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Li J, Li G, Zhu Y, Lei X, Chen G, Zhang J, Sun X. Role of LDL-C level alteration in increased mortality risks in spontaneous intracerebral hemorrhage patients: Systematic review and meta-analysis. Front Neurol 2023; 14:1114176. [PMID: 36925942 PMCID: PMC10011101 DOI: 10.3389/fneur.2023.1114176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Current studies indicate a contradictory relationship between decreased mortality risks of spontaneous intracerebral hemorrhage (sICH) and elevated low-density lipoprotein cholesterol (LDL-C) levels. Thus, this meta-analysis was designed to examine the involvement of high LDL-C levels in a lower mortality risk of sICH patients. Methods PubMed, Cochrane, and Embase databases were searched up to the date of August 3rd, 2022. Pooled odds ratio (OR) with a 95% confidence interval (CI) was estimated for the higher vs. lower serum LDL-C level groups. Subgroup and sensitivity analyses were also carried out. Egger's test was applied to detect any potential publication bias. Results Of 629 citations reviewed, 8 eligible cohort studies involving 83,013 patients were enrolled in this meta-analysis. Compared with lower serum LDL-C levels containing patients, higher serum LDL-C patients exhibited significantly decreased risks of 3-month mortality (OR: 0.51; 95%CI: 0.33-0.78; I2 = 47.8%); however, the LDL-C level change wasn't significantly associated with in-hospital mortality risks (OR: 0.92; 95%CI: 0.63-1.33; I2 = 91.4%) among sICH subjects. All studies included were classified as high-quality investigations. Conclusions This meta-analysis suggests a higher LDL-C level may decrease the mortality risk in sICH patients. LDL-C level increase is inversely associated with the 3-month mortality risks in these patients but not significantly correlated with the in-hospital mortality risks. Further well-designed prospective studies with extended follow-up periods are needed to confirm these findings and explore underlying cross-talks. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022318318, identifier: PROSPERO 2022 CRD42022318318.
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Affiliation(s)
- Jing Li
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Li
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yajun Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xingwei Lei
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guihu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiachun Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaochuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wen CP, Lee YC, Sun YT, Huang CY, Tsai CH, Chen PL, Chang WL, Yeh PY, Wei CY, Tsai MJ, Sun Y, Lin CH, Lee JT, Lai TC, Lien LM, Lin MC, Lin CL, Lee JH, Wang HK, Hsu CY. Low-Density Lipoprotein Cholesterol and Mortality in Patients With Intracerebral Hemorrhage in Taiwan. Front Neurol 2022; 12:793471. [PMID: 35113980 PMCID: PMC8802633 DOI: 10.3389/fneur.2021.793471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts. Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality. Results: Low cholesterol (LDL-C <100 mg/dL), found in 1/4 of the MJ cohort, was highly prevalent (36%) among young adults (age 20–39). There was a graded relationship between cholesterol and mortality for ICH [Hazard ratio, 1.56; 95% confidence interval (CI), 1.13–2.16]. Compared with patients with an LDL-C of 110–129 mg/dL in TSR, the risk for mortality was 1.84 (95% CI, 1.28–2.63) with an LDL-C of <100 mg/dL. Conclusion: Lower serum LDL-C level independently predicts higher mortality after acute ICH. While its causative role may vary, low cholesterol may pose potential harms in Taiwan.
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Affiliation(s)
- Chi-Pang Wen
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Yi-Che Lee
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Yuan Huang
- Department of Surgery, Faculty of Neurosurgical Service, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chon-Haw Tsai
- Division of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Jun Tsai
- Department of Neurology, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chih-Hao Lin
- Department of Neurology, Lin Shin Hospital, Taichung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, New Taipei City, Taiwan
| | - Ta-Chang Lai
- Department of Neurology, Cheng Hsin General Hospital, New Taipei City, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho Su Memorial Hospital, New Taipei City, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - June-Han Lee
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chung Y Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Feng X, Tang Q, Cheng C, Xu S. Low serum lipid levels, use of statin and cerebral microbleeds: A systematic review and meta-analysis. J Clin Neurosci 2021; 94:216-225. [PMID: 34863441 DOI: 10.1016/j.jocn.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/23/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous studies have shown that low serum lipids and statins may be related to cerebral hemorrhage. We made the meta-analysis to evaluate the associations between serum lipid levels or statins treatment and cerebral microbleeds (CMBs) to identify whether the similar correlation also existed. METHOD We comprehensively searched the Medline, Embase, Cochrane library, Web of Science, only included English journal articles, and systematically collected the observational studies and randomized controlled trials (RCTs) from September 1975 to August 2021. Random-effects model was used to pool data. Statistical heterogeneity was assessed by I2 statistic and chi-square. 11 items checklists recommended by the Agency for Healthcare Research and Quality (AHRQ), Newcastle-Ottawa Scale (NOS), and Cochrane Risk of Bias tool (ROB) were used to evaluate the methodological quality of cross-sectional studies, cohort studies and randomized controlled trial, respectively. RESULTS Five cohort studies, two RCTs, and ten cross-sectional studies, including 16,637 subjects and 2663 CMBs patients, were included in our quantitative synthesis. Our study found that after adjusting the covariates, total cholesterol (TC) was significantly inversely correlated with the prevalent CMBs in any location, while total triglycerides (TG) and High-density lipoprotein (HDL) were significantly inversely associated with prevalent deep CMBs. Low-density lipoprotein (LDL) was negatively associated with incident CMBs after adjusted confounders. We did not found statistical differences between statin and CMBs after adjusted covariates. CONCLUSION Serum major lipid (TC TG HDL LDL) levels may be inversely associated with CMBs. Currently, no sufficient evidence proves that statin therapy is the risk factor of CMBs.
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Affiliation(s)
- Xiao Feng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoqiao Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Cheng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Liu Q, Zhao W, Zou X, Xing Y, Zhou G, Li X. Sex Differences in Outcomes After Spontaneous Intracerebral Hemorrhage Among Patients With Low Total Cholesterol Levels. Am J Med Sci 2021; 362:462-471. [PMID: 33992602 DOI: 10.1016/j.amjms.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/21/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low total cholesterol (TC) levels were shown to be an independent predictor of intracerebral hemorrhagic stroke in previous studies. However, the role of sex in risk and outcome of patients with ICH and low TC levels is unclear. Therefore, the objective of our study was to assess the sex differences in the risk factors and outcomes after spontaneous intracerebral hemorrhage (ICH) in patients with low TC levels in China. METHODS This study recruited consecutive patients diagnosed with ICH who were admitted to the Stroke Registry System in Tianjin between May 2005 and May 2018. Patients with low TC levels (defined as TC<200mg/dl) were analyzed in this study. Sex differences in clinical features, risk factors, and outcomes at hospital discharge, 3 months, and 12 months after ICH were evaluated. RESULTS Of the 824 patients with low TC levels, 610 men (74%) and 214 women (26%). The mean age at ICH onset was younger in men than in women (60.93±12.54 vs. 64.5±12.28, P<0.001), and men were more likely to have higher educational levels than women. There were higher prevalence rates of hypertension, current smoking status, and alcohol consumption in men. Urinary tract infections were more prevalent in women, and hepatic/renal dysfunctions were more prevalent in men. Women had significantly higher neurological function deficits. With lower Barthel indices (BIs) and higher modified Rankin scale (mRS) scores at admission; but there was no significant difference between men and women in National Institutes of Health Stroke Scale (NIHSS) scores. The study showed that there was no significant difference in mortality and dependency rates at hospital discharge, 3 months, and 12 months after ICH. CONCLUSIONS Our study showed that there were no sex differences in clinical outcomes of patients with ICH and low TC levels, which suggests that the effect of low cholesterol as a risk factor for cerebral hemorrhage is the same on patients of different sexs. The possible mechanisms need larger, prospective, multicenter studies to further research.
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Affiliation(s)
- Qian Liu
- The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China.
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xuan Zou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Yonghong Xing
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xin Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
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5
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Liu Q, Zhao W, Xing Y, Hong Y, Zhou G. Low Triglyceride Levels are Associated with Unfavorable Outcomes in Patients with Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2020; 34:218-226. [PMID: 32557109 DOI: 10.1007/s12028-020-01023-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS The relationship between serum lipid level and clinical outcome after spontaneous intracerebral hemorrhage (ICH) remains controversial. We sought to evaluate the association of serum lipid levels with clinical outcomes in patients with ICH. METHODS Data on consecutive patients hospitalized with spontaneous ICH were prospectively collected from May 2005 to May 2018 and retrospectively analyzed. Following clinical and demographic data, age and gender, risk factors, serum lipid levels [total cholesterol, triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol] and the outcomes were analyzed. RESULTS A total of 1451 patients with ICH (mean age, 60.41 ± 12.3 years; 32.6% women) was evaluated. Although admission TG levels were associated with the outcomes at hospital discharge and 3 months in initial univariate analyses, the former association did not retain its statistical significance in multivariate logistic regression analyses adjusting for potential confounders. However, lower admission TG levels were independently associated (p = 0.045) with a higher likelihood of 12-month unfavorable outcomes (odds ratio 0.91, 95% confidence interval 0.83-0.99) in multivariate logistic regression models. CONCLUSIONS Low TG levels at hospital admission were an independent predictor for unfavorable long-term outcomes in patients with spontaneous ICH. The exact mechanisms of the association need further investigations.
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Affiliation(s)
- Qian Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350, China
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350, China
| | - Yonghong Xing
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350, China
| | - Yan Hong
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350, China
| | - Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 300350, China. .,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, 300350, China.
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6
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Association between Serum Lipid and Hematoma Expansion after Spontaneous Intracerebral Hemorrhage in Chinese Patients. J Stroke Cerebrovasc Dis 2020; 29:104793. [PMID: 32224203 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/22/2020] [Accepted: 02/26/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Although several studies have shown that interventions to lower blood lipid concentration may reduce the risk of coronary arterial disease and ischemic stroke, the correlation between serum lipid levels and hemorrhagic stroke remains controversial. To clarify any possible association between serum lipid and hematoma expansion, we examined various serum lipid indices in patients with and without early hematoma expansion. METHODS Data of 572 intracerebral hemorrhage (ICH) patients from the cerebral small vessel disease cohort of Peking Union Medical College Hospital were retrospectively analyzed. Patients who finished the baseline brain computed tomography (CT) examination within 6 h post-ictus and the follow-up CT within 48 h after initial CT were included in the study. Hematoma expansion was delimited as an enlargement of hemorrhage volume over 33% or 12.5 mL between baseline and subsequent CT. Both uni- and multivariate logistic regression analyses were conducted to explore the association between early hematoma growth and various serum lipid indices, including triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, ratios of LDL-C/HDL-C and LDL-C/TC, as well as other demographic and clinical features. RESULTS Out of 157 patients included in the analysis, hematoma growth occurred in 45 (28.7%). Only higher baseline systolic blood pressure was found to be correlated with an increased risk of hematoma growth based on both univariate (odds ratio [OR] 1.014, 95% confidence interval [CI]: 1.002-1.026, P = .024) and multivariate logistic regression analyses (OR 1.022, 95%CI: 1.008-1.037, P = .003). No associations were detected between the various serum lipid indices examined and other clinical features with a likelihood of early hematoma growth between groups or within various subgroups defined by different characteristics including age, gender, baseline Glasgow Coma Scale score, systolic blood pressure, intraventricular extension, and hematoma location. CONCLUSIONS No association between various indices of serum lipid and hematoma growth was identified among patients and subgroups with spontaneous ICH in the Chinese population; these findings may help to guide lipid management after ICH. However, further multi-centered, larger scale studies are expected to verify our results.
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Kim JH, Wi DH, Lee JH, Song HJ, Shin SD, Ro YS, Bae KH. Effects of cholesterol levels on outcomes of out-of-hospital cardiac arrest: a cross-sectional study. Clin Exp Emerg Med 2019; 6:242-249. [PMID: 31571440 PMCID: PMC6774009 DOI: 10.15441/ceem.18.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/12/2018] [Indexed: 12/15/2022] Open
Abstract
Objective High cholesterol level is a risk factor for coronary artery disease, and coronary artery disease is a major risk factor for out-of-hospital cardiac arrest (OHCA). However, the effect of cholesterol level on outcomes of OHCA has been poorly studied. This study aimed to determine the effect of cholesterol level on outcomes of OHCA. Methods This cross-sectional study used the CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance) project database in Korea. Multivariable conditional logistic regression analysis was performed to estimate the effect of cholesterol level on outcomes in OHCA. Results In all, 584 cases of OHCA were analyzed; those with cholesterol levels <120 mg/dL were classified as having low total cholesterol (TC) (n=197), those with levels ranging from 120–199 mg/dL as middle TC (n=322), and those with ≥200 mg/dL as high TC (n=65). Compared to low TC, more patients with middle TC and high TC survived to discharge (9.1% vs. 22.0% and 26.2%, respectively, P=0.001). The good cerebral performance category also increased in that order (4.1 % vs. 14.6% and 23.1%, respectively, P≤0.001). Comparing middle TC and high TC with low TC, adjusted odds ratios (95% confidence intervals) were 1.97 (1.06 to 3.64) and 2.53 (1.08 to 5.92) for survival to discharge, respectively, and 2.53 (1.07 to 5.98) and 4.73 (1.63 to 13.71) for good neurological recovery, respectively. Conclusion Higher cholesterol is associated with better outcomes in OHCA; cholesterol level is a good predictor of outcomes of OHCA.
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Affiliation(s)
- Jong Hwan Kim
- Department of Emergency Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Dae Han Wi
- Department of Emergency Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Jun Hee Lee
- Department of Emergency Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Hyung Jun Song
- Department of Emergency Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kwang-Ho Bae
- Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Korea
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Kamino D, Chau V, Studholme C, Liu M, Xu D, James Barkovich A, Ferriero DM, Miller SP, Brant R, Tam EW. Plasma cholesterol levels and brain development in preterm newborns. Pediatr Res 2019; 85:299-304. [PMID: 30635642 PMCID: PMC6433157 DOI: 10.1038/s41390-018-0260-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND To assess whether postnatal plasma cholesterol levels are associated with microstructural and macrostructural regional brain development in preterm newborns. METHODS Sixty preterm newborns (born 24-32 weeks gestational age) were assessed using MRI studies soon after birth and again at term-equivalent age. Blood samples were obtained within 7 days of each MRI scan to analyze for plasma cholesterol and lathosterol (a marker of endogenous cholesterol synthesis) levels. Outcomes were assessed at 3 years using the Bayley Scales of Infant Development, Third Edition. RESULTS Early plasma lathosterol levels were associated with increased axial and radial diffusivities and increased volume of the subcortical white matter. Early plasma cholesterol levels were associated with increased volume of the cerebellum. Early plasma lathosterol levels were associated with a 2-point decrease in motor scores at 3 years. CONCLUSIONS Higher early endogenous cholesterol synthesis is associated with worse microstructural measures and larger volumes in the subcortical white matter that may signify regional edema and worse motor outcomes. Higher early cholesterol is associated with improved cerebellar volumes. Further work is needed to better understand how the balance of cholesterol supply and endogenous synthesis impacts preterm brain development, especially if these may be modifiable factors to improve outcomes.
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Affiliation(s)
- Daphne Kamino
- Department of Paediatrics, Division of Neurology Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vann Chau
- Department of Paediatrics, Division of Neurology Hospital for Sick Children, Toronto, Ontario, Canada
| | - Colin Studholme
- Department of Pediatrics and Department of Bioengineering and Radiology, University of Washington, Seattle, WA
| | - Mengyuan Liu
- Department of Pediatrics and Department of Bioengineering and Radiology, University of Washington, Seattle, WA
| | - Duan Xu
- Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - A. James Barkovich
- Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA,Departments of Pediatrics and Neurology, University of California San Francisco, San Francisco, CA
| | - Donna M. Ferriero
- Departments of Pediatrics and Neurology, University of California San Francisco, San Francisco, CA
| | - Steven P. Miller
- Department of Paediatrics, Division of Neurology Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rollin Brant
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily W.Y. Tam
- Department of Paediatrics, Division of Neurology Hospital for Sick Children, Toronto, Ontario, Canada,Corresponding Author: Emily W.Y. Tam, MDCM, MAS, FRCPC, Hospital for Sick Children, Division of Neurology, 555 University Avenue, Toronto, ON M5G 1X8 Canada, Phone: 416-813-6660, Fax:416-813-6334,
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Siddiqui FM, Langefeld CD, Moomaw CJ, Comeau ME, Sekar P, Rosand J, Kidwell CS, Martini S, Osborne JL, Stutzman S, Hall C, Woo D. Use of Statins and Outcomes in Intracerebral Hemorrhage Patients. Stroke 2017; 48:2098-2104. [PMID: 28663510 PMCID: PMC5659292 DOI: 10.1161/strokeaha.117.017358] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/05/2017] [Accepted: 06/02/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Statin use may be associated with improved outcome in intracerebral hemorrhage patients. However, the topic remains controversial. Our analysis examined the effect of prior, continued, or new statin use on intracerebral hemorrhage outcomes using the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) data set. METHODS We analyzed ERICH (a multicenter study designed to examine ethnic variations in the risk, presentation, and outcomes of intracerebral hemorrhage) to explore the association of statin use and hematoma growth, mortality, and 3-month disability. We computed subset analyses with respect to 3 statin categories (prior, continued, or new use). RESULTS Two thousand four hundred and fifty-seven enrolled cases (mean age, 62 years; 42% females) had complete data on mortality and 3-month disability (modified Rankin Scale). Among those, 1093 cases were on statins (prior, n=268; continued, n=423; new, n=402). Overall, statin use was associated with reduced mortality and disability without any effect on hematoma growth. This association was primarily driven by continued/new statin use. A multivariate analysis adjusted for age and major predictors for poor outcome showed that continued/new statins users had good outcomes compared with prior users. However, statins may have been continued/started more frequently among less severe patients. When a propensity score was developed based on factors that could influence a physician's decision in prescribing statins and used as a covariate, continued/new statin use was no longer a significant predictor of good outcome. CONCLUSIONS Although statin use, especially continued/new use, was associated with improved intracerebral hemorrhage outcomes, this effect may merely reflect the physician's view of a patient's prognosis rather than a predictor of survival.
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Affiliation(s)
- Fazeel M Siddiqui
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.).
| | - Carl D Langefeld
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Charles J Moomaw
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Mary E Comeau
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Padmini Sekar
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Jonathan Rosand
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Chelsea S Kidwell
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Sharyl Martini
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Jennifer L Osborne
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Sonja Stutzman
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Christiana Hall
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
| | - Daniel Woo
- From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC (C.D.L., M.E.C.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (C.J.M., P.S., J.L.O., D.W.); Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R.); Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.); Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (S.S., C.H.)
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10
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Chen YW, Li CH, Yang CD, Liu CH, Chen CH, Sheu JJ, Lin SK, Chen AC, Chen PK, Chen PL, Yeh CH, Chen JR, Hsiao YJ, Lin CH, Hsu SP, Chen TS, Sung SF, Yu SC, Muo CH, Wen CP, Sung FC, Jeng JS, Hsu CY. Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry. PLoS One 2017; 12:e0171379. [PMID: 28422955 PMCID: PMC5396870 DOI: 10.1371/journal.pone.0171379] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/18/2017] [Indexed: 01/14/2023] Open
Abstract
The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160–200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41–2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11–1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76–8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.
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Affiliation(s)
- Yu-Wei Chen
- Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Hua Li
- Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Dong Yang
- Department of Neurosurgery, Taiwan Landseed Hospital, Taoyuan, Taiwan
| | - Chung-Hsiang Liu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shinn-Kuang Lin
- Department of Neurology, Taipei Tzu Chi Hospital, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - An-Chih Chen
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ping-Kun Chen
- Department of Neurology, Lin Shin Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Hsin Yeh
- Department of Neurology, Yuan Rung Hospital, Changhua, Taiwan
- Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan
- Department of Nursing, College of Medicine & Nursing, Hung-Kuang University, Taichung, Taiwan
| | - Jiunn-Rong Chen
- Department of Neurology, Yunlin Christian Hospital, Yunlin, Taiwan
| | - Yu-Jen Hsiao
- Department of Neurology, National Taiwan University Hospital—Yunlin Branch, Yunlin, Taiwan
| | - Ching-Huang Lin
- Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
| | | | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Shih-Chieh Yu
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chi Pang Wen
- National Health Research Institutes, Miaoli, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- * E-mail: (JSJ); (FCS)
| | - Jiann-Shing Jeng
- Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan
- Stroke Center, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (JSJ); (FCS)
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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11
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Duan D, Shen L, Cui C, Shu T, Zheng J. Association between Low-density lipoprotein cholesterol and occipital periventricular hyperintensities in a group of Chinese patients: an observational study. Lipids Health Dis 2017; 16:48. [PMID: 28241772 PMCID: PMC5327518 DOI: 10.1186/s12944-017-0436-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 02/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While occipital periventricular hyperintensities (OPVHs) are among the most common mild white matter hyperintensities, the clinical factors associated with OPVHs remain unclear. In this study, we investigated the role of clinical factors in development of pure OPVHs. METHODS This study included 97 patients with OPVHs and 73 healthy controls. Univariate analysis of clinical factors in OPVH patients and controls was followed by binomial logistic regression analysis to identify clinical factors significantly associated with OPVHs. RESULT Univariate analysis indicated that age, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein-B (Apo-B) levels differed significantly between the OPVH patients and controls (p < 0.05). Age and gender were correlated with OPVH scores (p < 0.05), while LDL-C, triglycerides, Apo-B and TC were anti-correlated with OPVHs scores (p < 0.05). Multivariate analysis indicated that LDL-C is negatively correlated with OPVHs (p < 0.05), and age is positively correlated with OPVHs (p < 0.001). CONCLUSION In summary, LDL-C was negatively and age was positively associated with OPVHs among Chinese patients in a hospital.
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Affiliation(s)
- Dazhi Duan
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, No. 183, Xinqiao Street, Chongqing, 400037, China.
| | - Lin Shen
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Chun Cui
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Tongsheng Shu
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Jian Zheng
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, No. 183, Xinqiao Street, Chongqing, 400037, China
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12
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You S, Zhong C, Xu J, Han Q, Zhang X, Liu H, Zhang Y, Shi J, Huang Z, Xiao G, Zhang C, Cao Y, Liu C. LDL-C/HDL-C ratio and risk of all-cause mortality in patients with intracerebral hemorrhage. Neurol Res 2016; 38:903-8. [PMID: 27412564 DOI: 10.1080/01616412.2016.1204797] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jiaping Xu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiao Han
- Department of Neurology, The hospital of traditional Chinese medicine, Suzhou, China
| | - Xia Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Huihui Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanlin Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jijun Shi
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhichao Huang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guodong Xiao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunyuan Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases & Institute of Neuroscience,Soochow University, Suzhou, China
| | - Chunfeng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases & Institute of Neuroscience,Soochow University, Suzhou, China
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13
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Jiang Y, Ma J, Li H, Liu Y, You C. Effect of apolipoprotein C3 genetic polymorphisms on serum lipid levels and the risk of intracerebral hemorrhage. Lipids Health Dis 2015; 14:48. [PMID: 25994187 PMCID: PMC4490767 DOI: 10.1186/s12944-015-0047-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/14/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Serum lipid levels are associated with the risk of intracerebral hemorrhage (ICH). Genetic variants in the apolipoprotein C3 (APOC3) gene were associated with plasma triglyceride (TG) and very-low-density lipoprotein (VLDL) levels. The aim of this study was to evaluate the effect of two genetic variants (1100 C/T and 3238 C/G) of APOC3 on serum lipid levels and risk of ICH. METHODS A prospective hospital-based case-control design and logistic regression analysis were utilized. We enrolled 150 ICH patients and 150 age- and gender-matched controls. The APOC3 gene polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS ICH patients had a significantly higher frequency of APOC3 3238 GG genotype [odds ratio (OR)=.97, 95% confidence interval (CI)=1.20, 7.38; P=0.02] and APOC3 3238 G allele (OR=.53, 95% CI=1.03, 2.27; P=0.04) than controls. The APOC3 3238 G allele was significantly associated with increasing plasma TG levels and VLDL levels both in ICH cases (P=0.01) and controls (P=0.02). No association was found between APOC3 1100 C/T polymorphisms and ICH. CONCLUSION To the best of our knowledge, this is the first report in the literature that the APOC3 3238 GG genotype and G allele might contribute to an increased risk of ICH as a result of its effect on serum lipid levels.
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Affiliation(s)
- Yan Jiang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxuexiang Street, Chengdu, 610041, China.
| | - Junpeng Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxuexiang Street, Chengdu, 610041, China.
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxuexiang Street, Chengdu, 610041, China.
| | - Yi Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxuexiang Street, Chengdu, 610041, China.
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxuexiang Street, Chengdu, 610041, China.
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14
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Senn R, Elkind MSV, Montaner J, Christ-Crain M, Katan M. Potential role of blood biomarkers in the management of nontraumatic intracerebral hemorrhage. Cerebrovasc Dis 2014; 38:395-409. [PMID: 25471997 DOI: 10.1159/000366470] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH), a subtype of stroke associated with high mortality and disability, accounts for 13% of all strokes. Basic and clinical research has contributed to our understanding of the complex pathophysiology of neuronal injury in ICH. Outcome rates, however, remain stable, and questions regarding acute management of ICH remain unanswered. Newer research is aiming at matching measured levels of serum proteins, enzymes, or cells to different stages of brain damage, suggesting that blood biomarkers may assist in acute diagnosis, therapeutic decisions, and prognostication. This paper provides an overview on the most promising blood biomarkers and their potential role in the diagnosis and management of spontaneous ICH. SUMMARY Information was collected from studies, reviews, and guidelines listed in PubMed up to November 2013 on blood biomarkers of nontraumatic ICH in humans. We describe the potential role and limitations of GFAP, S100B/RAGE, and ApoC-III as diagnostic biomarkers, β-Amyloid as a biomarker for etiological classification, and 27 biomarkers for prognosis of mortality and functional outcome. Within the group of prognostic markers we discuss markers involved in coagulation processes (e.g., D-Dimers), neuroendocrine markers (e.g., copeptin), systemic metabolic markers (e.g., blood glucose levels), markers of inflammation (e.g., IL-6), as well as growth factors (e.g., VEGF), and others (e.g., glutamate). Some of those blood biomarkers are agents of pathologic processes associated with hemorrhagic stroke but also other diseases, whereas others play more distinct pathophysiological roles and help in understanding the basic mechanisms of brain damage and/or recovery in ICH. KEY MESSAGES Numerous blood biomarkers are associated with different pathophysiological pathways in ICH, and some of them promise to be useful in the management of ICH, eventually contributing additional information to current tools for diagnosis, therapy monitoring, risk stratification, or intervention. Up to date, however, no blood biomarker of ICH has been studied sufficiently to find its way into clinical routine yet; well-designed, large-scale, clinical studies addressing relevant clinical questions are needed. We suggest that the effectiveness of biomarker research in ICH might be improved by international cooperation and shared resources for large validation studies, such as provided by the consortium on stroke biomarker research (http://stroke-biomarkers.com/page.php?title=Resources).
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Affiliation(s)
- Rebecca Senn
- Department of Endocrinology, University Hospital Basel, Basel, Switzerland
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15
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Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014; 45:315-53. [PMID: 24309587 PMCID: PMC5995123 DOI: 10.1161/01.str.0000437068.30550.cf] [Citation(s) in RCA: 548] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke mortality has been declining since the early 20th century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with the change in stroke risk and mortality. This statement considers the evidence for factors that have contributed to the decline and how they can be used in the design of future interventions for this major public health burden. METHODS Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiological studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and to indicate gaps in current knowledge. All members of the writing group had the opportunity to comment on this document and approved the final version. The document underwent extensive American Heart Association internal peer review, Stroke Council leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both sexes and for all racial/ethnic and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among people <65 years of age represents a reduction in years of potential life lost. The decline in mortality results from reduced incidence of stroke and lower case-fatality rates. These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. Although it is difficult to calculate specific attributable risk estimates, efforts in hypertension control initiated in the 1970s appear to have had the most substantial influence on the accelerated decline in stroke mortality. Although implemented later, diabetes mellitus and dyslipidemia control and smoking cessation programs, particularly in combination with treatment of hypertension, also appear to have contributed to the decline in stroke mortality. The potential effects of telemedicine and stroke systems of care appear to be strong but have not been in place long enough to indicate their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions. CONCLUSIONS The decline in stroke mortality is real and represents a major public health and clinical medicine success story. The repositioning of stroke from third to fourth leading cause of death is the result of true mortality decline and not an increase in mortality from chronic lung disease, which is now the third leading cause of death in the United States. There is strong evidence that the decline can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension. Thus, research studies and the application of their findings in developing intervention programs have improved the health of the population. The continued application of aggressive evidence-based public health programs and clinical interventions is expected to result in further declines in stroke mortality.
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16
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Lei C, Wu B, Liu M, Chen Y. Association between statin use and intracerebral hemorrhage: a systematic review and meta-analysis. Eur J Neurol 2013; 21:192-8. [PMID: 24118228 DOI: 10.1111/ene.12273] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 08/26/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Accumulating evidence suggests that statins exert neuroprotective effects, but whether their use affects the outcomes of intracerebral hemorrhage (ICH) remains controversial. Therefore, we performed a systematic review and meta-analysis to investigate whether statin use before spontaneous ICH affects unfavorable functional outcome or mortality. METHODS We searched the Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure databases for studies examining the effects of pre-ICH statin use on unfavorable functional outcome, mortality or neuroimaging outcomes in consecutively recruited patients with spontaneous ICH, regardless of the duration or dose of statin treatment. RESULTS A total of 12 studies were included that examined the effects of pre-ICH statin use on post-ICH outcomes in 1652 subjects in the favors pre-statin group and 5309 in the favors no pre-ICH statin group. Meta-analysis of 11 studies suggested that pre-ICH statin use did not significantly affect mortality across all three time points tested [in-hospital, 30 days, 90 days; odds ratio (OR) 0.85, 95% confidence interval (CI) 0.70-1.03]. However, meta-analysis of seven studies showed that pre-ICH statin use did significantly decrease 90-day mortality (OR 0.72, 95% CI 0.59-0.88). Meta-analysis of six studies showed that pre-ICH statin use was not associated with significant changes in unfavorable functional outcome. Moreover, pre-ICH statin use did not significantly affect admission hematoma volume (standardized mean difference 7.75, 95% CI -5.59 to 21.09). CONCLUSION Available evidence suggests that statin use before spontaneous ICH does not increase short-term mortality, unfavorable functional outcome or post-ICH hematoma volume at admission.
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Affiliation(s)
- C Lei
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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17
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Mustanoja S, Strbian D, Putaala J, Meretoja A, Curtze S, Haapaniemi E, Sairanen T, Hietikko R, Sirén J, Kaste M, Tatlisumak T. Association of prestroke statin use and lipid levels with outcome of intracerebral hemorrhage. Stroke 2013; 44:2330-2. [PMID: 23760210 DOI: 10.1161/strokeaha.113.001829] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE It is unclear whether blood lipid profiles and statin use before intracerebral hemorrhage (ICH) are associated with its outcome. METHODS The Helsinki ICH Study, a single-center observational registry of consecutive ICH patients, was used to study the associations between premorbid statin use, baseline lipid levels, and clinical outcome. RESULTS The registry includes 964 ICH patients. Statin users (n=187; 19%) were significantly older, had more frequent comorbidities and medication, lower lipid levels, and higher admission Glasgow Coma Scale compared with nonusers. Modified Rankin Scale at discharge or mortality did not differ between statin users and nonusers. Compared with survivors, significantly lower total cholesterol and low-density lipoprotein cholesterol levels were observed in patients who died in hospital (median, 4.1 mmol/L [interquartile range, 3.6-4.4] versus 4.5 [3.8-5.1]; P<0.01; 1.9 mmol/L [1.4-2.5] versus 2.4 [1.8-3.0]; P<0.001, respectively), at 3 or 12 months. After adjusting for known ICH prognostic factors based on univariate analysis that is, age, National Institutes of Health Stroke Scale, Glasgow Coma Scale, ICH volume, and intraventricular location, lower low-density lipoprotein levels were independently associated with in-hospital mortality (odds ratio, 0.54 [95% confidence interval, 0.31-0.93]; P=0.028). CONCLUSIONS Premorbid statin use did not affect the outcome of ICH, but lower low-density lipoprotein levels were associated with higher in-hospital mortality.
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Affiliation(s)
- Satu Mustanoja
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
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Valappil AV, Chaudhary NV, Praveenkumar R, Gopalakrishnan B, Girija AS. Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case-control study. Ann Indian Acad Neurol 2012; 15:19-22. [PMID: 22412267 PMCID: PMC3299064 DOI: 10.4103/0972-2327.93270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/13/2011] [Accepted: 11/24/2011] [Indexed: 12/04/2022] Open
Abstract
Introduction: An inverse association between serum cholesterol and the risk of hemorrhagic stroke has been noted in epidemiological studies. We performed a case–control study to assess the relationship between primary intracerebral hemorrhage (ICH) and low serum cholesterol. Materials and Methods: Prospectively recruited fully evaluated patients with ICH were compared with a control group based in a primary care practice, i.e. age- and sex-matched individuals attending the routine preventive health check-up. Low cholesterol was defined by the sex-specific lowest quintile of the population. Results: The proportion of ICH patients with low cholesterol was significantly higher than the controls (68% vs. 43%). Mean total cholesterol was also signficantly low in ICH patients compared with controls (177 mg/dL vs. 200 mg/dl; P-value = 0.0006). Low-density lipoprotein cholesterol (LDL-c) and triglycerides were also significantly low in ICH patients compared with controls. Mean LDL-C in the ICH patient group was 114 mg/dL, whereas it was 128.5 mg/dL in the control group (P-value = 0.016). There was no significant difference in the high-density lipoprotein (HDL) levels in both groups. In a subgroup analysis, both men and women in the ICH group had a significantly low mean cholesterol compared with the control group. Although lower mean cholesterol was seen in both young and older individuals in the ICH group than in controls, the difference was significant only in the older group (age >45 years). In multivariate analysis, presence of low cholesterol remained a significant predictor of hemorrhage. The odds ratio of low cholesterol in the hemorrhage cases was 2.75 (95% CI = 1.44–5.49) unadjusted and 2.15 (1.13–4.70) adjusted for age and hypertension. Conclusions: This study confirms an increased risk of primary ICH associated with low cholesterol both in men and women, especially in older individuals.
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Affiliation(s)
- Ashraf V Valappil
- Department of Neurology, Malabar Institute of Medical Sciences, Calicut, Kerala, India
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Lai YT, Hsieh CL, Lee HP, Pan SL. Are higher total serum cholesterol levels associated with better long-term motor function after ischemic stroke? Nutr Neurosci 2012; 15:239-43. [PMID: 22643364 DOI: 10.1179/1476830512y.0000000016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of the study was to investigate the prognostic role of total cholesterol (TC) level on the long-term motor function after ischemic stroke. METHODS One hundred and fourteen patients with ischemic stroke were included and divided into high total cholesterol (HTC; TC ≧5.18 mmol/l or ≧200 mg/dl) and low total cholesterol (LTC; TC <5.18 mmol/l or <200 mg/dl) groups. The motor outcome was evaluated using the motor score of the Fugl-Meyer assessment (MFMA) at 2 weeks (baseline), 1, 3, 6, and 12 months after stroke. Prognostic factors on the repeated measurements of the MFMA were investigated using the linear mixed regression model. RESULTS The TC, basal ganglion lesion, baseline MFMA, first-time stroke, and follow-up time were identified as significant predictors for serial MFMA scores. The HTC group had higher MFMA scores than the LTC group by 2.72 units (95% confidence interval (CI): 0.17, 5.27, P = 0.037). An elevation of one unit of baseline MFMA led to a 0.86 increase (95% CI: 0.82, 0.90, P < 0.001) of subsequent MFMA scores. Subjects with basal ganglion lesions had lower MFMA scores by -3.55 (95% CI: -5.97, -1.14, P = 0.004). DISCUSSION Higher total cholesterol at the acute phase of ischemic stroke is a favorable prognostic factor for long-term motor function.
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Roquer J, Cuadrado-Godia E, Rodríguez-Campello A, Jiménez-Conde J, Martínez-Rodríguez JE, Giralt E, Ois A. Serum cholesterol levels and survival after rtPA treatment in acute stroke. Eur J Neurol 2011; 19:648-54. [DOI: 10.1111/j.1468-1331.2011.03607.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Rodriguez-Luna D, Rubiera M, Ribo M, Coscojuela P, Pagola J, Piñeiro S, Ibarra B, Meler P, Maisterra O, Romero F, Alvarez-Sabin J, Molina CA. Serum Low-Density Lipoprotein Cholesterol Level Predicts Hematoma Growth and Clinical Outcome After Acute Intracerebral Hemorrhage. Stroke 2011; 42:2447-52. [DOI: 10.1161/strokeaha.110.609461] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Rodriguez-Luna
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rubiera
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Ribo
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Coscojuela
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Socorro Piñeiro
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bernardo Ibarra
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Meler
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olga Maisterra
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Romero
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Alvarez-Sabin
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos A. Molina
- From the Neurovascular Unit (D.R.-L., M.Ru., M.Ri., J.P., S.P., P.M., O.M., J.A.-S., C.M.) and Neuroradiology Department (P.C., B.I., F.R.), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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D'Amelio M, Terruso V, Famoso G, Ragonese P, Aridon P, Savettieri G. Cholesterol levels and risk of hemorrhagic transformation after acute ischemic stroke. Cerebrovasc Dis 2011; 32:234-8. [PMID: 21860236 DOI: 10.1159/000329315] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/10/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between cholesterol levels and hemorrhagic transformation (HT) is still controversial. Studies investigating this issue are influenced by treatments as some are characterized by a higher risk of HT. The aim of our study was to evaluate, in a hospital-based series of patients not treated with thrombolysis, the relationship between cholesterol levels and HT. METHODS We retrospectively collected information about total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) levels at admission in a consecutive series of 240 patients with anterior ischemic stroke (IS). The TC and LDLC levels were arranged in 3 groups according to their percentile distribution. RESULTS TC levels were available for 215 patients (89.6%), while LDLC levels were available for 184 patients (76.7%). The risk of HT significantly increased with decreasing levels of TC (p for trend = 0.03) and LDLC (p for trend = 0.01). In multivariate analysis, the risk of HT was significantly higher in the groups of patients with the lowest TC (OR 2.8, 95% CI 1.0-8.9, p = 0.05) and LDLC (OR 5.0, 95% CI 1.2-20.1, p = 0.002) values compared to those with the highest ones. CONCLUSION We confirm that lower TC and lower LDLC levels are associated with an increased risk of HT. As none of our patients received thrombolytic therapy, the results of our study provide baseline information about the natural history of HT.
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Affiliation(s)
- Marco D'Amelio
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, University of Palermo, Palermo, Italy
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Xiong YY, Mok V. Age-related white matter changes. J Aging Res 2011; 2011:617927. [PMID: 21876810 PMCID: PMC3163144 DOI: 10.4061/2011/617927] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/20/2022] Open
Abstract
Age-related white matter changes (WMC) are considered manifestation of arteriolosclerotic small vessel disease and are related to age and vascular risk factors. Most recent studies have shown that WMC are associated with a host of poor outcomes, including cognitive impairment, dementia, urinary incontinence, gait disturbances, depression, and increased risk of stroke and death. Although the clinical relevance of WMC has been extensively studied, to date, only very few clinical trials have evaluated potential symptomatic or preventive treatments for WMC. In this paper, we reviewed the current understanding in the pathophysiology, epidemiology, clinical importance, chemical biomarkers, and treatments of age-related WMC.
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Affiliation(s)
- Yun Yun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Shatin 999077, Hong Kong
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Wang X, Kong Y, Chen H, Zhang JH, Wang Y. Characteristics of acute cerebral hemorrhage with regard to lipid metabolism and glycometabolism among different age groups. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:367-371. [PMID: 21725784 DOI: 10.1007/978-3-7091-0693-8_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study investigated the lipid metabolism and glycometabolism of patients with acute cerebral hemorrhage from 2006-2008 in order to find a possible association among lipid metabolism, glycometabolism and different age groups of adults in the Chinese Chongqing population. METHODS Data on levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and fasting serum glucose (GLU) were obtained from records of patients (548) from the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University. Participants ranging in age from 21-94 years were divided into three groups; the first group was the young group in which all participants were 21-44 years old; the second group was the middle-age group in which all participants were 45-59 years old, and the last group was the elderly group in which all participants were 60-94 years old. RESULTS Levels of TC, TG, HDL-C, LDL-C and GLU were not significantly different among the three groups (P>0.05). Proportions of hypercholesterolemia high LDL-C, low HDL-C, impaired fasting glucose and diabetes mellitus were not different among the three groups (P>0.05). Only the proportion of hypertriglyceridemia patients was significantly different. The risk of being diagnosed with hypertriglyceridemia in the middle-age group was increased 2.371 times (95% CI: 1.542-3.645) and in the young group increased 2.281 times (95% CI: 1.211 -4.296). CONCLUSION Age and hypertriglyceridemia are risk factors associated with an increased incidence rate of acute cerebral hemorrhage in the Chongqing population in China.
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Affiliation(s)
- Xiaolin Wang
- The Medical Examination Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Rost NS, Rosand J, Woo D. Can hyperlipidemia be protective to the brain? The paradox of lowering lipid levels in cerebrovascular disease. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/clp.10.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jimenez-Conde J, Biffi A, Rahman R, Kanakis A, Butler C, Sonni S, Massasa E, Cloonan L, Gilson A, Capozzo K, Cortellini L, Ois A, Cuadrado-Godia E, Rodriguez-Campello A, Furie KL, Roquer J, Rosand J, Rost NS. Hyperlipidemia and reduced white matter hyperintensity volume in patients with ischemic stroke. Stroke 2010; 41:437-42. [PMID: 20133919 PMCID: PMC3787512 DOI: 10.1161/strokeaha.109.563502] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 11/30/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensity (WMH), or leukoaraiosis, is a radiologic finding generally assumed to reflect diseased small cerebral vasculature. WMH has significant functional impact through its relation to cognitive decline and risk of ischemic and hemorrhagic stroke. Accumulating evidence suggests that some manifestations of small-vessel disease such as intracerebral hemorrhage are associated with low levels of cholesterol. We sought to determine the relation between hyperlipidemia and WMH severity in patients with acute ischemic stroke (AIS). METHODS We analyzed 2 independent, hospital-based AIS cohorts. Demographic and clinical data were collected prospectively. WMH was measured using semiautomated volumetric image analysis and a semiquantitative visual grading scale. Univariate and multivariable regression analyses were used to assess the relation between WMH severity and study variables. RESULTS A total of 631 and 504 subjects in the first and second cohorts, respectively, were included. In univariate analyses, advancing age and hypertension were associated with severity of WMH (P<0.001) in both cohorts. In the multivariable analysis, after controlling for age, sex, and significant risk factors in the univariate and age-adjusted analyses, patients with a history of hyperlipidemia had less severe WMH in both cohorts (P<0.01). CONCLUSIONS Results from 2 independent cohorts demonstrate that AIS patients with a history of hyperlipidemia have less severe WMH at the time of stroke. These data support the hypothesis that hyperlipidemia may play a relatively protective role in cerebral small-vessel disease.
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Affiliation(s)
- Jordi Jimenez-Conde
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
- Neurovascular Research Unit of Neurology Department, Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
- Program in Inflamation and Cardiovascular Disorders Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Alessandro Biffi
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Rosanna Rahman
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Allison Kanakis
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Christi Butler
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Shruti Sonni
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Efi Massasa
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Lisa Cloonan
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Aaron Gilson
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Karen Capozzo
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Lynelle Cortellini
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Angel Ois
- Neurovascular Research Unit of Neurology Department, Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Neurovascular Research Unit of Neurology Department, Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
- Program in Inflamation and Cardiovascular Disorders Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Ana Rodriguez-Campello
- Neurovascular Research Unit of Neurology Department, Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Karen L. Furie
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Jaume Roquer
- Neurovascular Research Unit of Neurology Department, Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
- Program in Inflamation and Cardiovascular Disorders Institut Municipal d’Investigació Mèdica - Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Jonathan Rosand
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
| | - Natalia S. Rost
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, MA, USA
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Lee HK, Ghani ARI, Awang MS, Sayuthi S, Idris B, Abdullah JM. Role of High Augmentation Index in Spontaneous Intracerebral Haemorrhage. Asian J Surg 2010; 33:42-50. [DOI: 10.1016/s1015-9584(10)60008-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2010] [Indexed: 10/19/2022] Open
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Gomis M, Ois A, Rodríguez-Campello A, Cuadrado-Godia E, Jiménez-Conde J, Subirana I, Dávalos A, Roquer J. Outcome of intracerebral haemorrhage patients pre-treated with statins. Eur J Neurol 2009; 17:443-8. [PMID: 19912325 DOI: 10.1111/j.1468-1331.2009.02838.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Statins treatment may have potential clinical impact in vascular disease beyond cholesterol lowering. Its benefits have been documented in cerebral ischaemia and in subarachnoid haemorrhage. In intracerebral haemorrhage (ICH), experimental models in statin-treated animals have better outcome than non-treated ones, but in humans the relationship is unclear. We investigated whether patients treated with statins before the onset of intracerebral haemorrhage have a better outcome at 3 months than patients without statins pre-treatment. METHODS Retrospective review of primary intracerebral haemorrhage case series from a prospective stroke register. We recorded demographics, vascular risk factors, previous statin treatment, Glasgow coma scale (GCS) at onset, ICH scale, hematoma volume and location, ventricular extension of the hematoma, and functional outcome at 3 months. The effect of prior statin treatment on good outcome (modified Rankin scale [mRS] 0 to 2) was analysed by logistic regression analysis. RESULTS We included 269 patients (age 71.9 +/- 12.4, mean +/- SD, 152 males). Thirty-four patients (12.6%) were on prior statin treatment when admitted. There were no differences in fasting serum cholesterol and triglycerides levels between the statin pre-treated groups and the group without statin pre-treatment. Multivariate regression analysis showed a significant association between age (OR: 0.95; CI 0.92-0.97), ICH volume (OR: 0.96; CI 0.94-0.98), GCS (OR: 1.55; CI 1.21-1.98), pre-treatment with statins (OR: 4.21; CI 1.47-12.17; P = 0.008), and good outcome at 3 months. CONCLUSIONS Statins pre-treatment of patients with intracerebral haemorrhage may provide better functional outcome at 3 months of acute onset.
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Affiliation(s)
- M Gomis
- Unitat d'Ictus, Servei de Neurologia, Hospital del Mar, Departament de Medicina de la Universitat Autònoma de Barcelona, IMIM-Hospital del Mar, NeuroMar, Barcelona, Spain.
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Schmitz M, McKamie W, Johnson C, Horgan E, Imamura M, Jaquiss R. Hemorrhagic Stroke in a Child With Low Total Serum Cholesterol and a Pulsatile Left Ventricular Assist Device. Artif Organs 2009; 33:1030-2. [DOI: 10.1111/j.1525-1594.2009.00939.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin 2009; 26:871-95, vii. [PMID: 19026895 DOI: 10.1016/j.ncl.2008.07.003] [Citation(s) in RCA: 262] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The epidemiology of ischemic and hemorrhagic stroke is an ongoing exploration to identify risk factors that continue to expand with the advent of technological advancements and preventative medical practices. Identification of risk factors that can or cannot be modified is a crucial step in determining stroke risk. Many of the modifiable risk factors are well established, and specific interventions to reduce stroke risk have been established. Some risk factors are less established, and intervention to reduce risk is yet to be determined by evidence-based medicine. Data from ongoing randomized clinical trials continue to enhance our ability to prevent a first stroke.
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Affiliation(s)
- Rebbeca A Grysiewicz
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, USA
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Ramírez-Moreno JM, Casado-Naranjo I, Portilla JC, Calle ML, Tena D, Falcón A, Serrano A. Serum cholesterol LDL and 90-day mortality in patients with intracerebral hemorrhage. Stroke 2009; 40:1917-20. [PMID: 19299638 DOI: 10.1161/strokeaha.108.536698] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Prognostic significance of low-density lipoprotein cholesterol (LDL-C) in intracranial hemorrhage (ICH) is unclear. The objective of this study was to determine the association between LDL-C and mortality in ICH. METHODS Consecutive patients (n=88) presenting with ICH were included in the study. Lipid profile was obtained during the first hours after admission. We analyzed the impact of LDL-C on 90-day mortality using the Hazard Rate (HR) crude, analysis crude for trend by Mantel-Haenszel Test, Multiple Cox Proportional Hazards model, and analysis of survival curves. Association between LDL-C and severity markers of ICH were explored using Spearman correlation coefficient. RESULTS Low LDL-C levels were independently associated with death after intracranial hemorrhage (HR=3.07 (95% CI:1.04 to 9.02; P=0.042) in multivariable analysis after controlling for confounding factors. Analysis for trend showed a significant association (Xt=-2.144; P=0.032) by Mantel-Haenszel Test. Spearman analysis showed no correlation between LDL-C and variables that are markers of ICH severity: NIH score (r=-0.091; P=0.400), GCS score (r=0.136; P=0.207), ICH volume (r=0.140; P=0.192), and length of stay (r=-0.111; P=0.308). CONCLUSIONS Low levels of LDL-C are independently associated with an increased risk of death in patients with brain hemorrhage. We have not found evidences that the levels of LDL-C can act as a biological marker of severity.
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Affiliation(s)
- José María Ramírez-Moreno
- Department of Neurology, Section of Neurology, Infanta Cristina Universitary Hospital, Badajoz, Spain.
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Sex differences in the prognostic value of the lipid profile after the first ischemic stroke. J Neurol 2009; 256:989-95. [DOI: 10.1007/s00415-009-5059-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 12/16/2008] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
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Cortina MG, Campello AR, Conde JJ, Ois A, Voustianiouk A, Téllez MJ, Cuadrado E, Roquer J. Monocyte count is an underlying marker of lacunar subtype of hypertensive small vessel disease. Eur J Neurol 2008; 15:671-6. [PMID: 18452544 DOI: 10.1111/j.1468-1331.2008.02145.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the hypertensive small vessel disease (HSVD), it remains unclear why some patients develop lacunar infarcts (LIs) whilst others develop deep intracerebral hemorrhages (dICHs). Inflammation might be related to LI, and leukocyte and monocyte counts are regarded as an inflammatory marker of ischemic stroke. OBJECTIVE We investigated the relationship between leukocyte and monocyte counts determined in the first 24 h after stroke onset in HSVD patients. METHODS We prospectively studied 236 patients with first acute stroke because of HSVD (129 LI and 107 dICH). We analyzed demographic data, vascular risk factors, and white blood cell count subtypes obtained in the first 24 h after stroke. RESULTS The multivariate analysis showed that LI subtype of HSVD was correlated with hyperlipidemia (P < 0.0001), a higher monocyte count (P = 0.002), and showed a trend with current smoking (P = 0.051), whereas dICH subtype was correlated with low serum total cholesterol (P = 0.003), low serum triglycerides (P < 0.0001), and high neutrophil count (P = 0.050). CONCLUSIONS In patients who developed HSVD-related stroke, high monocyte count, current smoking, and hyperlipidemia are prothrombotic factors related to LI, whereas low cholesterol and triglyceride values are related to dICH. Monocyte count might be an inflammatory risk marker for the occlusion of small vessels in hypertensive patients.
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Affiliation(s)
- M Gomis Cortina
- Stroke Unit, Neurology Department, Hospital del Mar, Departament de Medicina de la Universitat Autónoma de Barcelona, Barcelona, Spain.
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Li W, Liu M, Wu B, Liu H, Wang LC, Tan S. Serum lipid levels and 3-month prognosis in Chinese patients with acute stroke. Adv Ther 2008; 25:329-41. [PMID: 18414815 DOI: 10.1007/s12325-008-0045-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The possible correlation between serum lipid levels and outcome after stroke is still controversial. Therefore we examined whether serum lipid levels at admission had any prognostic value in the 3-month outcome after stroke. METHODS We performed a prospective, observational study of 649 patients with acute ischaemic stroke and intracerebral haemorrhagic stroke (ICH). Information on age, sex, history of arterial hypertension, diabetes mellitus, drinking, current smoking status, stroke type, Glasgow Coma Scale and Scandinavian Stroke Scale score, time from stroke onset, and presence of atrial fibrillation was obtained. Serum lipid levels were measured in blood samples taken from fasting patients 12 to 48 hours following ictus. Death and poor neurological outcome (Modified Rankin Scale score of > or =3 points) were defined as outcome events. A logistic regression model was performed to estimate the effect of the above variables on outcome after stroke. RESULTS We found that the median levels of serum total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) in good outcome patients with acute stroke were significantly higher (P<0.005) than those of poor outcome patients. The low levels of serum TC, TG and HDL-C (P<0.05) were independently related to increased 3-month poor outcome after acute ischaemic stroke and ICH. However, there was no significant relationship between LDL-C levels and 3-month outcome. CONCLUSION The data from this study show that low levels of serum TC, TG and HDL-C are strong independent predictors of 3-month poor outcome in patients with acute ischaemic stroke and ICH.
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Marrugat J, López-López JR, Heras M, Tamargo J, Valverde M. Red cardiovascular HERACLES. Rev Esp Cardiol 2008. [DOI: 10.1157/13114959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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ten Boekel E, Vroonhof K, Huisman A, van Kampen C, de Kieviet W. Clinical laboratory findings associated with in-hospital mortality. Clin Chim Acta 2006; 372:1-13. [PMID: 16697361 DOI: 10.1016/j.cca.2006.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 03/17/2006] [Accepted: 03/21/2006] [Indexed: 01/08/2023]
Abstract
The diagnostic approach and the clinical management of critically ill patients is challenging. The recognition of biomarkers related to in-hospital mortality is of importance for identification of patients at increased risk of death. Many prediction models assessing the severity of illness and likelihood of hospital survival were developed using logistic regression analyses. These models include several laboratory parameters, such as white blood cell counts, serum bilirubin, serum albumin, blood glucose, serum electrolytes and markers which reflect acid-base disturbances. Recently, several other biomarkers, including troponin, B-type natriuretic peptide (BNP), N-terminal proBNP, C-reactive protein, procalcitonin, cholesterol and coagulation related markers have emerged as clinically useful tools for risk stratification and mortality prediction of heterogeneous and more specific subgroups of critically ill patients. More investigations are required to verify whether risk stratification based on mortality-related biomarkers may translate into targeted treatment strategies to improve clinical outcome of the critical illness. Biomarkers which are related to in-hospital mortality are highlighted in the current review.
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Affiliation(s)
- Edwin ten Boekel
- Clinical Laboratory, Sint Lucas Andreas Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands.
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