Lung Yen-Ju, Weng Wei-Chieh, Wu Chia-Lun, Huang Wen-Yi
Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):1040-1047. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.030. Epub 2019 Jan 11.
Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence.
One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups.
117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio) = 1.88, 95% CI (confidence interval) = 1.09-3.23, P = .023).
Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some stroke patients.
强化降脂治疗可降低心血管事件风险，但在卒中患者中仍存在争议。我们研究了总胆固醇水平对伴有重度颈内动脉（ICA）狭窄的缺血性卒中患者5年预后及卒中后功能依赖的影响。
纳入196例急性缺血性卒中伴重度ICA狭窄且出院时改良Rankin量表评分≥3分的患者，并对其进行为期5年的前瞻性观察。根据入院时总胆固醇水平将患者分为两组：≥200mg/dL或<200mg/dL。比较两组患者的人口统计学特征、血管危险因素、合并症及预后情况。
117例（59.7%）患者总胆固醇水平较高，79例（40.3%）患者总胆固醇水平较低。总胆固醇水平较低的患者中，老年和房颤的患病率显著更高；总胆固醇水平较高的患者中，糖尿病的患病率更高。在对已确定的不良预后临床预测因素进行校正后，多因素Cox回归显示，较低的总胆固醇水平是5年死亡率的显著预测因素（风险比（HR）=1.88，95%置信区间（CI）=1.09-3.23，P=0.023）。
伴有重度ICA狭窄及卒中后功能依赖的缺血性卒中患者，较低的总胆固醇水平与5年死亡风险增加相关。尽管强化降脂治疗可降低部分卒中患者的动脉粥样硬化性心血管疾病及卒中复发风险，但对于这些患者应谨慎考虑。
