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The Triglyceride Paradox in Stroke Survivors: A Prospective Study

DOI: 10.1155/2013/870608

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Abstract:

Objective. The purpose of our study was to understand the association between serum triglycerides and outcomes in acute ischemic stroke (AIS) patients. Methods. A cohort of all adult patients presenting to the Emergency Department (ED) with an AIS from March 2004 to December 2005 were selected. The lipid profile levels were measured within 24 hours of stroke onset. Demographics, admission stroke severity (NIHSS), functional outcome at discharge (modified Rankin Scale (mRS)), and mortality at 3 months were recorded. Results. The final cohort consisted of 334 subjects. A lower level of triglycerides at presentation was found to be significantly associated with worse National Institutes of Health Stroke Scale (NIHSS) ( ), worse mRS ( ), and death at 3 months ( ). After adjusting for age and gender and NIHSS, the association between triglyceride and mortality at 3 months was not significant ( ). Conclusion. Lower triglyceride levels seem to be associated with a worse prognosis in AIS. 1. Introduction Ischemic stroke is the third leading cause of death worldwide with 5 million annual deaths [1]. Every years approximately 795,000 people experience a stroke and someone dies of stroke in the United States every 3-4 minutes [2]. One of the prominent objectives of stroke research has been to investigate factors that could potentially improve stroke outcome. Acute factors affecting stroke outcome such as awareness of symptoms [3], blood pressure [4], elevated glucose [5], and electrocardiographic intervals [6] have all been of interest. In this paper, we turn our attention to the lipid profile in the setting of acute ischemic stroke. It is known that high serum lipids including triglycerides constitute major risk factors for stroke [7, 8]. Little has been reported to date on the role of triglycerides in acute stroke and their role in poststroke recovery. The few studies that have evaluated this association have reported diverse associations [9–12]. The purpose of our research was to study the relation between poststroke serum triglyceride levels and functional stroke outcome, in a large prospective cohort of acute ischemic stroke patients. 2. Methods This study is a substudy of an Emergency Department (ED) acute stroke registry. The ED Stroke registry is an institutional review board approved prospective consecutive cohort study. All adult patients presenting to the ED of our academic tertiary care centre with a diagnosis of acute ischemic stroke were eligible for inclusion. For this substudy, pediatric stroke patients (age <18 years), patients with hemorrhagic

References

[1]  J. Bogousslavsky, J. Aarli, and J. Kimura, “Stroke and neurology: a plea from the WFN,” Lancet Neurology, vol. 2, no. 4, pp. 212–213, 2003.
[2]  D. Lloyd-Jones, R. Adams, M. Carnethon et al., “Heart disease and stroke statistics-2009 update. A report from the American heart association statistics committee and stroke statistics subcommittee,” Circulation, vol. 119, no. 3, pp. 480–486, 2009.
[3]  L. G. Stead, L. Vaidyanathan, M. F. Bellolio et al., “Knowledge of signs, treatment and need for urgent management in patients presenting with an acute ischaemic stroke or transient ischaemic attack: a prospective study,” Emergency Medicine Journal, vol. 25, no. 11, pp. 735–739, 2008.
[4]  L. G. Stead, R. M. Gilmore, W. W. Decker, A. L. Weaver, and R. D. Brown Jr., “Initial emergency department blood pressure as predictor of survival after acute ischemic stroke,” Neurology, vol. 65, no. 8, pp. 1179–1183, 2005.
[5]  L. G. Stead, R. M. Gilmore, M. F. Bellolio et al., “Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients presenting with acute ischemic stroke,” Neurocritical Care, vol. 10, no. 2, pp. 181–186, 2009.
[6]  L. G. Stead, R. M. Gilmore, M. F. Bellolio et al., “Prolonged QTc as a predictor of mortality in acute ischemic stroke,” Journal of Stroke and Cerebrovascular Diseases, vol. 18, no. 6, pp. 469–474, 2009.
[7]  D. Tanne, N. Koren-Morag, E. Graff, and U. Goldbourt, “Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention (BIP) registry: high triglycerides constitute an independent risk factor,” Circulation, vol. 104, no. 24, pp. 2892–2897, 2001.
[8]  P. Laloux, L. Galanti, and J. Jamart, “Lipids in ischemic stroke subtypes,” Acta Neurologica Belgica, vol. 104, no. 1, pp. 13–19, 2004.
[9]  T. Dziedzic, A. Slowik, E. A. Gryz, and A. Szczudlik, “Lower serum triglyceride level is associated with increased stroke severity,” Stroke, vol. 35, no. 6, pp. e151–e152, 2004.
[10]  W. Li, M. Liu, B. Wu, H. Liu, L. C. Wang, and S. Tan, “Serum lipid levels and 3-month prognosis in Chinese patients with acute stroke,” Advances in Therapy, vol. 25, no. 4, pp. 329–341, 2008.
[11]  C. J. Weir, N. Sattar, M. R. Walters, and K. R. Lees, “Low triglyceride, not low cholesterol concentration, independently predicts poor outcome following acute stroke,” Cerebrovascular Diseases, vol. 16, no. 1, pp. 76–82, 2003.
[12]  A. M. Simundic, N. Nikolac, E. Topic, V. Basic-Kes, and V. Demarin, “Are serum lipids measured on stroke admission prognostic?” Clinical Chemistry and Laboratory Medicine, vol. 46, no. 8, pp. 1163–1167, 2008.
[13]  G. Sulter, C. Steen, and J. De Keyser, “Use of the barthel index and modified rankin scale in acute stroke trials,” Stroke, vol. 30, no. 8, pp. 1538–1541, 1999.
[14]  G. R. Warnick, R. H. Knopp, V. Fitzpatrick, and L. Branson, “Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints,” Clinical Chemistry, vol. 36, no. 1, pp. 15–19, 1990.
[15]  W. S. Ryu, S. H. Lee, C. K. Kim, B. J. Kim, and B. W. Yoon, “Effects of low serum triglyceride on stroke mortality: a prospective follow-up study,” Atherosclerosis, vol. 212, no. 1, pp. 299–304, 2010.
[16]  K. H. Choi, M. S. Park, J. T. Kim et al., “Serum triglyceride level is an important predictor of early prognosis in patients with acute ischemic stroke,” Journal of the Neurological Sciences, vol. 319, no. 1-2, pp. 111–116, 2012.
[17]  S. Pikija, V. Trkulja, L. Juvan, M. Ivanec, and D. Duk?i, “Higher on-admission serum triglycerides predict less severe disability and lower all-cause mortality after acute ischemic stroke,” Journal of Stroke and Cerebrovascular Diseases, 2012.
[18]  S. Pikija, D. Milev?i?, V. Trkulja, S. Kidemet-Piska?, I. Pavli?ek, and N. Sokol, “Higher serum triglyceride level in patients with acute ischemic stroke is associated with lower infarct volume on CT brain scans,” European Neurology, vol. 55, no. 2, pp. 89–92, 2006.
[19]  V. Bittner, Impact of Gender and Life Cycle on Triglyceride Levels, Medscape Family Medicine (CME), Omaha, Neb, USA, 2008.
[20]  “Clinic M. Menopause,” http://www.mayoclinic.com/health/menopause/DS00119/DSECTION=symptoms.
[21]  M. C. Carr, “The emergence of the metabolic syndrome with menopause,” Journal of Clinical Endocrinology and Metabolism, vol. 88, no. 6, pp. 2404–2411, 2003.
[22]  E. T. Poehlman, M. J. Toth, P. A. Ades, and C. J. Rosen, “Menopause-associated changes in plasma lipids, insulin-like growth factor I and blood pressure: a longitudinal study,” European Journal of Clinical Investigation, vol. 27, no. 4, pp. 322–326, 1997.
[23]  M. D. Carroll, D. A. Lacher, P. D. Sorlie et al., “Trends in serum lipids and lipoproteins of adults, 1960–2002,” Journal of the American Medical Association, vol. 294, no. 14, pp. 1773–1781, 2005.
[24]  R. B. Verdery and R. L. Walford, “Changes in plasma lipids and lipoproteins in humans during a 2-year period of dietary restriction in biosphere 2,” Archives of Internal Medicine, vol. 158, no. 8, pp. 900–906, 1998.
[25]  M. Dennis, “Poor nutritional status on admission predicts poor outcomes after stroke observational data from the food trial,” Stroke, vol. 34, no. 6, pp. 1450–1455, 2003.
[26]  S. E. Gariballa, S. G. Parker, N. Taub, and C. M. Castleden, “Influence of nutritional status on clinical outcome after acute stroke,” American Journal of Clinical Nutrition, vol. 68, no. 2, pp. 275–281, 1998.

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