[PHNUTR-L] Look Beyond LDL Cholesterol to Triglycerides For Risk of Specific Stroke Type

[Kathrynne Holden]

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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
http://www.medpagetoday.com/Neurology/Strokes/dh/7797

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.

Action Points

     * 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 
April 2007.

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, 
non-small-vessel patients:

     * 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 
4.11, P=0.022).

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
Source reference:
Bang O, "Association of serum indices with large artery atherosclerotic 
stroke" Neurology 2007; DOI: 10.1212/01.wnl.0000294323.48661.a9.
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