Hyperlipidemia is a strong risk factor for intracranial atherosclerotic disease (ICAD) and clinical stroke recurrence. A recent study suggests that low-density lipoprotein and triglyceride levels at the time of index stroke or transient ischemic attack can predict recurrent infarcts independent of other clinical and imaging factors. The study findings were published in the Journal of Stroke & Cerebrovascular Diseases on October 26, 2021.
ICAD is a common cause of ischemic stroke with a high risk of clinical stroke recurrence. Multiple mechanisms may underlie cerebral ischemia in this condition. Dr Shyam Prabhakaran and his team conducted a study to explore the effect of serum lipid levels on subclinical infarct recurrence in the Mechanisms of earlY Recurrence in Intracranial Atherosclerotic Disease (MYRIAD) study.
In this present study, the researchers included 74 patients from the MYRIAD study with lipid measurements and brain MRI at baseline and brain MRI at 6-8 weeks. They determined infarct recurrence as new infarcts in the territory of the symptomatic artery on brain MRI at 6-8 weeks compared to baseline brain MRI. Using multivariable logistic regression, they assessed the association between baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels and recurrent infarction at 6-8 weeks.
Key findings of the study:
Upon analysis, the researchers observed that the mean HDL-C (37.2 vs 43.9 mg/dL) was lower and TG (113.5 vs 91.3 mg/dL) was higher, while TC (199.8 vs 174.3 mg/dL) and LDL-C (124.3 vs 101.2 mg/dL) were nominally higher among those with recurrent infarcts than those without.
After adjusting for other clinical and imaging factors, they noted that LDL-C (adj. OR 1.022) and TG (adj. OR 1.009) were predictors of recurrent infarct at 6-8 weeks.
The authors concluded, "Baseline cholesterol markers can predict early infarct recurrence in patients with symptomatic ICAD. More intensive and rapid lipid lowering drugs may be required to reduce the risk of early recurrence."
They further added, "More aggressive and rapid reduction of lipid levels may be required to reduce the burden of early clinical and subclinical recurrence in patients with symptomatic intracranial stenosis."
For further information:
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106141