Bang O Y, Saver J L, Liebeskind D S, Pineda S, Ovbiagele B
Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
Neurology. 2008 Mar 11;70(11):841-7. doi: 10.1212/01.wnl.0000294323.48661.a9. Epub 2007 Dec 26.
Low-density lipoprotein cholesterol (LDL) is the primary lipid target for vascular risk reduction in stroke patients, but emerging data suggest that other lipid indices may better predict vascular hazard. We evaluated the relationship between several measures of the classically obtained serum lipid panel and the occurrence of large artery atherosclerotic stroke.
Data prospectively collected over a 4-year period on subjects admitted with ischemic stroke or TIA to a university medical center were analyzed. Independent associations of fasting serum lipid indices with large artery atherosclerotic (LAA) stroke mechanism were evaluated.
Of 1,049 patients, 247 (23.5%) were classified with LAA, 224 (21.4%) were classified with small vessel disease (SVD), and 578 (55%) were non-LAA, non-SVD subtype. Lipid levels were similar between LAA and SVD patients. Total cholesterol, triglycerides, LDL, non-high-density lipoprotein cholesterol (HDL), and triglyceride:HDL ratio were significantly higher in LAA vs non-LAA, non-SVD patients. After adjustment for age, hypertension, diabetes, smoking, body mass index, and premorbid statin use, significant odds ratios (ORs) for LAA compared with all other ischemic stroke subtypes for patients in the uppermost lipid quartiles (vs lowest) were triglycerides (OR 2.69, 95% CI 1.44 to 5.02) and non-HDL (OR 2.39, 95% CI 1.40 to 4.11). LDL was not associated with LAA.
Compared with all other ischemic stroke subtypes, elevated levels of serum triglycerides and non-high-density lipoprotein, but not low-density lipoprotein (LDL), are associated with large artery atherosclerotic stroke. These non-LDL lipid measures may have utility in delineating atherosclerotic stroke risk.
低密度脂蛋白胆固醇（LDL）是降低中风患者血管风险的主要脂质靶点，但新出现的数据表明，其他脂质指标可能能更好地预测血管风险。我们评估了经典血清脂质指标的几种测量值与大动脉粥样硬化性中风发生之间的关系。
对一所大学医学中心在4年期间前瞻性收集的缺血性中风或短暂性脑缺血发作（TIA）患者的数据进行分析。评估空腹血清脂质指标与大动脉粥样硬化（LAA）中风机制的独立相关性。
在1049例患者中，247例（23.5%）被归类为LAA，224例（21.4%）被归类为小血管疾病（SVD），578例（55%）为非LAA、非SVD亚型。LAA患者和SVD患者的脂质水平相似。与非LAA、非SVD患者相比，LAA患者的总胆固醇、甘油三酯、LDL、非高密度脂蛋白胆固醇（HDL）和甘油三酯：HDL比值显著更高。在调整年龄、高血压、糖尿病、吸烟、体重指数和病前他汀类药物使用情况后，脂质四分位数最高（与最低相比）的患者中，LAA与所有其他缺血性中风亚型相比的显著优势比（OR）为甘油三酯（OR 2.69，95% CI 1.44至5.02）和非HDL（OR 2.39，95% CI 1.40至4.11）。LDL与LAA无关。
与所有其他缺血性中风亚型相比，血清甘油三酯和非高密度脂蛋白水平升高，而非低密度脂蛋白（LDL）水平升高，与大动脉粥样硬化性中风相关。这些非LDL脂质指标可能有助于描绘动脉粥样硬化性中风风险。
