氧化型低密度脂蛋白（LDL）和 LDL 胆固醇与小卒中及 TIA 的结局相关。
Oxidized low-density lipoprotein (LDL) and LDL cholesterol are associated with outcomes of minor stroke and TIA.
机构信息
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Tangshan Gongren Hospital, North China University of Science and Technology, Tangshan, China.
出版信息
Atherosclerosis. 2020 Mar;297:74-80. doi: 10.1016/j.atherosclerosis.2020.02.003. Epub 2020 Feb 19.
BACKGROUND AND AIMS
Low-density lipoprotein (LDL) and oxidized low-density lipoprotein (oxLDL) levels are thought to be related to recurrent stroke. However, the joint association of circulating LDL and oxLDL levels with the outcomes of acute minor ischemic stroke and transient ischemic attack (TIA) remains unclear. The goal of the study was to evaluate whether LDL and oxLDL have a combined effect on outcomes of acute minor stroke and TIA.
METHODS
In the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial, a subgroup of 3019 patients with baseline oxLDL and LDL levels were analyzed. Patients were divided into four groups according to different combinations of LDL (LDL < 3.37 mmol/L, LDL ≥ 3.37 mmol/L) and oxLDL levels (oxLDL <13.96 μg/dL, oxLDL ≥ 13.96 μg/dL). The primary outcome was any stroke within 90 days. The secondary outcomes included any stroke within 1 year and ischemic stroke and combined vascular events within 90 days and 1 year. The poor functional outcome included modified Rankin Scale (mRS) 3-6 at 90-day and 12-month follow-up. The association of LDL and oxLDL with the prognosis of patients was examined using multivariable Cox regression models.
RESULTS
Among 3019 patients included in this study, the medians (interquartile range) of oxLDL and LDL were 13.96 (6.65-28.81) μg/dL and 3.1 (2.5-3.8) mmol/L, respectively. The cumulative occurrence of recurrent stroke, ischemic stroke, and combined vascular events was 9.74%, 9.54%, and 9.80% within 90 days of follow-up. Compared with those with low LDL and oxLDL levels (LDL < 3.37 mmol/L with oxLDL <13.96 μg/dL), patients with high levels of LDL and oxLDL (LDL ≥3.37 mmol/L, oxLDL ≥13.96 μg/dL) had significantly increased risk of recurrent stroke at 90 days (HR,1.57; 95% CI, 1.10-2.24) and 1 year (HR,1.49; 95% CI, 1.10-2.04). Patients in groups with LDL ≥3.37 mmol/L, oxLDL <13.96 μg/dL (HR,1.35; 95% CI, 0.94-1.93) or LDL < 3.37 mmol/L with oxLDL ≥13.96 μg/dL (HR,1.11; 95% CI, 0.77-1.59) showed no statistical difference for stroke recurrence. Similar results were found for functional outcomes.
CONCLUSIONS
The presence of higher combined serum oxLDL and LDL levels was associated with increased risk of recurrent stroke and poor functional outcomes in minor stroke or high-risk TIA patients.
背景与目的
低密度脂蛋白（LDL）和氧化型低密度脂蛋白（oxLDL）水平被认为与复发性中风有关。然而，循环 LDL 和 oxLDL 水平与急性小卒中和短暂性脑缺血发作（TIA）结局的联合关联尚不清楚。本研究的目的是评估 LDL 和 oxLDL 是否对急性小卒中和 TIA 的结局有联合影响。
方法
在氯吡格雷在伴有急性非致残性脑血管事件的高危患者（CHANCE）试验中，对基线 oxLDL 和 LDL 水平的 3019 例患者进行了亚组分析。根据 LDL（LDL <3.37 mmol/L，LDL ≥3.37 mmol/L）和 oxLDL 水平（oxLDL <13.96 μg/dL，oxLDL ≥13.96 μg/dL）的不同组合，患者被分为四组。主要结局是 90 天内任何卒中。次要结局包括 1 年内任何卒中和缺血性卒中和 90 天和 1 年内的联合血管事件。不良功能结局包括 90 天和 12 个月随访时改良 Rankin 量表（mRS）3-6。使用多变量 Cox 回归模型检查 LDL 和 oxLDL 与患者预后的关系。
结果
在纳入本研究的 3019 例患者中，oxLDL 和 LDL 的中位数（四分位距）分别为 13.96（6.65-28.81）μg/dL 和 3.1（2.5-3.8）mmol/L。随访 90 天内复发性卒中、缺血性卒中和联合血管事件的累积发生率分别为 9.74%、9.54%和 9.80%。与 LDL 和 oxLDL 水平均较低的患者（LDL <3.37 mmol/L，oxLDL <13.96 μg/dL）相比，LDL 和 oxLDL 水平均较高的患者（LDL ≥3.37 mmol/L，oxLDL ≥13.96 μg/dL）在 90 天（HR，1.57；95%CI，1.10-2.24）和 1 年（HR，1.49；95%CI，1.10-2.04）时发生复发性卒中的风险显著增加。LDL≥3.37 mmol/L、oxLDL <13.96 μg/dL（HR，1.35；95%CI，0.94-1.93）或 LDL <3.37 mmol/L、oxLDL≥13.96 μg/dL（HR，1.11；95%CI，0.77-1.59）的患者卒中复发无统计学差异。功能结局也有类似结果。
结论
较高的血清 oxLDL 和 LDL 联合水平与小卒中或高危 TIA 患者的复发性卒中风险增加和不良功能结局相关。
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