Achieving low density lipoprotein-cholesterol < 70 mg/dL may be associated with a trend of reduced progression of carotid artery atherosclerosis in ischemic stroke patients

Background and Purpose: Hemorrhagic transformation (HT) is a potentially serious complication in patients with acute ischemic stroke (AIS). Whether the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) is associated with HT remains unclear. Methods: Ischemic stroke patients within 7 days of stroke onset from January 2016 to November 2017 were included in this study. Lipid profiles were measured within 24h after admission. HT was determined by a second computed tomography or magnetic resonance imaging within 7 days after admission. Univariate and multivariate logistic regression analysis was used to assess the association between LDL-C/HDL-C and HT. Results: We enrolled 1239 patients with AIS (788 males; mean age, 64 ± 15 years), of whom 129 (10.4%) developed HT. LDL-C/HDL-C was significantly lower on admission in patients with HT than those without HT (2.00 ± 0.89 vs. 2.25 ± 1.02, P=0.009). The unadjusted odds ratio (OR) of low LDL-C/HDL-C for HT was 2.07 (95% confidence interval [CI] 1.42-3.01, P＜0.001). After adjustment for possible confounders, lower LDL-C/HDL-C (≤1.52) was significantly associated with HT (OR 1.53, 95% CI: 1.02-2.31, P=0.046). Similar results were observed between lower LDL-C (≤ 4 mmol/L) and HT (OR 4.17, 95% CI: 1.25-13.90, P=0.02). However, no significant association was found between HT and high HDL-C, low triglycerides or low total cholesterol. Conclusion: Lower LDL-C/HDL-C and LDL-C were significantly associated with increased risk of HT after AIS. Further investigations are warranted to confirm these findings and then optimize lipid management in stroke patients with lower LDL/HDL-C or LDL-C.

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Abstract WP320: The Management of low Density Lipid Cholesterol and Predictors of Goal Achievement in Stroke Patients in China

Stroke ◽

10.1161/str.47.suppl_1.wp320 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Chunjuan Wang ◽

Yilong Wang ◽

Zixiao Li ◽

Yongjun Wang

Keyword(s):

Ischemic Stroke ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Goal Achievement ◽

Lipoprotein Cholesterol ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Stroke Patients

Background and Purpose: Modification of low-density lipoprotein cholesterol (LDL-C) has been proved to be an essential component in the primary and secondary prevention of stroke. However, limited data are available on LDL-C goal achievement in patients with ischemic stroke in China. The aim of this study was to assess the management of low-density lipoprotein cholesterol (LDL-C) in patients suffering from ischemic stroke within 6-12 months and to explore the predictors of the achievement of LDL-C target. Method: This study was a nation-wide, multicenter, cross-sectional study conducted from July 2013 to August 2013. Patients who had an ischemic stroke within 6-12 months and were more than 18-year old were included into this study. All data referred to personal information, medical history, medication and laboratory tests were collected by face-to-face questionnaires, physical examination and blood tests. The predictors for the achievement of LDL-C target (<1.8mmol/l or <70mg/dl) were analyzed by the multivariate analysis. Results: In this study, a total of 3956 cases from 56 centers suffered from ischemic stroke within 6-12 months were finally included into this study. The average serum level of LDL-C in all these patients was 2.42 ± 0.91mmol/l with the median of 2.30 mmol/l and the total LDL-C goal achievement rate is 27.35% (95% CI: 25.97%-28.77%). Lipid-lowering therapy (Odds Ratio [OR]=3.045, 95%CI: 2.456-3.810) was the most significant predictor for LDL-C target achievement and female (OR=0.684, 95% CI: 0.540-0.867), current smoking (OR=0.627, 95% CI: 0.480-0.817), and history of dyslipidemia (OR=0.592, 95% CI: 0.497-0.704) were three other important factors for the LDL-C goal achievement. Conclusions: Although the lipid modulation in stroke patients is recommended by the international guidelines, the goal achievement of LDL-C was still very low in this population in China. The modifiable predictors including the use of lipid-lowering drugs and smoking cessation should be improved in dyslipidemia management.

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Plasma lipoprotein(a) levels: a comparison between diabetic and non-diabetic patients with acute ischemic stroke

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000200008 ◽

2004 ◽

Vol 62 (2a) ◽

pp. 233-236 ◽

Cited By ~ 3

Author(s):

Maurus Marques de Almeida Holanda ◽

Rosália Gouveia Filizola ◽

Maria José de Carvalho Costa ◽

Rodrigo Vasconcelos C.L. de Andrade ◽

José Alberto Gonçalves da Silva

Keyword(s):

Ischemic Stroke ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Diabetic Patients ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

OBJECTIVE: The aim of this study was to evaluate lipoprotein(a) (Lp(a)), total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL ), triglycerides , apolipoprotein A (apo A) and B100 (apo B100), uric acid, glycaemic and insulin plasmatic concentrations in patients affected by acute stroke. In this group of patients, we have compared the variables between type 2 diabetic patients and non-diabetic patients. METHOD: We evaluate a total of 34 non-diabetic patients (22 males and 12 females; mean age 66.71 ± 10.83 years) and a group of 26 type 2 diabetic patients (15 males and 11 females; mean age 66.35 ± 9.92 years) in a cross-sectional study. RESULTS: Mean Lp(a) concentration did not significantly differ between type 2 diabetic patients and non-diabetic subjects (29.49 ± 23.09 vs 44.81 ± 44.34 mg/dl). The distribution of Lp(a)levels was highly skewed towards the higher levels in both groups, being over 30 mg/dl in 50%. Lp(a) concentration was positively correlated with abdominal adiposity, using waist-hip ratio(WHR)(p< 0.05). No association was found between Lp(a) and others risk factors like sex, age, other lipidic parameters and the presence of stroke. CONCLUSIONS: Our results showed that there were no significant differences between diabetic and non-diabetic patients' serum Lp(a) levels, which indicates that elevated Lp(a) levels were associated with ischemic stroke, irrespective of the presence of type 2 diabetes mellitus (type 2 DM).

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Statin-based therapy for primary and secondary prevention of ischemic stroke: A meta-analysis and critical overview

International Journal of Stroke ◽

10.1177/1747493019873594 ◽

2019 ◽

Vol 15 (4) ◽

pp. 377-384 ◽

Cited By ~ 1

Author(s):

Haralampos Milionis ◽

George Ntaios ◽

Eleni Korompoki ◽

Konstantinos Vemmos ◽

Patrik Michel

Keyword(s):

Ischemic Stroke ◽

Secondary Prevention ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Lipid Lowering ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Primary And Secondary Prevention ◽

Prevention Trials

Background and aims To reassess the effect of statin-based lipid-lowering therapy on ischemic stroke in primary and secondary prevention trials with regard to achieved levels of low-density lipoprotein-cholesterol in view of the availability of novel potent hypolipidemic agents. Methods English literature was searched (up to November 2018) for publications restricted to trials with a minimum enrolment of 1000 and 500 subjects for primary and secondary prevention, respectively, meeting the following criteria: adult population, randomized controlled design, and recorded outcome data on ischemic stroke events. Data were meta-analyzed and curve-estimation procedure was applied to estimate regression statistics and produce related plots. Results Four primary prevention trials and four secondary prevention trials fulfilled the eligibility criteria. Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary (risk ratio, RR 0.70, 95% confidence interval, CI, 0.60–0.82; p < 0.001) and in the secondary prevention setting (RR 0.80, 95% CI 0.70–0.90; p < 0.001). Curve-estimation procedure revealed a linear relationship between the absolute risk reduction of ischemic stroke and active treatment-achieved low-density lipoprotein-cholesterol levels in secondary prevention (adjusted R-square 0.90) in support of “the lower the better” hypothesis for stroke survivors. On the other hand, the cubic model followed the observed data well in primary prevention (adjusted R-square 0.98), indicating greater absolute risk reduction in high-risk cardiovascular disease-free individuals. Conclusions Statin-based lipid-lowering is effective both for primary and secondary prevention of ischemic stroke. Most benefit derives from targeting disease-free individuals at high cardiovascular risk, and by achieving low treatment targets for low-density lipoprotein-cholesterol in stroke survivors.

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