Gong Xiaoxian, Chen Luowei, Song Bo, Han Xiang, Xu Weihai, Wu Bo, Sheng Feng, Lou Min
Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, China.
Front Cardiovasc Med. 2022 Nov 3;9:893248. doi: 10.3389/fcvm.2022.893248. eCollection 2022.
The associations of lipid profiles with the risk of ischemic stroke (IS) or hemorrhagic stroke (HS) are controversial. In this study, we aimed to illustrate the optimal level for lipid levels in the risk of IS and HS.
We searched the electronic database of PubMed, Embase, and the Cochrane library from inception until November 2020. Prospective cohort studies published in English for the associations of lipid profiles (TC, TG, LDL-C, HDL-C, and non-HDL-C) with the risk of IS and HS were eligible for this study, and the publication status was not restricted. We calculated the pooled effect estimates using the random-effects model. We tested the associations of lipid profiles with IS and HS and compared their differences.
We retrieved 50 prospective cohort studies containing 3,301,613 individuals. An increase in total cholesterol (TC) is associated with an increased IS risk ( < 0.001) and a reduced HS risk ( < 0.001). Similarly, an increase in triglyceride links with a greater IS risk ( < 0.001) but with a lower HS risk ( = 0.014). On the opposite, high-density lipoprotein cholesterol (HDL-C) correlates with a reduced IS risk ( = 0.004) but has no significant association with the HS risk ( = 0.571). Moreover, an increase in low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol has no statistically significant effect on both IS and HS. The pooled effect estimates on the risk of IS and HS revealed that TC and LDL-C levels should be controlled under 6.0 and 3.5 mmol/L, respectively, to reduce worsening effects on the IS risk while maintaining potential beneficial effects on reducing the HS risk.
We revealed comprehensive relationships between lipid profiles and the risk of stroke, suggesting controlling the TC and LDL-C levels under 6.0 and 3.5 mmol/L, respectively, to balance both the IS and HS risk.
血脂水平与缺血性卒中（IS）或出血性卒中（HS）风险之间的关联存在争议。在本研究中，我们旨在阐明血脂水平在IS和HS风险中的最佳水平。
我们检索了从数据库建立至2020年11月的PubMed、Embase和Cochrane图书馆电子数据库。以英文发表的关于血脂谱（总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和非高密度脂蛋白胆固醇）与IS和HS风险关联的前瞻性队列研究符合本研究要求，且对发表状态无限制。我们使用随机效应模型计算合并效应估计值。我们检验了血脂谱与IS和HS的关联，并比较了它们的差异。
我们检索到50项前瞻性队列研究，共纳入3301613名个体。总胆固醇（TC）升高与IS风险增加（P<0.001）及HS风险降低（P<0.001）相关。同样，甘油三酯升高与更高的IS风险（P<0.001）相关，但与较低的HS风险（P = 0.014）相关。相反，高密度脂蛋白胆固醇（HDL-C）与降低的IS风险相关（P = 0.004），但与HS风险无显著关联（P = 0.571）。此外，低密度脂蛋白胆固醇（LDL-C）或非高密度脂蛋白胆固醇升高对IS和HS均无统计学显著影响。对IS和HS风险的合并效应估计显示，应分别将TC和LDL-C水平控制在6.0和3.5 mmol/L以下，以减少对IS风险的不良影响，同时维持对降低HS风险的潜在有益作用。
我们揭示了血脂谱与卒中风险之间的全面关系，建议分别将TC和LDL-C水平控制在6.0和3.5 mmol/L以下，以平衡IS和HS风险。
