scholarly journals Relationship of Familial Hypercholesterolemia and High Low-Density Lipoprotein Cholesterol to Ischemic Stroke

Circulation ◽  
2018 ◽  
Vol 138 (6) ◽  
pp. 578-589 ◽  
Author(s):  
Sabina Beheshti ◽  
Christian M. Madsen ◽  
Anette Varbo ◽  
Marianne Benn ◽  
Børge G. Nordestgaard
2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Aditya D Hendrani ◽  
Renato Quispe ◽  
Seth S Martin ◽  
Krishnaji R Kulkarni ◽  
Peter P Toth ◽  
...  

Background: RLP-C is comprised of atherogenic triglyceride- (TG-) rich lipoproteins, commonly defined as the sum of intermediate-density lipoprotein cholesterol (IDL-C) and very low-density lipoprotein cholesterol remnants (VLDL 3 -C). In clinical practice, the VLDL-C/TG ratio is used to diagnose type III dyslipidemia, a primary lipoprotein disorder characterized by high levels of RLP-C. Methods: Serum lipids of 556,307 U.S. adults with TG ≥130 mg/dL were analyzed by ultracentrifugation (VAP, Atherotech, Birmingham, AL). We estimated TG content in VLDL (VLDL-TG) as the product of VLDL-C and validated variable TG/VLDL-C factors. Non-VLDL-TG was then calculated as total TG minus VLDL-TG, for which negative values represented the presence of RLP-C. We examined the relationship of non-VLDL-TG to 1000 quantiles of VLDL-C/TG ratio. We defined a VLDL-C/TG ratio cutpoint for presence of RLP-C based on the quantile at which median non-VLDL-TG≤0. Results: We found median non-VLDL-TG≤0 at VLDL-C/TG = 0.18 (Figure) . There were 174,907 adults who did not meet diagnostic criteria for type III dyslipidemia (VLDL-C/TG 0.18 to <0.30), whose levels of RLP-C and non-VLDL-TG levels were 37 (31-46) and -20 (-40 to -8) mg/dL, respectively. A total of 1,550 adults met classical diagnostic criteria for type III dyslipidemia (VLDL-C/TG ≥0.3), whose plasma levels of RLP-C and non-VLDL-TG levels were 80 (67-101) and -187 (-290 to -129) mg/dL, respectively. Conclusion: A threshold of VLDL-C/TG ≥0.18 correlates with the accumulation of RLP-C in plasma. If validated in future studies, these findings will improve identification of individuals who are at greater risk for atherosclerotic disease.


2004 ◽  
Vol 62 (2a) ◽  
pp. 233-236 ◽  
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

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).


2019 ◽  
Vol 15 (4) ◽  
pp. 377-384 ◽  
Author(s):  
Haralampos Milionis ◽  
George Ntaios ◽  
Eleni Korompoki ◽  
Konstantinos Vemmos ◽  
Patrik Michel

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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