Abstract
Although dyslipidemia increases the risk for ischemic stroke, previous studies reported conflicting data regarding the association between lipid levels and stroke severity and outcome. To evaluate the predictive value of major lipids in patients with acute ischemic stroke. We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0 % males, age 79.4 ± 6.8 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Moderate/severe stroke was defined as NIHSS ≥5. The outcome was assessed with dependency rates at discharge (modified Rankin scale between 2 and 5) and with in-hospital mortality. Independent predictors of moderate/severe stroke were age (relative risk (RR) 1.05, 95 % confidence interval (CI) 1.02–1.08, p < 0.001), atrial fibrillation (RR 1.71, 95 % CI 1.19–2.47, p < 0.005), heart rate (RR 1.02, 95 % CI 1.01–1.04, p < 0.001), log-triglyceride (TG) levels (RR 0.24, 95 % CI 0.08–0.68, p < 0.01) and high-density lipoprotein cholesterol (HDL-C) levels (RR 0.97, 95 % CI 0.95–0.98, p < 0.001). Major lipids did not predict dependency at discharge. Independent predictors of in-hospital mortality were atrial fibrillation (RR 2.35, 95 % CI 1.09–5.04, p < 0.05), diastolic blood pressure (RR 1.05, 95 % CI 1.02–1.08, p < 0.001), log-TG levels (RR 0.09, 95 % CI 0.01–0.87, p < 0.05) and NIHSS at admission (RR 1.19, 95 % CI 1.14–1.24, p < 0.001). Low-density lipoprotein cholesterol levels were not associated with stroke severity or outcome. Lower TG and HDL-C levels are associated with more severe stroke. Lower TG levels also appear to predict in-hospital mortality in patients with acute ischemic stroke.
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Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, Sillesen H, Simunovic L, Szarek M, Welch KM, Zivin JA, Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators (2006) High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 355:549–559
Amarenco P, Labreuche J, Touboul PJ (2008) High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review. Atherosclerosis 196:489–496
Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 376:1670–1681
Bouziana SD, Tziomalos K (2011) Malnutrition in patients with acute stroke. J Nutr Metab 2011:167898
Cuadrado-Godia E, Jiménez-Conde J, Ois A, Rodríguez-Campello A, García-Ramallo E, Roquer J (2009) Sex differences in the prognostic value of the lipid profile after the first ischemic stroke. J Neurol 256:989–995
Dziedzic T, Slowik A, Gryz EA, Szczudlik A (2004) Lower serum triglyceride level is associated with increased stroke severity. Stroke 35:e151–e152
Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502
Jain M, Jain A, Yerragondu N, Brown RD, Rabinstein A, Jahromi BS, Vaidyanathan L, Blyth B, Stead LG (2013) The triglyceride paradox in stroke survivors: a prospective study. Neurosci J 2013:870608
Jun M, Foote C, Lv J, Neal B, Patel A, Nicholls SJ, Grobbee DE, Cass A, Chalmers J, Perkovic V (2010) Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet 375:1875–1884
Kisialiou A, Pelone G, Carrizzo A, Grillea G, Trimarco V, Marino M, Bartolo M, De Nunzio AM, Grella R, Landolfi A, Puca A, Colonnese C, Vecchione C (2012) Blood biomarkers role in acute ischemic stroke patients: higher is worse or better? Immun Ageing 9:22
Koton S, Molshatzki N, Bornstein NM, Tanne D (2012) Low cholesterol, statins and outcomes in patients with first-ever acute ischemic stroke. Cerebrovasc Dis 34:213–220
Labreuche J, Touboul PJ, Amarenco P (2009) Plasma triglyceride levels and risk of stroke and carotid atherosclerosis: a systematic review of the epidemiological studies. Atherosclerosis 203:331–345
Landray MJ, Haynes R, Hopewell JC, Parish S, Aung T, Tomson J, Wallendszus K, Craig M, Jiang L, Collins R, Armitage J (2014) Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med 371:203–212
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130:461–470
Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, Qizilbash N, Peto R, Collins R (2007) Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 370:1829–1839
Listenberger LL, Han X, Lewis SE, Cases S, Farese RV Jr, Ory DS, Schaffer JE (2003) Triglyceride accumulation protects against fatty acid-induced lipotoxicity. Proc Natl Acad Sci U S A 100:3077–3082
Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA, American Heart Association Council on Cardiovascular Nursing and the Stroke Council (2010) Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke 41:2402–2448
Olsen TS, Christensen RH, Kammersgaard LP, Andersen KK (2007) Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen stroke study. Stroke 38:2646–2651
Pikija S, Milevcic D, Trkulja V, Kidemet-Piskac S, Pavlicek I, Sokol N (2006) Higher serum triglyceride level in patients with acute ischemic stroke is associated with lower infarct volume on CT brain scans. Eur Neurol 55:89–92
Rader DJ, Hovingh GK (2014) HDL and cardiovascular disease. Lancet 384:618–625
Sanossian N, Saver JL, Kim D, Razinia T, Ovbiagele B (2006) Do high-density lipoprotein cholesterol levels influence stroke severity? J Stroke Cerebrovasc Dis 15:187–189
Simundic AM, Nikolac N, Topic E, Basic-Kes V, Demarin V (2008) Are serum lipids measured on stroke admission prognostic? Clin Chem Lab Med 46:1163–1167
Townsend N, Nichols M, Scarborough P, Rayner M (2015) Cardiovascular disease in Europe - epidemiological update 2015. Eur Heart J 36:2696–2705
Tuttolomondo A, Di Raimondo D, Di Sciacca R, Pedone C, La Placa S, Arnao V, Pinto A, Licata G (2013) Effects of clinical and laboratory variables at admission and of in-hospital treatment with cardiovascular drugs on short term prognosis of ischemic stroke. The GIFA study. Nutr Metab Cardiovasc Dis 23:642–649
Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP (2009) Dyslipidemia as a risk factor for ischemic stroke. Curr Top Med Chem 9:1291–1297
Vauthey C, de Freitas GR, van Melle G, Devuyst G, Bogousslavsky J (2000) Better outcome after stroke with higher serum cholesterol levels. Neurology 54:1944–1949
Weir CJ, Sattar N, Walters MR, Lees KR (2003) Low triglyceride, not low cholesterol concentration, independently predicts poor outcome following acute stroke. Cerebrovasc Dis 16:76–82
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Tziomalos, K., Giampatzis, V., Bouziana, S.D. et al. Prognostic significance of major lipids in patients with acute ischemic stroke. Metab Brain Dis 32, 395–400 (2017). https://doi.org/10.1007/s11011-016-9924-9
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DOI: https://doi.org/10.1007/s11011-016-9924-9