The University of Chicago, Chicago, IL, USA.
University of California at Los Angeles, Los Angeles, CA, USA.
J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106141. doi: 10.1016/j.jstrokecerebrovasdis.2021.106141. Epub 2021 Oct 26.
Hyperlipidemia is a strong risk factor for intracranial atherosclerotic disease (ICAD) and clinical stroke recurrence. We explored the effect of serum lipid levels on subclinical infarct recurrence in the Mechanisms of earlY Recurrence in Intracranial Atherosclerotic Disease (MYRIAD) study.
We included enrolled MYRIAD patients with lipid measurements and brain MRI at baseline and brain MRI at 6-8 weeks. Infarct recurrence was defined as new infarcts in the territory of the symptomatic artery on brain MRI at 6-8 weeks compared to baseline brain MRI. We assessed the association between baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels and recurrent infarct at 6-8 weeks using multivariable logistic regression.
Among 74 patients (mean age 64.2±12.9 years, 59.5% were white, 60.8% men), 20 (27.0%) had new or recurrent infarcts. Mean HDL-C (37.2 vs. 43.9 mg/dL, P=0.037) was lower and TG (113.5 vs. 91.3 mg/dL, P=0.008) was higher while TC (199.8 vs. 174.3 mg/dL, P=0.061) and LDL-C (124.3 vs. 101.2 mg/dL, P=0.053) were nominally higher among those with recurrent infarcts than those without. LDL-C (adj. OR 1.022, 95% CI 1.004-1.040, P=0.015) and TG (adj. OR 1.009, 95% CI 1.001-1.016, P=0.021) were predictors of recurrent infarct at 6-8 weeks adjusting for other clinical and imaging factors.
Baseline cholesterol markers can predict early infarct recurrence in patients with symptomatic ICAD. More intensive and rapid lipid lowering drugs may be required to reduce risk of early recurrence.
高血脂是颅内动脉粥样硬化性疾病（ICAD）和临床中风复发的一个强有力的危险因素。我们在 Mechanisms of earlY Recurrence in Intracranial Atherosclerotic Disease（MYRIAD）研究中探讨了血清脂质水平对亚临床梗死复发的影响。
我们纳入了在基线和 6-8 周时进行了血脂测量和脑部 MRI 的 MYRIAD 研究患者。梗死复发定义为在症状性动脉供血区的新梗死在 6-8 周时与基线脑部 MRI 相比。我们使用多变量逻辑回归评估了基线总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯（TG）水平与 6-8 周时复发性梗死之间的相关性。
在 74 例患者（平均年龄 64.2±12.9 岁，59.5%为白人，60.8%为男性）中，有 20 例（27.0%）出现新的或复发性梗死。与无复发性梗死者相比，有复发性梗死者的 HDL-C 水平较低（37.2 与 43.9mg/dL，P=0.037），TG 水平较高（113.5 与 91.3mg/dL，P=0.008），TC 水平和 LDL-C 水平略高（199.8 与 174.3mg/dL，P=0.061；124.3 与 101.2mg/dL，P=0.053）。在校正其他临床和影像学因素后，LDL-C（调整后 OR 1.022，95%CI 1.004-1.040，P=0.015）和 TG（调整后 OR 1.009，95%CI 1.001-1.016，P=0.021）是 6-8 周时复发性梗死的预测因素。
基线胆固醇标志物可预测有症状性 ICAD 患者的早期梗死复发。可能需要更强化和更快速的降脂药物来降低早期复发的风险。
