Evaluation of the lipoprotein profile in stroke patients in different disease phases
Summary. Aim — to evaluate the lipid profile in patients with cerebral stroke (CS) and its associations with clinical and demographic characteristics, vascular risk factors, stroke phase and global outcome. Material and methods. In 502 patients (43.0% women), admitted in 2010 through 2018 in various stroke phases (from hyperacute to chronic), baseline levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were directly assessed, then non-HDL-C levels were calculated. Qualitative variables are expressed as numbers and percentages, quantitative variables are presented using the median and interquartile range. Results. 428 (85.2%) participants were diagnosed with ischemic stroke (IS), 74 (14.8%) with intracerebral hemorrhage. Higher levels of TC, LDL-C, and non-HDL-C were significantly (p<0.05) associated with lacunar and other/undetermined subtypes of IS, obesity, and no history of atrial fibrillation, stroke, or diabetes mellitus. Among 137 patients admitted after 30 days from the index IS, 115 (83.9%) had elevated LDL-C, 116 (84.7%) had elevated non-HDL-C, and 94 (68.5%) had a low level of HDL-C levels. Conclusions. Elevated levels of atherogenic lipoproteins documented in the majority of patients admitted with subacute or chronic IS point to unmet needs in secondary prevention.
- Amarenco P., Bogousslavsky J., Caplan L.R. et al. (2009) Classification of stroke subtypes. Cerebrovasc. Dis., 27(5): 493–501. DOI: 10.1159/000210432.
- Amarenco P., Kim J.S., Labreuche J. et al. (2019) Treat stroke to target trial design: First trial comparing two LDL targets in patients with atherothrombotic strokes (https://journals.sagepub.com/doi/full/10.1177/2396987319838100).
- Assarzadegan F., Tabesh H., Shoghli A. et al. (2015) Relation of Stroke Risk Factors with Specific Stroke Subtypes and Territories. Iran J. Public Health, 44(10): 1387–1394.
- Bernhardt J., Hayward K.S., Kwakkel G. et al. (2017) Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int. J. Stroke, 12(5): 444–450. doi: 10.1177/1747493017711816.
- Chang J.J., Katsanos A.H., Khorchid Y. et al. (2018) Higher low-density lipoprotein cholesterol levels are associated with decreased mortality in patients with intracerebral hemorrhage. Atherosclerosis, 269: 14–20. doi: 10.1016/j.atherosclerosis.2017.12.008.
- Chen C.J., Ding D., Ironside N. et al. (2019) Statins for neuroprotection in spontaneous intracerebral hemorrhage. Neurology, 93(24): 1056–1066. doi: 10.1212/WNL.0000000000008627.
- Collins R., Reith C., Emberson J. et al. (2016) Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet, 388(10059): 2532–2561. doi: 10.1016/S0140-6736(16)31357-5.
- Global Burden of Disease Study (2018) GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool).
- Grundy S.M., Stone N.J., Bailey A.L. et al. (2019) 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 139(25): e1082–e1143. doi: 10.1161/CIR.0000000000000625.
- Hackam D.G., Hegele R.A. (2019) Cholesterol Lowering and Prevention of Stroke. Stroke, 50(2): 537–541. doi: 10.1161/STROKEAHA.118.023167.
- Hindy G., Engström G., Larsson S.C. et al. (2018) Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes. A Mendelian Randomization Study. Stroke, 49(4): 820–827. https://doi.org/10.1161/STROKEAHA.117.019653.
- Hurford R., Sekhar A., Hughes T.A.T., Muir K.W. (2020) Diagnosis and management of acute ischaemic stroke. Pract. Neurol., 20(8): 306–318. doi:10.1136/practneurol-2020-002557.
- Jackova J., Sedova P., Brown R.D.Jr. et al. (2020) Risk Factors in Ischemic Stroke Subtypes: A Community-Based Study in Brno, Czech Republic. J. Stroke Cerebrovasc. Dis., 29(2): 104503. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104503.
- Kernan W.N., Ovbiagele B., Black H.R. et al.; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease (2014) Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–236. doi: 10.1161/STR.0000000000000024.
- Lewington S., Whitlock G., Clarke R. et al.; Prospective Studies Collaboration (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.
- Mach F., Baigent C., Catapano A.L. et al.; ESC Scientific Document Group (2020) 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur. Heart J., 41(1): 111–188. doi: 10.1093/eurheartj/ehz455.
- Minhas J.S., Wang X., Arima H. et al. (2018) Lipid-Lowering Pretreatment and Outcome Following Intravenous Thrombolysis for Acute Ischaemic Stroke: A Post Hoc Analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study Trial. Cerebrovasc. Dis., 45(5–6): 213–220. doi: 10.1159/000488911.
- Sacco R.L., Kasner S.E., Broderick J.P. et al.; American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Council on Nutrition, Physical Activity and Metabolism (2013) An Updated Definition of Stroke for the 21st Century. A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 44(7): 2064–2089. doi: 10.1161/STR.0b013e318296aeca.
- Virani S.S., Alonso A., Benjamin E.J. et al. (2020) American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics — 2020 Update: A Report from the American Heart Association. Circulation, 141(9): e139–e596.
- Wechsler L.R. (2020) Statins and Stroke — It’s Complicated. N. Engl. J. Med., 382(1): 81–82. doi: 10.1056/NEJMe1914757.
- Yeramaneni S., Kleindorfer D.O., Sucharew H. et al. (2017) Hyperlipidemia is associated with lower risk of poststroke mortality independent of statin use: A population-based study. Int. J. Stroke, 12(2): 152–160. doi: 10.1177/1747493016670175.