scholarly journals The risk of ischemic stroke and hemorrhagic stroke in Chinese adults with low-density lipoprotein cholesterol concentrations < 70 mg/dL

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhijun Wu ◽  
Zhe Huang ◽  
Alice H. Lichtenstein ◽  
Yesong Liu ◽  
Shuohua Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Training Dataset ◽  
Validation Dataset ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol

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.

Abstract P181: Atherogenic Lipoproteins and Incident Atherosclerotic Cardiovascular Disease in the Framingham Offspring Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Hiroaki Ikezaki ◽  
Elise Lim ◽  
Ching-Ti Liu ◽  
L Adrienne Cupples ◽  
Bela F Asztalos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Significant Information ◽  
Ascvd Risk

Introduction: Elevated plasma low-density lipoprotein cholesterol (LDL-C), small-dense LDL-C (sdLDL-C), LDL-triglyceride (LDL-TG), triglycerides (TG), remnant-lipoprotein cholesterol (RLP-C), triglyceride-rich lipoprotein-C (TRL-C), very low-density lipoprotein cholesterol (VLDL-C), and lipoprotein(a) [Lp(a)] levels have been associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. However, these parameters have not been included in risk factors for ASCVD in the pooled cohort equation (PCE). Hypothesis: We assessed the hypothesis that these atherogenic lipoprotein parameters add significant information for ASCVD risk prediction in the Framingham Offspring Study. Methods: We evaluated 3,147 subjects without ASCVD at baseline (mean age 58 years) from participants of Framingham Offspring Study cycle 6, 677 (21.5%) of whom developed inclusive ASCVD over 16 years. Biomarkers of risk were assessed in frozen plasma samples. Total cholesterol, TG, HDL-C, direct LDL-C, sdLDL-C, LDL-TG, Lp(a), RLP-C, and TRL-C were measured by standardized automated analysis. Calculated LDL-C, large buoyant low-density lipoprotein cholesterol (lbLDL-C), VLDL-C, and non-HDL-C values were calculated. Data were analyzed using Cox proportional regression analysis and net reclassification improvement (NRI) analysis to identify parameters significantly associated with the incidence of ASCVD after controlling for standard ASCVD risk factor and applying the PCE model. Results: All specialized lipoprotein parameters were significant ASCVD risk factors on univariate analysis, but only direct LDL-C, sdLDL-C, and Lp(a) were significant on multivariate analysis with standard risk factors in the model. Together these parameters significantly improved the model c statistic (0.716 vs 0.732, P < 0.05) and net risk reclassification (mean NRI 0.104, P < 0.01) for ASCVD risk. Using the ASCVD risk pooled cohort equation, sdLDL-C, TG, LDL-TG, LDL-C, RLP-C, and TRL-C individually added significant information, but no other parameter added significant information with sdLDL-C (hazard ratio 1.30 for 75th vs 25th percentile, P < 0.0001) in the model. Conclusions: In multivariate analysis, sdLDL-C, direct LDL-C, and Lp(a) contributed significantly to ASCVD risk, but only sdLDL-C added significant risk information to the PCE model, indicating that sdLDL-C may be the most atherogenic lipoprotein particle.

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

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
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).

scholarly journals Cardiometabolic risk factors are associated with immune cell mitochondrial respiration in humans

2020 ◽  
Vol 319 (2) ◽  
pp. H481-H487
Author(s):  
Theodore M. DeConne ◽  
Eric R. Muñoz ◽  
Faria Sanjana ◽  
Joshua C. Hobson ◽  
Christopher R. Martens
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Mitochondrial Respiration ◽  
Cardiometabolic Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol

Independent of other cardiometabolic risk factors, low-density lipoprotein cholesterol, and systolic blood pressure were found to be negatively associated with several parameters of mitochondrial respiration in peripheral blood mononuclear cells of healthy adults. These data suggest that low-density lipoprotein cholesterol and systolic blood pressure may induce metabolic reprogramming of immune cells, contributing to increased cardiovascular disease risk and impaired immune health.

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

2019 ◽  
Vol 15 (4) ◽  
pp. 377-384 ◽  
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.

scholarly journals Gambaran dislipidemia pada pasien stroke akut di Rumah Sakit Umum Daerah Arifin Achmad Provinsi Riau periode Januari-Desember 2019

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dimas Pramita Nugraha ◽  
Eka Bebasari ◽  
Sahwal Sahputra
Keyword(s):  
Ischemic Stroke ◽  
High Density Lipoprotein ◽  
Acute Stroke ◽  
General Hospital ◽  
Normal Level ◽  
Hemorrhagic Stroke ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Cross Sectional

Abstrak. Stroke adalah penyakit gangguan fungsional otak yang timbul mendadak dan berlangsung lebih dari 24 jam atau berakhir dengan kematian tanpa diketahui penyebab yang jelas selain gangguan vaskuler. Stroke secara umum diklasifikasikan menjadi stroke iskemik atau stroke non hemoragik dan stroke hemoragik. Salah satu faktor risiko terjadinya stroke adalah dislipidemia. Tujuan penelitian ini adalah untuk mengetahui gambaran dislipidemia pada pasien stroke akut di RSUD Arifin Achmad Provinsi Riau Periode Januari–Desember 2019. Desain penelitian yang digunakan adalah penelitian deskriptif  dengan rancangan cross sectional menggunakan data sekunder rekam medis pasien stroke akut di  RSUD Arifin Achmad Provinsi Riau  Periode Januari-Desember 2019 dengan jumlah sampel sebanyak 103 kasus. Hasil penelitian menunjukkan stroke banyak terjadi pada jenis kelamin laki-laki yaitu 63 orang (61,2%). Usia terbanyak terjadi pada rentang usia 51-65 tahun sebanyak 54 (52,4%). Jenis stroke terbanyak adalah stroke hemoragik yaitu 59 orang (57,3%). Kadar kolesterol total terbanyak pada  rentang normal yaitu sebanyak 46 orang (44,7%). Kadar High Density Lipoprotein (HDL)  terbanyak pada rentang normal yaitu sebanyak 49 orang (47,6%). Kadar Low Density  Lipoprotein (LDL) terbanyak pada kategori tinggi sebanyak 26 orang (25,2%) dan normal tapi berisiko sebanyak 26 orang (25,2%). Kadar trigliserida terbanyak pada kategori normal sebanyak 65 orang (63,1%). Terdapat 17 orang (16,5%) pasien dislipidemia, sebanyak 9 orang (52,9%) adalah stroke iskemik. Kesimpulan dari penelitian ini adalah dislipidemia lebih banyak terjadi pada stroke iskemik disbanding stroke hemoragik.Kata kunci:  dislipidemia, stroke, stroke non hemoragikAbstract. Stroke is a disease of the brain functional disorders that arises suddenly and lasts more than 24 hours or ends in death situation without a known cause other than vascular disorders. Strokes are generally classified into ischemic stroke (non-hemorrhagic) and hemorrhagic stroke, One of the risk factors of stroke is dyslipidemia. The aim of this study was to describe dyslipidemia in acute stroke patients at Arifin Achmad Regioal General Hospital of Riau Province in January to December 2019. This was a descriptive study design with cross sectional study method by using secondary data of the acute stroke patient's medical record at Arifin Achmad Regional General Hospital of Riau Province in January to December 2019 with a total sample of 103 cases. The results show that stroke is more common in male that is 63 (61.2%) cases, and the majority happened within the 51-65 years age groups with 54 (52.4%) cases. Most of the stroke’s type in patients were hemorrhagic stroke in 59 (57.3%) cases. Highest total of cholesterol level remains normal in 46 (44.7%) cases. The majority of patients still presented with normal level of High Density Lipoprotein (HDL) in 49 (47.6%) cases. In contrary, most patients presented with high level of Low Density Lipoprotein (LDL) in 26 (25.2%) cases and also with normal level but considered as high-risk group in  26 (25.2%) cases. Most patients still presented with normal level of triglyceride in 65 (63.1%) cases. There were 17 (16.5%) cases of patient with dyslipidemia, 9 of them were considered as ischemic stroke (52.9%). The conclusion of this study is that dyslipidemia commonly occurs in ischemic stroke types compared to a hemorrhagic stroke.Keywords: dyslipidemia, stroke, non hemorrhagic stroke

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