[PHNUTR-L] Look Beyond LDL Cholesterol to Triglycerides For Risk of
Specific Stroke Type
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Thu Dec 27 07:52:44 PST 2007
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Look Beyond LDL Cholesterol For Risk of Specific Stroke Type
By Todd Neale, Staff Writer, MedPage Today
Published: December 26, 2007
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news
LOS ANGELES, Dec. 26 -- Patients with the highest levels of
triglycerides were 2.7 times more likely to suffer a large artery
atherosclerotic stroke than those with lower levels, researchers here found.
* Explain to interested patients that this study found that high
levels of triglycerides and non-HDL, but not LDL, cholesterol increased
the risk of suffering a large artery atherosclerotic stroke.
* Point out that it is still important to monitor LDL cholesterol
to reduce risk of other types of cardiovascular conditions.
* Also point out that this is a cross-sectional study and needs
verification by other prospective studies.
The risk was 2.4 times greater for those with the highest levels of
non-HDL cholesterol, reported Bruce Ovbiagele, M.D., of the University
of California at Los Angeles, and colleagues, in the Dec. 26 online
issue of Neurology.
But neither LDL cholesterol level nor LDL to HDL cholesterol ratio was
linked to the risk of large artery atherosclerotic stroke, they said.
"Recent studies … have shown an association between serum cholesterol
levels and ischemic stroke," the authors wrote, "but few studies have
reported on the kinship between serum lipids and the subtype of ischemic
stroke likely to be most directly related to lipid metabolism: large
artery atherosclerotic stroke."
Determining which lipid variables can best predict risk of
atherosclerotic stroke may be important, the researchers said, because
evidence indicates that plasma lipids may affect atherogenesis in the
cerebral and coronary vascular beds differently.
So they looked retrospectively at data from 1,049 patients (mean age of
67, 54% male) admitted to a university medical center within seven days
of onset of acute ischemic stroke or TIA from September 2002 through
All patients had lipid panels drawn following an overnight fast. Lipid
indices evaluated were total cholesterol, triglycerides, HDL, LDL, and
non-HDL cholesterol (total minus LDL), total cholesterol to HDL ratio,
triglyceride to HDL ratio, and LDL to HDL ratio.
Patients were also evaluated for metabolic syndrome and were considered
to have it if they met abnormality criteria for at least three of five
factors: obesity, serum triglyceride levels ≥150 mg/dL, HDL levels <40
mg/dL for men and <50 mg/dL for women, hypertension, and fasting serum
glucose levels ≥110 mg/dL.
Of the patients, 247 (23.5%) were classified with large artery
atherosclerotic stroke, 224 (21.4%) with small vessel disease, and 578
(55%) with non-large-artery, non-small-vessel subtype.
The following indices were significantly higher in large artery
atherosclerotic stroke patients than in the non-large-artery,
* Total cholesterol: 179.6 ± 50.8 versus 165 ± 41.8 mg/dL, P<0.001.
* Triglycerides: 149.0 ± 106.3 versus 117.4 ± 73.1 mg/dL, P<0.001.
* LDL: 108.7 ± 44.2 versus 99.1 ± 34.1 mg/dL, P<0.001.
* Non-HDL: 135.1 ± 48.2 versus 121.3 ± 38.1 mg/dL, P<0.001.
* Triglyceride to HDL ratio: 3.85 ± 3.40 versus 3.13 ± 3.06, P=0.002.
After adjusting for age, hypertension, diabetes, smoking, BMI, and
statin use, the researchers found that patients in the highest quartile
for triglycerides were significantly more likely to have large artery
atherosclerotic stroke than those in the lowest quartile (OR: 2.69, 95%
CI: 1.44 to 5.02, P=0.002). Likewise, patients in the highest quartile
for non-HDL cholesterol were more likely (OR: 2.39, 95% CI: 1.40 to
LDL was not associated with large artery atherosclerotic stroke.
Dr. Ovbiagele and colleagues also found that metabolic syndrome was a
strong independent risk factor of large artery atherosclerotic stroke:
* In statin non-users, 46.3% of large artery atherosclerotic stroke
patients had metabolic syndrome compared with 35.1% of other stroke
patients, a significant difference at P=0.019.
* In statin users, 61.5% of large artery atherosclerotic stroke
patients had metabolic syndrome compared with 43.5% of other stroke
patients, a significant difference at P=0.007.
This emphasizes "the importance of identifying and treating metabolic
syndrome in patients with known cervicocephalic atherosclerosis
regardless of lipid profile or statin use," the authors wrote.
The researchers indicated that caution should be used when interpreting
the results of the study because it was cross-sectional and the data
came from a single hospital registry.
Differences in timing of the lipid panel draws was another limitation
listed by the authors.
"Our observation suggests that clinicians may consider focusing
additional attention on other aspects of the lipid panel routinely
obtained when treating patients with or at risk for atherosclerotic
stroke," Dr. Ovbiagele and colleagues said.
However, they added, "we cannot discount the importance of LDL levels to
the overall health of the patient."
The authors reported no conflicts of interest or sources of study funding.
Primary source: Neurology
Bang O, "Association of serum indices with large artery atherosclerotic
stroke" Neurology 2007; DOI: 10.1212/01.wnl.0000294323.48661.a9.
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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