Center for Stroke Research Berlin (CSB) (A.H.N., N.K., T.G.L., M. Endres), Charité - Universitätsmedizin Berlin, Germany.
Klinik und Hochschulambulanz für Neurologie (A.H.N., N.K., T.G.L., M. Endres), Charité - Universitätsmedizin Berlin, Germany.
Stroke. 2022 Aug;53(8):2512-2520. doi: 10.1161/STROKEAHA.122.038732. Epub 2022 May 9.
Elevated triglyceride and glucose levels are associated with an increased cardiovascular disease risk including ischemic stroke. It is not known whether the response to a combined oral triglyceride and glucose challenge after ischemic stroke improves identification of patients with increased risk for recurrent vascular events.
The prospective, observational Berlin "Cream&Sugar" study was conducted at 3 different university hospital sites of the Charité-Universitätsmedizin Berlin, Germany, between January 24, 2009 and July 31, 2017. Patients with first-ever ischemic stroke were recruited 3 to 7 days after stroke. An oral triglyceride tolerance test (OTTT) and consecutive blood tests before (t) as well as 3 (t), 4 (t), and 5 hours (t) after OTTT were performed in fasting patients. An oral glucose tolerance test was performed in all nondiabetic patients 3 hours after the start of OTTT. Outcomes of the study were recurrent fatal or nonfatal stroke as well as a composite vascular end point including stroke, transient ischemic attack, myocardial infarction, coronary revascularization, and cardiovascular death assessed 1 year after stroke. Cox regression models were used to estimate hazard ratios and corresponding 95% CIs between patients with high versus low levels of triglyceride and glucose levels.
Overall 755 patients were included; 523 patients completed OTTT and 1-year follow-up. Patients were largely minor strokes patients with a median National Institutes of Health Stroke Scale score of 1 (0-3). Comparing highest versus lowest quartiles of triglyceride levels, neither fasting (adjusted hazard ratio, 1.24 [95% CI, 0.45-3.42]) nor postprandial triglyceride levels (adjusted hazard ratio, 0.44 [95% CI, 0.16-1.25]) were associated with recurrent stroke. With regard to recurrent vascular events, results were similar for fasting triglycerides (adjusted hazard ratio, 1.09 [95% CI, 0.49-2.43]), however, higher postprandial triglyceride levels were significantly associated with a lower risk for recurrent vascular events (adjusted hazard ratio, 0.42 [95% CI, 0.18-0.95]). No associations were observed between fasting and post-oral glucose tolerance test blood glucose levels and recurrent vascular risk. All findings were irrespective of the diabetic status of patients.
In this cohort of patients with first-ever' minor ischemic stroke, fasting triglyceride or glucose levels were not associated with recurrent stroke at one year after stroke. However, higher postprandial triglyceride levels were associated with a lower risk of recurrent vascular events which requires further validation in future studies. Overall, our results do not support the routine use of a combined OTTT/oral glucose tolerance test to improve risk prediction for recurrent stroke.
甘油三酯和血糖水平升高与包括缺血性中风在内的心血管疾病风险增加有关。目前尚不清楚在缺血性中风后，联合口服甘油三酯和葡萄糖负荷试验的反应是否能改善对复发性血管事件风险增加的患者的识别。
前瞻性、观察性的柏林“奶油和糖”研究在德国柏林夏里特医科大学的 3 个不同的大学医院进行，于 2009 年 1 月 24 日至 2017 年 7 月 31 日期间招募了首次发生缺血性中风的患者。中风后 3 至 7 天招募患者。在空腹患者中进行口服甘油三酯耐量试验（OTTT）和连续的血液检测（t）以及 OTTT 后 3（t）、4（t）和 5 小时（t）。所有非糖尿病患者在 OTTT 开始后 3 小时进行口服葡萄糖耐量试验。研究的结局是中风后 1 年时复发性致命或非致命性中风以及包括中风、短暂性脑缺血发作、心肌梗死、冠状动脉血运重建和心血管死亡的复合血管终点。Cox 回归模型用于估计甘油三酯和葡萄糖水平高与低的患者之间的风险比和相应的 95%置信区间。
共纳入 755 例患者；523 例患者完成了 OTTT 和 1 年随访。患者主要为小卒中患者，中位数 NIH 卒中量表评分为 1（0-3）。与甘油三酯水平最高与最低四分位数相比，空腹（调整后的风险比，1.24[95%CI，0.45-3.42]）和餐后甘油三酯水平（调整后的风险比，0.44[95%CI，0.16-1.25]）均与复发性中风无关。关于复发性血管事件，空腹甘油三酯的结果相似（调整后的风险比，1.09[95%CI，0.49-2.43]），然而，较高的餐后甘油三酯水平与复发性血管事件的风险降低显著相关（调整后的风险比，0.42[95%CI，0.18-0.95]）。口服葡萄糖耐量试验后空腹和血糖水平与复发性血管风险之间没有观察到关联。所有发现均不依赖于患者的糖尿病状态。
在本队列中，首次发生的轻度缺血性中风患者中，中风后 1 年时空腹甘油三酯或血糖水平与中风复发无关。然而，餐后甘油三酯水平升高与复发性血管事件的风险降低相关，这需要在未来的研究中进一步验证。总体而言，我们的结果不支持常规使用联合 OTTT/口服葡萄糖耐量试验来改善中风复发的风险预测。
