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Hoshino T. Prognostic Implications of the Acute Lipid Levels in Stroke Patients. J Atheroscler Thromb 2024; 31:1133-1134. [PMID: 38658326 PMCID: PMC11300718 DOI: 10.5551/jat.ed261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Takao Hoshino
- Department of Neurology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
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Xu Q, Li C, Jing P, Li H, Tian X, Xia X, Zhang Y, Zhang X, Wang Y, Wang A, Meng X. Low-Density Lipoprotein Cholesterol to Triglyceride Ratio and Clinical Outcomes after Acute Ischaemic Stroke or Transient Ischaemic Attack. J Atheroscler Thromb 2024; 31:1162-1178. [PMID: 38382995 PMCID: PMC11300661 DOI: 10.5551/jat.64704] [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: 10/26/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024] Open
Abstract
AIMS Studies showed that low-density lipoprotein cholesterol (LDL-C) to triglyceride (TG) ratio could be used as a predictive parameter of low-density lipoprotein oxidation in vivo and the level of small dense LDL-C. However, whether LDL-C/TG ratio is associated with stroke prognosis remains unclear. We investigated the associations of LDL-C/TG ratio with outcomes in patients with acute ischaemic stroke (AIS) or transient ischaemic attacks (TIA) and explored whether it produced more predictive value than LDL-C and TG. METHODS Data were derived from the Third China National Stroke Registry (CNSR-III). Multivariable Cox regression for stroke recurrence, composite vascular events and all-cause death and logistic regression for the poor functional outcome (modified Rankin Scale score 3-6) were used. RESULTS A total of 14123 patients were included. After adjusting for confounding factors, quartile 4 of LDL-C/TG ratio was associated with an increased risk of recurrent stroke (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.03-1.56), composite vascular events (HR,1.23; 95% CI, 1.00-1.52), death (HR,1.70; 95% CI, 1.13-2.54) and poor functional outcome (odds ratio, 1.34; 95% CI, 1.12-1.61) at 3 months follow-up compared with quartile 1. We also found that quartile 4 of LDL-C and TG was positively and negatively associated with poor functional outcome at 3 months, respectively. LDL-C/TG ratio performed better than LDL-C or TG in predicting clinical outcomes. CONCLUSIONS LDL-C/TG ratio was associated with the risk of stroke recurrence, composite vascular events, death and poor functional outcome in patients with AIS or TIA.
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Affiliation(s)
- Qin 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
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Changjun Li
- Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Jing
- Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 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
| | - Xue Tian
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xue Xia
- 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
| | - Yijun Zhang
- 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
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- 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
| | - 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
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Anxin 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
- Beijing Municipal Key Laboratory of Clinical Epidemiology, 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
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Kim JT, Lee JS, Kim H, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee K, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Ryu WS, Park KY, Lee J, Bae HJ. Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes. J Clin Lipidol 2024; 18:e207-e217. [PMID: 38101971 DOI: 10.1016/j.jacl.2023.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/26/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Because ischemic stroke is heterogeneous, the associations between low-density lipoprotein (LDL)-cholesterol levels and early vascular outcomes might be different according to the stroke subtype in acute ischemic stroke patients. METHODS This study was an analysis of a prospective, multicenter, stroke registry. Acute ischemic stroke patients previously not treated with statins were included. Admission LDL-cholesterol levels were divided into 7 groups at 20 mg/dl intervals for comparison. The primary early vascular outcome was a composite of stroke, myocardial infarction (MI) and all-cause mortality within 3 months. RESULTS A total of 38,531 patients (age, 68.5 ± 12.8 yrs; male, 59.6%) were analyzed for this study. The 3-month cumulative incidences of the composite of stroke, MI, and all-cause mortality significantly differed among the LDL-cholesterol level groups, with the highest event rate (11.11%) in the lowest LDL-cholesterol group (<70 mg/dl). After adjustment, the U-shaped associations of LDL-cholesterol levels with primary outcome and all-cause mortality were observed. For the stroke subtypes, there were substantial interactions between the LDL-cholesterol groups and stroke subtype and all-cause mortality (Pinteraction=0.07). Different patterns, with higher risks of all-cause mortality in the lower LDL-cholesterol in the large artery atherosclerosis subtype (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 0.98-1.69), but in the higher LDL-cholesterol in the cardioembolism subtype (aHR 1.71 95% CI [1.28-2.29]), were observed among stroke subtypes. CONCLUSION We found that there were differential associations of admission LDL-cholesterol levels with all-cause mortality within 3 months among stroke subtypes. These results suggest that admission LDL-cholesterol and early vascular outcomes had complex relationships in patients with ischemic stroke according to the stroke subtypes.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (Drs Kim and Park).
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Dr Lee)
| | - Hyunsoo Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (Drs Kim and Park)
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (Drs Kim, Kang, Lee, and Bae)
| | - Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (Drs Kim, Kang, Lee, and Bae)
| | - Keon-Joo Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (Drs Kim, Kang, Lee, and Bae); Department of Neurology, Korea University Guro Hospital, Seoul, Korea (Dr Lee)
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Korea (Dr Park)
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea (Dr Kang)
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea (Drs Lee and Kim)
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea (Drs Lee and Kim)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea (Drs Cha and Kim)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea (Drs Cha and Kim)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea (Dr Park)
| | - Kyungbok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea (Dr Lee)
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea (Dr Lee)
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (Drs Hong, Cho, and Park)
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (Drs Hong, Cho, and Park)
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (Drs Hong, Cho, and Park)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (Drs Lee, Yu, and Oh)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (Drs Lee, Yu, and Oh)
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (Drs Lee, Yu, and Oh)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (Dr Kim)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea (Dr Choi)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea (Drs Kwon and Kim)
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea (Drs Kwon and Kim)
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (Drs Shin and Yum)
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (Drs Shin and Yum)
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea (Drs Sohn and Hong)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea (Drs Sohn and Hong)
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Korea (Dr Lee)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (Drs Kim and Park)
| | - Wi-Sun Ryu
- Artificial Intelligence Research Center, JLK Inc, Seoul, Korea (Dr Ryu)
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (Dr Park)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (Dr Lee)
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (Drs Kim, Kang, Lee, and Bae).
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Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee K, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Lee J, Park KY, Bae HJ. Admission LDL-cholesterol, statin pretreatment and early outcomes in acute ischemic stroke. J Clin Lipidol 2023; 17:612-621. [PMID: 37574400 DOI: 10.1016/j.jacl.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission. OBJECTIVE This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes. PATIENTS AND METHODS This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored. RESULTS A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (Pnon-linearity<0.001), with substantial relationships in the no pretreatment subgroup. CONCLUSIONS The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Ji Sung Lee
- Clinical Research Center (Dr Lee), Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jihoon Kang
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keon-Joo Lee
- Department of Neurology (Dr Lee), Korea University Guro Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology (Dr Park), Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Korea
| | - Kyusik Kang
- Department of Neurology (Dr Kang), Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology (Drs Lee, Kim), Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae Guk Kim
- Department of Neurology (Drs Lee, Kim), Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae-Kwan Cha
- Department of Neurology (Drs Cha, Kim), Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology (Drs Cha, Kim), Dong-A University Hospital, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology (Dr Park), Seoul Medical Center, Seoul, Korea
| | - Kyungbok Lee
- Department of Neurology (Dr Lee), Soonchunhyang University Hospital, Seoul, Korea
| | - Jun Lee
- Department of Neurology (Dr Lee), Yeungnam University Hospital, Daegu, Korea
| | - Keun-Sik Hong
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Sun Oh
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong-Eog Kim
- Department of Neurology (Drs Kim, Ryu), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Wi-Sun Ryu
- Department of Neurology (Drs Kim, Ryu), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology (Dr Choi), Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jee-Hyun Kwon
- Department of Neurology (Drs Kwon, Kim), Ulsan University College of Medicine, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology (Drs Kwon, Kim), Ulsan University College of Medicine, Ulsan, Korea
| | - Dong-Ick Shin
- Department of Neurology (Drs Shin, Yum), Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Sun Yum
- Department of Neurology (Drs Shin, Yum), Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Il Sohn
- Department of Neurology (Drs Sohn, Hong), Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology (Drs Sohn, Hong), Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang-Hwa Lee
- Department of Neurology (Dr Lee), Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Man-Seok Park
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Juneyoung Lee
- Department of Biostatistics (Dr Lee), Korea University College of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology (Dr Park), Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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Azeez TA, Yaria J, Adetunji TA. Stroke and dyslipidaemia in Africa: a meta-analysis of case-control studies. J Thromb Thrombolysis 2023:10.1007/s11239-023-02823-9. [PMID: 37148438 DOI: 10.1007/s11239-023-02823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Stroke is an acute neurological disorder characterized by an abrupt reduction in blood flow to the brain, spinal cord, or retina. There is a complex relationship between stroke and dyslipidaemia. The objective of the study was to determine the likelihood of dyslipidaemia in African stroke patients. METHODS AND RESULTS This study is a systematic review and meta-analysis of case-control studies to determine the odds ratio of dyslipidaemia among stroke patients in Africa. It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The sources of data included Google Scholar, PubMed, SCOPUS, African Journal Online (AJOL), Research Square, SciELO, and medRxiv databases. The case-control studies eligible were conducted in Africa. The meta-analysis was carried out with Meta XL version 5.3, using the random effect model. RESULTS Ten studies met the eligibility criteria and the total sample size was 9599. The odds ratio of dyslipidaemia in all stroke cases in Africa was 1.61 (95% CI: 1.28-2.03) while that of ischaemic stroke and haemorrhagic stroke are 1.27 (0.54-2.98) and 1.71 (1.43-2.05) respectively. CONCLUSION Although not particularly substantial, there is an association between dyslipidaemia and stroke in Africa.
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Affiliation(s)
- Taoreed Adegoke Azeez
- Department of Medicine, Reddington Multi-Specialist Hospital, 12, Idowu Martins Street, Victoria Island, Lagos, Nigeria.
| | - Joseph Yaria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
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Vandewalle L, Duchi F, Verhelle K, Vanacker P. Suboptimal lipid management in patients with acute ischemic stroke. Clin Neurol Neurosurg 2023; 229:107717. [PMID: 37079961 DOI: 10.1016/j.clineuro.2023.107717] [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: 11/16/2022] [Revised: 03/17/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Lipid-lowering drugs are among the most widely used drugs in cardiovascular prevention. Statins are often abandoned due to side effects, or under dosed, leading to unreached LDL-cholesterol goals and increased occurrence of cardiovascular events. METHODS We included hospitalized patients with an ischemic stroke or transient ischemic attack. Of 92 patients, low density lipoprotein cholesterol (LDL-C) levels and lipid lowering therapy at admission and discharge were assessed. Based on their cardiovascular risk before the current event according to the most recent European guidelines, LDL-C targets were determined. Low, moderate, high and very high risk corresponded with LDL-C targets below 116, 100, 70 and 55 mg/dL respectively. RESULTS Before current event, 59 (64%) were very high, 21 (23%) high, 11 (12%) moderate and 1 low risk patients and eight patients were treated with low, 23 moderate, and 21 high intensity lipid-lowering therapy. Upon admission, 75 patients had insufficiently managed LDL-cholesterol levels, yet 39 of them were taking lipid lowering therapy. Only eight of the 21 patients on high intensity lipid lowering therapy reached their LDL-C target. During hospitalization 40 patients were switched to a high-intensity statin. Thirty-three patients switched from no treatment or a lower-intensity to a moderate-intensity lipid lowering therapy. Three were dismissed with low-intensity lipid lowering therapy, and five in association with Ezetimibe. Three patients had documented statin-intolerance. CONCLUSION In this study, LDL-cholesterol was insufficiently managed according to international guidelines for prevention of ischemic stroke. Further optimization of lipid management in primary and secondary prevention and the use of higher intensity lipid lowering therapy in clinical practice is mandatory.
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Affiliation(s)
- L Vandewalle
- Department of Neurology, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium; Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Neurosciences, Experimental neurology, KU Leuven - University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - F Duchi
- Department of Clinical Pharmacy, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - K Verhelle
- Department of Clinical Pharmacy, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - P Vanacker
- Department of Neurology, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium; Research Group on Translational Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Antwerp University Hospital, Neurovascular Reference Center, Department of Neurology, Drie Eikenstraat 655, 2650 Edegem, Belgium.
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Simmons CA, Poupore N, Nathaniel TI. Age Stratification and Stroke Severity in the Telestroke Network. J Clin Med 2023; 12:jcm12041519. [PMID: 36836054 PMCID: PMC9963120 DOI: 10.3390/jcm12041519] [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: 12/24/2022] [Revised: 01/30/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Age is one of the most important risk factors for stroke, and an estimated 75% of strokes occur in people 65 years old and above. Adults > 75 years of age experience more hospitalizations and higher mortality. In this study, we aimed to investigate how age and various clinical risk factors affect acute ischemic stroke (AIS) severity in two age categories. METHODS This retrospective data analysis study was conducted using data collected from the PRISMA Health Stroke Registry between June 2010 and July 2016. Baseline clinical and demographic data were analyzed for 65-74-year-old patients and those ≥ 75 years of age. This study aimed to investigate risk factors associated with stroke severity in these two age categories of AIS patients treated in telestroke settings. RESULTS An adjusted multivariate analysis showed that the acute ischemic stroke (AIS) population of 65-74-year-old patients experiencing heart failure (odds ratio (OR) = 4.398, 95% CI = 3.912-494.613, p = 0.002) and elevated high-density lipoprotein (HDL) levels (OR = 1.066, 95% CI = 1.009-1.126, p = 0.024) trended towards worsening neurological function, while patients experiencing obesity (OR = 0.177, 95% CI = 0.041-0.760, p = 0.020) exhibited improved neurological functions. For the patients ≥ 75 years of age, direct admission (OR = 0.270, 95% CI = 0.085-0.856, p = 0.026) was associated with improved functions. CONCLUSIONS Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions in patients aged 65-74. Obese patients and individuals ≥ 75 years of age who were directly admitted were most likely to exhibit improving neurological functions.
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Affiliation(s)
- Cassie A. Simmons
- Department of Biology, North Greenville University, Tigerville, SC 29688, USA
| | - Nicolas Poupore
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Thomas I. Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
- Correspondence: ; Tel.: +1-44559846; Fax: +1-44558404
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Impact of Traditional and Non-Traditional Lipid Parameters on Outcomes after Intravenous Thrombolysis in Acute Ischemic Stroke. J Clin Med 2022; 11:jcm11237148. [PMID: 36498722 PMCID: PMC9737232 DOI: 10.3390/jcm11237148] [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: 11/14/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Contradicting evidence exists regarding the role of lipids in outcomes following intravenous (IV) thrombolysis with tissue plasminogen activator (tPA). Restricted cubic spline curves and adjusted logistic regression were used to evaluate associations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and LDL-C/HDL-C ratio with poor functional outcome, symptomatic intracranial hemorrhage (SICH) and 90-day mortality, among 1004 acute ischemic stroke (AIS) patients who received IV tPA in a comprehensive stroke center. Quartile (Q) 1, Q2 and Q3 of HDL-C were associated with increased odds of poor functional outcome (adjusted odds ratio (adjOR) 1.66, 95% CI 1.06-2.60, p = 0.028, adjOR 1.63, 95% CI 1.05-2.53, p = 0.027, adjOR 1.56, 95% CI 1.01-2.44, p = 0.048) compared to Q4. Q2 and Q4 of non-HDL-C were associated with increased odds of SICH (adjOR 4.28, 95% CI 1.36-18.90, p = 0.025, adjOR 5.17, 95% CI 1.64-22.81, p = 0.011) compared to Q3. Q1 and Q2 of LDL-C was associated with increased odds of mortality (adjOR 2.57, 95% CI 1.27-5.57, p = 0.011 and adjOR 2.28, 95% CI 1.10-5.02, p = 0.032) compared to Q3. In AIS patients who received IV tPA, low LDL-C was associated with increased odds of mortality while HDL-C may be protective against poor functional outcome.
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9
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Lu Q, Zhang H, Cao X, Fu J, Pan Y, Zheng X, Wang J, Geng D, Zhang J. Quantitative collateral score for the prediction of clinical outcomes in stroke patients: Better than visual grading. Front Neurosci 2022; 16:980135. [PMID: 36389251 PMCID: PMC9641373 DOI: 10.3389/fnins.2022.980135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To identify preoperative prognostic factors for acute ischemic stroke (AIS) patients receiving mechanical thrombectomy (MT) and compare the performance of quantitative collateral score (qCS) and visual collateral score (vCS) in outcome prediction. Methods Fifty-five patients with AIS receiving MT were retrospectively enrolled. qCS was defined as the percentage of the volume of collaterals of both hemispheres. Based on the dichotomous outcome assessed using a 90-day modified Rankin Scale (mRS), we compared qCS, vCS, age, sex, National Institute of Health stroke scale score, etiological subtype, platelet count, international normalized ratio, glucose levels, and low-density lipoprotein cholesterol (LDL-C) levels between favorable and unfavorable outcome groups. Logistic regression analysis was performed to determine the effect on the clinical outcome. The discriminatory power of qCS, vCS, and their combination with cofounders for determining favorable outcomes was tested with the area under the receiver-operating characteristic curve (AUC). Results vCS, qCS, LDL-C, and age could all predict clinical outcomes. qCS is superior over vCS in predicting favorable outcomes with a relatively higher AUC value (qCS vs. vCS: 0.81 vs. 0.74) and a higher sensitivity rate (qCS vs. vCS: 72.7% vs. 40.9%). The prediction power of qCS + LDL-C + age was best with an AUC value of 0.91, but the accuracy was just increased slightly compared to that of qCS alone. Conclusion Collateral scores, LDL-C and age were independent prognostic predictors for patients with AIS receiving MT; qCS was a better predictor than vCS. Furthermore, qCS + LDL-C + age offers a strong prognostic prediction power and qCS alone was another good choice for predicting clinical outcome.
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Affiliation(s)
- Qingqing Lu
- State Key Laboratory of Medical Neurobiology, Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Haiyan Zhang
- State Key Laboratory of Medical Neurobiology, Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Cao
- State Key Laboratory of Medical Neurobiology, Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Junyan Fu
- State Key Laboratory of Medical Neurobiology, Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuning Pan
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Xiaodong Zheng
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jianhong Wang,
| | - Daoying Geng
- State Key Laboratory of Medical Neurobiology, Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Daoying Geng,
| | - Jun Zhang
- State Key Laboratory of Medical Neurobiology, Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Huashan Hospital, Fudan University, Shanghai, China
- Jun Zhang,
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10
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Ha SH, Ryu JC, Bae JH, Koo S, Kwon B, Song Y, Lee DH, Chang JY, Kang DW, Kwon SU, Kim JS, Kim BJ. High serum total cholesterol associated with good outcome in endovascular thrombectomy for acute large artery occlusion. Neurol Sci 2022; 43:5985-5991. [DOI: 10.1007/s10072-022-06269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
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11
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Andone S, Farczádi L, Imre S, Bălașa R. Fatty Acids and Lipid Paradox-Neuroprotective Biomarkers in Ischemic Stroke. Int J Mol Sci 2022; 23:ijms231810810. [PMID: 36142720 PMCID: PMC9505290 DOI: 10.3390/ijms231810810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Stroke is the primary cause of death and disability worldwide, with ischemic stroke up to 80% of the total cases. Lipid profile was established as a major risk factor for stroke, but recent studies show a paradoxical relationship between serum values and the outcome of stroke patients. Our study aims to analyze the impact of the classic extended lipid profile, including fatty acids as potential neuroprotective biomarkers for the outcome of ischemic stroke patients. We included 298 patients and collected clinical, paraclinical, and outcome parameters. We used a method consisting of high-performance liquid chromatography coupled with mass spectrometry to quantify serum fatty acids. We observed a negative correlation between National Institutes of Health Stroke Scale (NIHSS) at admission and total cholesterol (p = 0.040; r = −0.120), respectively triglycerides (p = 0.041; r = −0.122). The eicosapentaenoic to arachidonic acid ratio has a negative correlation, while the docosahexaenoic to eicosapentaenoic acid ratio positively correlates with all the prognostic parameters, showing a potential neuroprotective role for eicosapentaenoic acid in preventing severe ischemic stroke. The impact of the lipid profile paradox and the dependency relationship with the fatty acids represent a significant predictive factor for the functional and disability prognostic of ischemic stroke patients.
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Affiliation(s)
- Sebastian Andone
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Târgu Mures, Romania
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Correspondence:
| | - Lénárd Farczádi
- Center for Advanced Medical and Pharmaceutical Research, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Silvia Imre
- Center for Advanced Medical and Pharmaceutical Research, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
- Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Rodica Bălașa
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Târgu Mures, Romania
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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12
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Brechtel L, Poupore N, Monroe M, Knisely K, Sanders C, Edrissi C, Rathfoot C, Nathaniel TI. Role of dyslipidemia in ischemic stroke patients treated in the telestroke network. Adv Med Sci 2021; 66:254-261. [PMID: 33940526 DOI: 10.1016/j.advms.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The relationship between the telestroke technology and clinical risk factors in a dysplipidemic ischemic stroke population and neurologic outcomes is not fully understood. This issue was investigated in this study. PATIENTS AND METHODS We analyzed retrospective data collected from a regional stroke registry to identify demographic and clinical risk factors in patients with improving (NIHSS ≤ 7) or worsening (NIHSS > 7) neurologic outcome in dyslipidemic ischemic stroke population. We used logistic multivariate models to identify independent predictors of improving or worsening outcome based on dyslipidemia disease status in ischemic stroke patients. RESULTS In the adjusted analysis for dyslipidemic ischemic stroke population, cholesterol reducer use (odd ratio; [OR] = 0.393, 95% confidence interval [CI], 0.176-0.879, P = 0.023) and direct admission (OR = 0.435, 95% CI, 0.199-0.953, P = 0.037) were more likely to be associated with neurologic improvement and no clinical or demographic factors were associated with poor neurologic outcome in dyslipidemic ischemic stroke patients treated in the telestroke network. For the ischemic stroke population without dyslipidemia, increasing age (OR = 1.070, 95% CI, 1.031-1.109, P < 0.001), coronary artery disease (OR = 3.633, 95% CI, 1.307-10.099, P = 0.013), history of drug or alcohol abuse (OR = 6.548, 95% CI, 1.106-38.777, P = 0.038), and improvement in ambulatory outcome (OR = 2.880, 95% CI, 1.183-7.010, P = 0.020) were associated with worsening neurological functions, while being Caucasian (OR = 0.294, 95% CI, 0.098-0.882, P = 0.029) was associated with improving neurologic functions. CONCLUSION Demographic and clinical risk factors among the dysplipidemic ischemic stroke population in the telestroke network were not associated with worsening neurologic functions.
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13
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Wu Z, Huang Z, Lichtenstein AH, Liu Y, Chen S, Jin Y, Na M, Bao L, Wu S, Gao X. The risk of ischemic stroke and hemorrhagic stroke in Chinese adults with low-density lipoprotein cholesterol concentrations < 70 mg/dL. BMC Med 2021; 19:142. [PMID: 34130689 PMCID: PMC8207613 DOI: 10.1186/s12916-021-02014-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/20/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The risk of stroke in individuals with very low low-density lipoprotein cholesterol (LDL-C) concentrations remains high. We sought to prioritize predictive risk factors for stroke in Chinese participants with LDL-C concentrations < 70 mg/dL using a survival conditional inference tree, a machine learning method. METHODS The training dataset included 9327 individuals with LDL-C concentrations < 70 mg/dL who were free of cardiovascular diseases and did not use lipid-modifying drugs from the Kailuan I study (N = 101,510). We examined the validity of this algorithm in a second Chinese cohort of 1753 participants with LDL-C concentrations < 70 mg/dL from the Kailuan II study (N = 35,856). RESULTS During a mean 8.5-9.0-year follow-up period, we identified 388 ischemic stroke cases and 145 hemorrhagic stroke cases in the training dataset and 20 ischemic stroke cases and 8 hemorrhagic stroke cases in the validation dataset. Of 15 examined predictors, poorly controlled blood pressure and very low LDL-C concentrations (≤ 40 mg/dL) were the top hierarchical predictors of both ischemic stroke risk and hemorrhagic stroke risk. The groups, characterized by the presence of 2-3 of aforementioned risk factors, were associated with a higher risk of ischemic stroke (hazard ratio (HR) 7.03; 95% confidence interval (CI) 5.01-9.85 in the training dataset; HR 4.68, 95%CI 1.58-13.9 in the validation dataset) and hemorrhagic stroke (HR 3.94, 95%CI 2.54-6.11 in the training dataset; HR 4.73, 95%CI 0.81-27.6 in the validation dataset), relative to the lowest risk groups (presence of 0-1 of these factors). There was a linear association between cumulative average LDL-C concentrations and stroke risk. LDL-C concentrations ≤ 40 mg/dL was significantly associated with increased risk of ischemic stroke (HR 2.07, 95%CI 1.53, 2.80) and hemorrhagic stroke (HR 2.70, 95%CI 1.70, 4.30) compared to LDL-C concentrations of 55-70 mg/dL, after adjustment for age, hypertension status, and other covariates. CONCLUSION Individuals with extremely low LDL-C concentrations without previous lipid-modifying treatment could still be at high stroke risk. TRIAL REGISTRATION Chinese Clinical Trial Register, ChiCTR-TNRC-11001489 . Registered on 24-08-2011.
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Affiliation(s)
- Zhijun Wu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Zhe Huang
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd, Tangshan, 063000, People's Republic of China
| | - Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Yesong Liu
- Department of Neurology, Kailuan General Hospital, Tangshan, People's Republic of China
| | - Shuohua Chen
- Health Care Center, Kailuan Medical Group, Tangshan, People's Republic of China
| | - Yao Jin
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Muzi Na
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
| | - Le Bao
- Department of Statistics, The Pennsylvania State University, 109 Chandlee Lab, State College, University Park, PA, 16802, USA
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd, Tangshan, 063000, People's Republic of China.
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA.
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14
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Sanders CB, Knisely K, Edrissi C, Rathfoot C, Poupore N, Wormack L, Nathaniel T. Obstructive sleep apnea and stroke severity: Impact of clinical risk factors. Brain Circ 2021; 7:92-103. [PMID: 34189352 PMCID: PMC8191529 DOI: 10.4103/bc.bc_57_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Specific clinical and demographic risk factors may be associated with improving or worsening neurologic outcomes within a population of acute ischemic stroke (AIS) patients with a history of obstructive sleep apnea (OSA). The objective of this study was to determine the changes in neurologic outcome during a 14-day recovery as it relates to initial stroke severity in AIS patients with OSA. METHODS This retrospective study analyzed baseline clinical risk factors and demographic data collected in a regional stroke center from January 2010 to June 2016. Our primary endpoint measure was the National Institutes of Health Stroke Scale (NIHSS) score and our secondary endpoint measures included the clinical factors associated with improving (NIHSS score ≤7) or worsening (NIHSS score >7) neurological outcome. The relative contribution of each variable to stroke severity and related outcome was determined using a logistic regression. The regression models were checked for the overall correct classification percentage using a Hosmer-Lemeshow test, and the sensitivity of our models was determined by the area under the receiver operating characteristic curve. RESULTS A total of 5469 AIS patients were identified. Of this, 96.89% did not present with OSA while 3.11% of AIS patients presented with OSA. Adjusted multivariate analysis demonstrated that in the AIS population with OSA, atrial fibrillation (AF) (odds ratio [OR] = 3.36, 95% confidence interval [CI], 1.289-8.762, P = 0.013) and changes in ambulatory status (OR = 2.813, 95% CI, 1.123-7.041, P = 0.027) showed an association with NIHSS score >7 while being Caucasian (OR = 0.214, 95% CI, 0.06-0.767, P = 0.018) was associated with NIHSS score ≤7. CONCLUSION In AIS patients with OSA, AF and changes in ambulatory status were associated with worsening neurological outcome while Caucasian patients were associated with improving neurological outcome. Our findings may have significant implications for patient stratification when determining treatment protocols with respect to neurologic outcomes in AIS patients with OSA.
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Affiliation(s)
- Carolyn Breauna Sanders
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Krista Knisely
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Camron Edrissi
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Chase Rathfoot
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Nicolas Poupore
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Leah Wormack
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Thomas Nathaniel
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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15
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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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16
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Xun K, Mo J, Ruan S, Dai J, Zhang W, Lv Y, Du N, Chen S, Shen Z, Wu Y. A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy. Cerebrovasc Dis 2020; 50:185-199. [PMID: 33378751 DOI: 10.1159/000512609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Posterior circulation stroke is characterized by poor prognosis because its optimal thrombolysis "time window" is always missed. After mechanical thrombectomy (MT), the recanalization rate of posterior circulation obstruction is significantly increased, but prognosis remains poor. To best manage patients, prognostic factors are needed to inform MT triaging after posterior circulation stroke. METHODS A systematic literature search was done for the period through April 2020. Studies included those with posterior circulation stroke cases that underwent MT. The primary outcome measure in this study was the modified Rankin Scale on day 90. RESULTS No outcome differences were found in gender, atrial fibrillation, smoking, and coronary artery disease (OR = 1.07, 95% CI: 0.90-1.28; OR = 1.02, 95% CI: 0.82-1.26; OR = 1.26, 95% CI: 0.94-1.68; and OR = 0.84, 95% CI: 0.58-1.22, respectively). Hypertension, diabetes mellitus, and previous stroke correlated with poorer prognosis (OR = 0.61, 95% CI: 0.48-0.77; OR = 0.60, 95% CI: 0.50-0.73; and OR = 0.74, 95% CI: 0.55-0.99, respectively). However, hyperlipidemia correlated with better prognosis (OR = 1.28, 95% CI: 1.04-1.58). CONCLUSION Our analysis indicates that hypertension, diabetes mellitus, or previous stroke correlate with poorer outcomes. Intriguingly, hyperlipidemia correlates with better prognosis. These factors may help inform triage decisions when considering MT for posterior circulation stroke patients. However, large, multicenter, randomized controlled trials are needed to validate these observations.
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Affiliation(s)
- Kai Xun
- Department of Emergency, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiahang Mo
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shunyi Ruan
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinyao Dai
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenting Zhang
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuqi Lv
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Nannan Du
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shengyue Chen
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zefeng Shen
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yuanxi Wu
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China,
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17
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From hemorrhagic stroke to lipid paradox: a double-hit hypothesis underlying low low-density lipoprotein cholesterol related cardiovascular risk—a narrative review. JOURNAL OF BIO-X RESEARCH 2020. [DOI: 10.1097/jbr.0000000000000067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Feng H, Wang X, Wang W, Zhao X. Association Between Non-high-density Lipoprotein Cholesterol and 3-Month Prognosis in Patients With Spontaneous Intracerebral Hemorrhage. Front Neurol 2020; 11:920. [PMID: 32973669 PMCID: PMC7473302 DOI: 10.3389/fneur.2020.00920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Previous studies have indicated a significant correlation between cholesterol levels and the incidence and outcomes of intracerebral hemorrhage (ICH), However, the association between non-high-density lipoprotein cholesterol (non-HDLC) levels and ICH functional outcomes are still unclear. Method: We included 654 consecutive spontaneous ICH patients who were enrolled in a prospective registry. We collected clinical, demographic, and laboratory data using standardized forms, and non-HDLC levels and 3-month modified Rankin Scale (mRS) scores were recorded. We performed multivariate logistic regression and interaction analyses to explored the association between non-HDLC levels and ICH functional outcomes. Results: Of 654 patients included in the study, 281 (42.9%) had poor functional outcome. Univariate analysis showed that high non-HDLC level was associated with good functional outcome at 90 days (p = 0.001). After adjustment for confounding factors, a high non-HDLC level (≥154.89 mg/dl) remained as an indicator of good functional outcome at 90 days [multivariate-adjusted odds ratios (OR) 0.50, 95%CI 0.27–0.92; p-value for trend = 0.043], and was stronger for female patients (OR: 0.13, 95%CI: 0.03–0.50). Conclusion: ICH patients with higher non-HDLC levels had a decreased prevalence of poor functional outcome at 90 days, and a high non-HDLC level is an independent indicator of good functional outcome at 90 days from onset, especially in females.
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Affiliation(s)
- Hao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Wenjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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