Lipid and lipoprotein levels remain stable in acute ischemic stroke: the Northern Manhattan Stroke Study

Background and Purpose-The apolipoprotein B (apoB)/apoAI ratio is recognized as a better indicator of cardiovascular disease than other cholesterol measures. Whether intracranial or extracranial atherosclerosis is more closely associated with an increased apoB/apoAI ratio has not been investigated. Methods-A total of 464 statin or fibrate naïve Korean patients with acute ischemic stroke was categorized into 3 groups:intracranial (ICAS, nϭ236), extracranial (nϭ44), and no cerebral atherosclerotic stenosis (nϭ184). The apoB/apoAI ratio and demographics, including the presence of metabolic syndrome, were compared among the groups. Results-The ICAS group showed a higher apoB/apoAI ratio (0.81Ϯ0.02) than both the extracranial atherosclerotic stenosis (0.74Ϯ0.03) and no cerebral atherosclerotic stenosis (0.72Ϯ0.02) groups (Pϭ0.002). The ratio was substantially increased (0.93Ϯ0.03) in patients with advanced ICAS (Ն3 intracranial stenoses). With a multivariable analysis, the highest apoB/apoAI ratio quartile was an independent predictor of ICAS (OR, 2.13; 95% CI, 1.05 to 4.33).A dose-response relationship was observed between the presence of advanced ICAS and the apoB/apoAI ratio quartiles (OR, 4.03; 95% CI, 1.26 to 12.88 for the second quartile; OR, 4.88; 95% CI, 1.54 to 15.49 for the third quartile; and OR, 7.79; 95% CI, 2.41 to 25.16 for the fourth quartile when referenced to the first quartile). Patients having more metabolic syndrome components were more likely to have ICAS, advanced ICAS, and a higher apoB/apoAI ratio (PϽ0.001 for all). Conclusions-A higher apoB/apoAI ratio is a predictor of ICAS rather than of extracranial atherosclerotic stenosis or no cerebral atherosclerotic stenosis. The apoB/apoAI ratio might be a biomarker for ICAS in Asian patients with stroke. (Stroke. 2011;42:3040-3046.)

Section: Discussionmentioning

confidence: 45%

High Levels of Apolipoprotein B/AI Ratio Are Associated With Intracranial Atherosclerotic Stenosis

Park

Hong

Lee

et al. 2011

“…Another limitation and a potential source of discrepancy with other reports might be the fact that lipid panels were analyzed in a nonfasting state, yet cholesterol and triglyceride levels have been shown to remain stable within the first 48 hours after cerebrovascular events. 52,53 At last, compliance with statin treatment could not directly be controlled but was based on information given by the patients or their proxies. Nevertheless, to our knowledge, this is the largest study analyzing the association of statin pretreatment and ICH after IAT for acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Prior Statin Use, Intracranial Hemorrhage, and Outcome After Intra-Arterial Thrombolysis for Acute Ischemic Stroke

Meier

Nedeltchev

Brekenfeld

et al. 2009

Background and Purpose-There are only limited data on whether prior statin use and/or cholesterol levels are associated with intracranial hemorrhage (ICH) and outcome after intra-arterial thrombolysis. The purpose of this study was to evaluate the association of statin pretreatment and cholesterol levels with the overall frequency of ICH, the frequency of symptomatic ICH, and clinical outcome at 3 months. Methods-We analyzed 311 consecutive patients (mean age, 63 years; 43% women) who received intra-arterial thrombolysis. Results-Statin pretreatment was present in 18%.

“…56 However, methodological limitations of some of these studies should be borne in mind, particularly small sample size 6,58,60 and poststroke measurements of HDL-C. 6,7,19,58,60 Whether the concentration of HDL-C after stroke reasonably estimates habitual levels is debatable. [62][63][64][65] Several cohort studies reported an inverse association between HDL-C and incident ischemic stroke, 16,55,59 fatal ischemic stroke, 61 or unclassified stroke. 56 However, 2 cohorts did not enroll women, 56,61 2 studies reported no statistical evidence for multiplicative interaction with sex, 16,55 and only 1 group reported sex-specific analyses, with Յ30 ischemic strokes for each sex.…”

Section: Discussionmentioning

confidence: 99%

Plasma Lipid Profile and Incident Ischemic Stroke

Shahar

Chambless

Rosamond

et al. 2003

279

122

Background and Purpose-The role of circulating lipids and lipoproteins in the pathogenesis of ischemic stroke remains uncertain despite 3 decades of research. We examined this issue in a large population-based cohort. Methods-Between 1987 and 1989, 14 175 middle-aged men and women, free of clinical cardiovascular disease, took part in the first examination of the Atherosclerosis Risk in Communities (ARIC) study cohort. Baseline measurements included plasma levels of LDL cholesterol, HDL cholesterol, apolipoprotein B, apolipoprotein A-1, and triglycerides and myriad risk factors for cardiovascular disease. The cohort was followed for cardiovascular disease end points. Results-Over an average follow-up of 10 years (142 704 person-years at risk), we documented clinical ischemic stroke in 305 participants (161 men and 144 women). After multivariable adjustment for stroke risk factors, categorical and spline regression analyses of the entire sample, as well as the sample of men alone, revealed weak and inconsistent associations between ischemic stroke and each of the 5 lipid factors. Among women, the most consistent findings were decreasing risk of ischemic stroke within the top half of the distribution of HDL cholesterol and increasing risk within the lower range of the triglyceride distribution. Conclusions-The relation of circulating cholesterol to ischemic stroke does not resemble its well-known relation to coronary heart disease. Either the pathogenesis of a substantial proportion of ischemic strokes does not involve classic atherosclerotic mechanisms, or the effect of plasma lipids on atherogenesis is substantially different in the intracranial vascular bed.