Dai Li-Rui, Lyu Liang, Zhan Wen-Yi, Jiang Shu, Zhou Pei-Zhi
Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan University, Chengdu, Sichuan, China.
Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan University, Chengdu, Sichuan, China.
World Neurosurg. 2025 Mar;195:123649. doi: 10.1016/j.wneu.2024.123649. Epub 2025 Feb 20.
Mendelian randomization was employed to investigate the impact of circulating lipids, specifically residual lipids, on the risk of susceptibility to cerebral hemorrhage and ischemic stroke.
According to the previous studies, we chose 19 circulating lipids, comprising 6 regular lipids and 13 residual lipids, to investigate their potential causal relationship with intracranial hemorrhage and ischemic stroke. The effect estimates were computed utilizing the random-effects inverse-variance-weighted methodology.
The findings revealed negative correlations between high-density lipoprotein cholesterol (HDL-C) and cerebral hemorrhage and large artery stroke. HDL-C, apolipoprotein A1 (Apo A1), TG in very small VLDL, and TG in IDL were found to be negatively correlated with any ischemic stroke. apolipoprotein B (Apo B), triglycerides (TG), low-density lipoprotein cholestrol (LDL-C), L.VLDL-TG, TG in medium VLDL, and TG in small VLDL exhibited positive correlations with large artery stroke. TG in very large HDL and TG in IDL were positively correlated with cardioembolic stroke. No significant causal relationship was observed between circulating lipids, with the exception of HDL-C and cerebral hemorrhage. No causal relationship was identified between any circulating lipids and small vessel stroke. Furthermore, the causal relationships were only found between residual lipids and ischemic stroke.
This study provides evidence for the beneficial impact of Apo A1 and HDL-C in reducing the risk of ischemic stroke, as well as the protective effect of HDL-C against cerebral hemorrhage. It highlights the detrimental effects of Apo B, TG, and LDL-C in increasing the risk of ischemic stroke, particularly in cases of large artery stroke. Furthermore, the study underscores the heterogeneity and 2-sided effects of the causal relationship between triglyceride-rich lipoproteins and ischemic stroke, offering a promising avenue for the treatment of ischemic stroke.
采用孟德尔随机化方法研究循环脂质，特别是残留脂质，对脑出血和缺血性中风易感性风险的影响。
根据先前的研究，我们选择了19种循环脂质，包括6种常规脂质和13种残留脂质，以研究它们与颅内出血和缺血性中风之间的潜在因果关系。使用随机效应逆方差加权方法计算效应估计值。
研究结果显示高密度脂蛋白胆固醇（HDL-C）与脑出血和大动脉中风之间呈负相关。发现HDL-C、载脂蛋白A1（Apo A1）、极小微密度脂蛋白中的甘油三酯（TG）和中间密度脂蛋白中的TG与任何缺血性中风呈负相关。载脂蛋白B（Apo B）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、大极低密度脂蛋白-TG、中密度脂蛋白中的TG和小极低密度脂蛋白中的TG与大动脉中风呈正相关。超大HDL中的TG和中间密度脂蛋白中的TG与心源性栓塞性中风呈正相关。除HDL-C与脑出血外，未观察到循环脂质之间存在显著因果关系。未发现任何循环脂质与小血管中风之间存在因果关系。此外，仅在残留脂质与缺血性中风之间发现了因果关系。
本研究为Apo A1和HDL-C降低缺血性中风风险的有益作用以及HDL-C对脑出血的保护作用提供了证据。它强调了Apo B、TG和LDL-C增加缺血性中风风险的有害作用，特别是在大动脉中风的情况下。此外，该研究强调了富含甘油三酯的脂蛋白与缺血性中风之间因果关系的异质性和双向作用，为缺血性中风的治疗提供了一个有前景的途径。
