Hypertriglyceridemia: A Neglected Risk Factor for Ischemic Stroke?

Liang, Hui; Zhang, Qingyi; Hu, Yitong; Liu, Guoqing; Qi, Rong

doi:10.5853/jos.2021.02831

Cited by 31 publications

(20 citation statements)

References 146 publications

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“…We think hypertriglyceridemia may increase the risk of postoperative stroke by promoting atherosclerosis in the older patients ( Peng et al, 2017 ). Firstly, hypertriglyceridemia may theoretically cause subendothelial retention of remnant particles and elicitation of endothelial dysfunction, to establish chronic inflammation in the cerevascular ( Liang et al, 2022 ). Secondly, hypertriglyceridemia may cause hyperviscosity and promote thrombosis through a procoagulant effect involved in the disturbance of both blood coagulation and fibrinolysis, and led to postoperative stroke.…”

Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia is associated with stroke after non-cardiac, non-neurological surgery in the older patients: A nested case-control study

Chen

Wen²,

Ma³

et al. 2022

Front. Aging Neurosci.

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IntroductionGeriatric postoperative stroke is a rare but serious complication after surgery. The association between hypertriglyceridemia and postoperative stroke remains controversial, especially in older patients undergoing non-cardiac, non-neurological surgery. The study aims to address this clinical dilemma.Materials and methodsWe conducted a nested case-control study among 9601 aged patients undergoing non-cardiac non-neurological surgery from October 2015 to 2021. A total of 22 positive cases were matched for the surgical type and time, to 88 control patients by a ratio of 1:4. The effect of hypertriglyceridemia on the occurrence of postoperative stroke within 30 days after surgery was estimated using conditional logistic regression analysis by adjusting to various potential confounders.ResultsA total of 22 cases developed ischemia stroke after surgery, and compared with the non-stroke group, they had more postoperative ICU admission, longer postoperative hospitalization and higher total cost (all p < 0.05), and more patients were presenting with preoperative hypertriglyceridemia [8 (36.4%) vs. 15 (17.0%), p = 0.045]. There was a significant association between hypertriglyceridemia and postoperative stroke, with adjusted odds ratios of 6.618 (95% CI 1.286, 34.064) (p = 0.024). The above results remained robust in the sensitivity analyses.ConclusionAmong older patients undergoing non-cardiac and non-neurological surgery, hypertriglyceridemia was associated with significant increased risk of postoperative stroke.

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Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia is associated with stroke after non-cardiac, non-neurological surgery in the older patients: A nested case-control study

Chen

Wen²,

Ma³

et al. 2022

Front. Aging Neurosci.

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“…102,103,106 The high seTG increases blood viscosity, reduces tissue microcirculation, and leads to brain or cardiovascular system ischemia. 107,108 Furthermore, hyperviscosity can cause pancreatic ischemia leading to cellular acidosis. 109 The acidosis may increase the potential for trypsinogen activation by cathepsin B 109 and initiate or aggravate inflammation.…”

Section: Induces or Aggravates Apmentioning

confidence: 99%

“…Another theory regarding the mechanism of HTG, which increases disease severity, focuses on plasma hyperviscosity (Figure 2). 102,103,106 The high seTG increases blood viscosity, reduces tissue microcirculation, and leads to brain or cardiovascular system ischemia 107,108 . Furthermore, hyperviscosity can cause pancreatic ischemia leading to cellular acidosis 109 .…”

Section: Mechanisms On How Htg Induces or Aggravates Apmentioning

confidence: 99%

Mechanisms linking hypertriglyceridemia to acute pancreatitis

et al. 2023

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Hypertriglyceridemia (HTG) is a metabolic disorder, defined when serum or plasma triglyceride concentration (seTG) is >1.7 mM. HTG can be categorized as mild to very severe groups based on the seTG value. The risk of acute pancreatitis (AP), a serious disease with high mortality and without specific therapy, increases with the degree of HTG. Furthermore, even mild or moderate HTG aggravates AP initiated by other important etiological factors, including alcohol or bile stone. This review briefly summarizes the pathophysiology of HTG, the epidemiology of HTG‐induced AP and the clinically observed effects of HTG on the outcomes of AP. Our main focus is to discuss the pathophysiological mechanisms linking HTG to AP. HTG is accompanied by an increased serum fatty acid (FA) concentration, and experimental results have demonstrated that these FAs have the most prominent role in causing the consequences of HTG during AP. FAs inhibit mitochondrial complexes in pancreatic acinar cells, induce pathological elevation of intracellular Ca2+ concentration, cytokine release and tissue injury, and reduce the function of pancreatic ducts. Furthermore, high FA concentrations can induce respiratory, kidney, and cardiovascular failure in AP. All these effects may contribute to the observed increased AP severity and frequent organ failure in patients. Importantly, experimental results suggest that the reduction of FA production by lipase inhibitors can open up new therapeutic options of AP. Overall, investigating the pathophysiology of HTG‐induced AP or AP in the presence of HTG and determining possible treatments are needed.

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“…Epidemiological data support associations of TG and low HDL with the development of cardiovascular diseases, and it was hypothesized that substantially increasing HDL or decreasing TG would lead to risk reductions ( Tall et al, 2022 ). However, the causal role was debated and clinical trials have shown discouraging results ( Tall, 2021 ; Liang et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Association and mediating mechanism between remnant cholesterol and first-ever stroke among the Chinese general population

Song

et al. 2023

Front. Neurosci.

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BackgroundRemnant cholesterol (RC) has been suggested to be implicated in atherosclerosis. The objective of the study was to evaluate the association between RC and first-ever stroke in the Chinese general population and to investigate whether the association is mediated via hypertension or diabetes.MethodsThis study is a retrospective cohort analysis of participants from the China Health and Nutrition Survey. Participants without previous stroke and myocardial infarction in 2009 were enrolled and followed up in 2011 and 2015. Logistic regression analyses were adopted to explore the association of RC with stroke risk. Propensity score methods and doubly robust estimation method were used to ensure the robustness of our findings. Potential mediators were identified by mediation analyses.ResultsA total of 7,035 participants were involved, and during 6 years of follow-up, 78 (1.1%) participants experienced a first-ever stroke. Participants with high RC had a significantly higher incidence of stroke (1.4% versus 0.8%; p = 0.007). High RC was associated with 74% higher stroke risk after adjusting for multiple relevant variables (odds ratio [OR], 1.74; 95% CI, 1.06–2.85). The association was consistent in analyses using propensity score methods and doubly robust estimation method. Hypertension showed a significant mediating effect on the association between RC and stroke, while the mediating effect of diabetes was not significant.ConclusionHigh RC increased the risk of first-ever stroke in the Chinese general population without previous stroke and myocardial infarction, partially through the pathway of hypertension. RC might be a potential target for the primary prevention of stroke.

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Hypertriglyceridemia: A Neglected Risk Factor for Ischemic Stroke?

Cited by 31 publications

References 146 publications

Hypertriglyceridemia is associated with stroke after non-cardiac, non-neurological surgery in the older patients: A nested case-control study

Hypertriglyceridemia is associated with stroke after non-cardiac, non-neurological surgery in the older patients: A nested case-control study

Mechanisms linking hypertriglyceridemia to acute pancreatitis

Association and mediating mechanism between remnant cholesterol and first-ever stroke among the Chinese general population

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