertensive or lipid-lowering medications and the risk of Alzheimer's disease, are reviewed. These studies provide evidence to suggest that elevated blood pressure and cholesterol levels earlier in life may have an important role in the development and expression of late-life Alzheimer's disease. Based on these data, we propose that proper, early interventions aimed at reducing these cardiovascular risk factors may have an impact on the future incidence and prevalence of Alzheimer's disease.

Issues surrounding age: vascular disease in the elderly

One-fifth of all humans who have survived beyond the age of 65 are alive today, and in the industrialized world the elderly segment of the population is expanding most rapidly. In biological terms, these survivors are healthier than the elderly of previous generations. However 'there are no diseases peculiar to old age and very few from which it is exempt' (Alfred Worcester, 1855-1951), and so society will inevitably accumulate a significant share of degenerative diseases within the ranks of its senior citizens. In the last two decades, the prevalence of stroke, diabetes mellitus, arthritis and heart disease has increased significantly as a tangible index of ageing in the population, and these diseases have been accompanied by degenerating cognitive function and physical disability, both of which are adding increasing stress to community healthcare and social services. Policy-makers need to understand and monitor these trends in order to make informed and cogent decisions about the management of this growing problem. This review highlights some of the key health issues facing the elderly in regard to coronary artery disease, insulin resistance, redox status, and statin therapy, in the hope that enlightened debate will inform decision making on resource allocation for this important and growing segment of society.