Interaction Analysis of Abnormal Lipid Indices and Hypertension for Ischemic Stroke: A 10-Year Prospective Cohort Study

Abstract

BackgroundDyslipidemia and hypertension are two important independent risk factors for ischemic stroke (IS); however, their combined effect on IS remains uncertain.ObjectivesThis present study aimed to evaluate the interaction effect of hypertension and abnormal lipid indices on IS in a 10-year prospective cohort in Chinese adults.MethodsThe cohort study of 4,128 participants was conducted in May 2009 and was followed up to July 2020. All qualified participants received a questionnaire survey, physical examination, and blood sample detection. Cox regression was used to evaluate the association of dyslipidemia and hypertension with IS, and calculate the hazard ratio (HR) and 95% confidence interval (CI). The relative excess risk of interaction (RERI) and the HR (95%CI) of interaction terms were used to examine additive and multiplicative interactions.ResultsIn the hypertensive population, Non-HDL-C ≥190 mg/dl, LDL-C/HDL-C ≥2 and HDL-C ≥60 mg/dl were statistically associated with IS, and after adjusting for covariates, HRs (95%CIs) were 1.565 (1.007–2.429), 1.414 (1.034–1.933) and 0.665 (0.450–0.983), respectively. While in the non-hypertension population, no significant association of Non-HDL-C ≥190 mg/dl, LDL-C/HDL-C ≥2, and HDL-C ≥60 was detected with IS (P > 0.05). There was a significant association between TC/HDL-C ≥ 3.6 and the decreased risk of IS in the non-hypertension population, and the HR (95%CI) was 0.479 (0.307–0.750). Whereas, a similar association was not observed in the hypertensive population. HDL-C ≥ 60 mg/dl, Non-HDL-C ≥ 190 mg/dl, TC/HDL-C ≥ 3.6, and TG/HDL-C ≥ 1 have additive and multiplicative interactions with hypertension (P < 0.05). The RERIs (95% CIs) of the additive interaction are −0.93 (−1.882–0.044), 1.394 (0.38–2.407), 0.752 (0.354–1.151) and 0.575 (0.086–1.065), respectively. The HRs (95% CIs) of the multiplicative interaction terms were 0.498 (0.272–0.911), 4.218 (1.230–14.464), 2.423 (1.437–4.086) and 1.701 (1.016–2.848), respectively.ConclusionHigh concentration of HDL-C reduces the impact of hypertension on IS, while the high concentration of Non-HDL-C, TC/HDL-C, and TG/HDL-C positively interact with hypertension affecting the incidence of IS. This study provides useful evidence for the combined effects of dyslipidemia and hypertension in predicting IS.

Association of atherosclerosis indices, serum uric acid to high‐density lipoprotein cholesterol ratio and triglycerides‐glucose index with hypertension: A gender‐disaggregated analysis

“…The pathophysiological mechanism by which lipids may have a role in hypertension development is not fully clear. It could be partly explained by the evidence that dyslipidemia triggers endothelial injury, and the loss of physiological vasomotor activity which induced by endothelial injury may become presented as increased blood pressure 49,50 . Our study showed that the mean levels of triglyceride, total cholesterol, and LDL‐C were significantly higher in the hypertensive group, which is consistent with the results of previous studies 51 .…”

“…It could be partly explained by the evidence that dyslipidemia triggers endothelial injury, and the loss of physiological vasomotor activity which induced by endothelial injury may become presented as increased blood pressure. 49,50 Our study showed that the mean levels of triglyceride, total cholesterol, and LDL-C were significantly higher in the hypertensive group, which is consistent with the results of previous studies. 51 We found that the mean level of HDL-C was not statistically different between hypertensive and non-hypertensive groups.…”

“…The AIP, non‐HDL‐C, AC, CRI I, and CRI II are lipid indices derived from HDL‐C but also measure other serum lipids. Therefore, these non‐traditional lipid indicators may indicate a more accurate and comprehensive lipid status than the traditional parameters alone 50 . The result of the logistic regression analysis showed that among the reported atherosclerosis indices, AIP was an independent factor for hypertension among women.…”

Individual and combined contributions of non-high-density lipoprotein cholesterol and brachial-ankle pulse wave velocity to cardiovascular disease risk: Results of a prospective study using the Kailuan cohort

“…In addition, we found that the highest risk of CVD was in individuals with both high non-HDL-C and high baPWV, and that this was 1.89 times higher than in individuals with both normal non-HDL-C concentration and baPWV. Although the present study is the first to demonstrate the combined effect of non-HDL-C and baPWV on the risk of CVD, similar analyses ( 32 – 34 ) of the combined effects of lipids and blood pressure on CVD risk have been performed previously. Yang et al ( 34 ) showed that individuals with both hypertension and hypercholesterolemia are at a higher risk of CVD than those with hypertension or hypercholesterolemia alone in a study of 5,092 participants who were followed for 20.84 years.…”

Triglyceride to high-density lipoprotein cholesterol ratio and total cholesterol to high-density lipoprotein cholesterol ratio and risk of benign prostatic hyperplasia in Chinese male subjects

“…For instance, Sánchez-Íñigo et al (24) evidenced that triglycerides-related variables had the advantage to evaluate the risk of developing hypertension in the Spanish population. Wei et al (25) found that a high concentration of lipid ratios worked synergistically with hypertension to affect the incidence of ischemic stroke. A lot of research pointed out that TG/HDL-C was favorable to identify increased urinary albuminto-creatinine ratio, insulin resistance, diabetes risk, incident hypertension, and cardiovascular events (26)(27)(28)(29)(30)(31).…”