Atherogenic Dyslipidemia and Residual Vascular Risk After Stroke or Transient Ischemic Attack

Stroke ◽  
2021 ◽  
Author(s):  
Takao Hoshino ◽  
Kentaro Ishizuka ◽  
Sono Toi ◽  
Takafumi Mizuno ◽  
Ayako Nishimura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Cardiovascular Events ◽  
Density Lipoprotein ◽  
Annual Rate ◽  
Atherogenic Dyslipidemia ◽  
Major Adverse Cardiovascular Events ◽  
Intracranial Artery ◽  
Vascular Risk ◽  
Ischemic Attack

Background and Purpose: Notwithstanding the current guideline-based management, patients with stroke retain a substantial risk of further vascular events. We aimed to assess the contribution of atherogenic dyslipidemia (AD) to this residual risk. Methods: This was a prospective observational study, in which 792 patients (mean age, 70.1 years; male, 60.2%) with acute ischemic stroke (n=710) or transient ischemic attack (n=82) within 1 week of onset were consecutively enrolled and followed for 1 year. AD was defined as having both elevated levels of triglycerides ≥150 mg/dL and low HDL-C (high-density lipoprotein cholesterol) <40 mg/dL in men or <50 mg/dL in women, under fasting conditions. The primary outcome was a composite of major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death. Results: The prevalence of AD was 12.2%. Patients with AD more often had intracranial artery stenosis than those without (42.3% versus 24.1%; P =0.004), whereas no differences were observed in the prevalence of extracranial artery stenosis (17.7% versus 12.9%; P =0.62) or aortic plaques (33.3% versus 27.0%; P =0.87). At 1 year, patients with AD were at a greater risk of major adverse cardiovascular events (annual rate, 24.5% versus 10.6%; hazard ratio [95% CI], 2.33 [1.44–3.80]) and ischemic stroke (annual rate, 16.8% versus 8.6%; hazard ratio [95% CI], 1.84 [1.04–3.26]) than those without AD. When patients were stratified according to baseline LDL-C (low-density lipoprotein cholesterol) level, AD was predictive of major adverse cardiovascular events among those with LDL-C ≥100 mg/dL (n=509; annual rate, 20.5% versus 9.6%; P =0.036) as well as those with LDL-C <100 mg/dL (n=283; annual rate, 38.6% versus 12.4%; P <0.001). Conclusions: AD is associated with intracranial artery atherosclerosis and a high residual vascular risk after a stroke or transient ischemic attack. AD should be a promising modifiable target for secondary stroke prevention. REGISTRATION: URL: https://upload.umin.ac.jp ; Unique identifier: UMIN000031913.

scholarly journals Optimal Duration of Aspirin Plus Clopidogrel After Ischemic Stroke or Transient Ischemic Attack

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 947-953 ◽  
Author(s):  
Hammad Rahman ◽  
Safi U. Khan ◽  
Fahad Nasir ◽  
Tehseen Hammad ◽  
Michael A. Meyer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Controlled Trials ◽  
Short Term ◽  
All Cause Mortality ◽  
Ischemic Attack

Background and Purpose— The role of aspirin plus clopidogrel (A+C) therapy compared with aspirin monotherapy in patients presenting with acute ischemic stroke (IS) or transient ischemic attack remains uncertain. We conducted this study to determine the optimal period of efficacy and safety of A+C compared with aspirin monotherapy. Methods— Ten randomized controlled trials (15 434 patients) were selected using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (inception June 2018) comparing A+C with aspirin monotherapy in patients with transient ischemic attack or IS. The primary efficacy outcome was recurrent IS, and the primary safety outcome was major bleeding. The secondary outcomes were major adverse cardiovascular events (composite of stroke, myocardial infarction, and cardiovascular mortality) and all-cause mortality. We stratified analysis based on the short- (≤1 month), intermediate- (≤3 month), and long-term (>3 month) A+C therapy. Effects were estimated as relative risk (RR) with 95% CI. Results— A+C significantly reduced the risk of recurrent IS at short-term (RR, 0.53; 95% CI, 0.37–0.78) and intermediate-term (RR, 0.72; 95% CI, 0.58–0.90) durations. Similarly, major adverse cardiovascular event was significantly reduced by short-term (RR, 0.68; 95% CI, 0.60–0.78) and intermediate-term (RR, 0.76; 95% CI, 0.61–0.94) A+C therapy. However, long-term A+C did not yield beneficial effect in terms of recurrent IS (RR, 0.81; 95% CI, 0.63–1.04) and major adverse cardiovascular events (RR, 0.87; 95% CI, 0.71–1.07). Intermediate-term (RR, 2.58; 95% CI, 1.19–5.60) and long-term (RR, 1.87; 95% CI, 1.36–2.56) A+C regimens significantly increased the risk of major bleeding as opposed to short-term A+C (RR, 1.82; 95% CI, 0.91–3.62). Excessive all-cause mortality was limited to long-term A+C (RR, 1.45; 95% CI, 1.10–1.93). Conclusions— Short-term A+C is more effective and equally safe in comparison to aspirin alone in patients with acute IS or transient ischemic attack.

Abstract 492: Atherogenic Dyslipidemia in Patients with Transient Ischemic Attack

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Hye-Yeon Choi
Keyword(s):  
Transient Ischemic Attack ◽  
Ldl Cholesterol ◽  
Recurrent Stroke ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Cholesterol Concentration ◽  
Atherogenic Dyslipidemia ◽  
Ischemic Attack

Background: The risk of recurrent stroke following transient ischemic attack (TIA) is reported up to 15% at 90 days after the attack. Urgent assessment and combined use of preventive treatments in appropriate patients can reduce this risk significantly. The atherogenic dyslipidemia in patients with TIA may be associated with intracranial artery stenosis and higher risk of early recurrent stroke. This study was aimed to investigate if dyslipidemia was related to atherosclerotic vascular lesions in the TIA patients. Methods: Patients with TIA who admitted to single hospital were included. TIA was defined as an acute loss of focal cerebral function, lasting fewer than 24 hours. If brain magnetic resonance imaging scans showed acute infarction, the patient was judged to have a TIA with a new lesion; if not, the event was classified as TIA without a new lesion. Radiologic findings were reviewed retrospectively. Association between presence of atherosclerotic vascular lesions and lipid profile were examined. Atherogenic dyslipidemia was defined as high density lipoprotein (HDL) cholesterol ≤ 40 mg/dL and triglycerides ≥ 150 mg/dL. Level of non-HDL cholesterol was calculated as total cholesterol concentration minus HDL cholesterol concentration. Presence of classic risk factors of atherosclerosis and vascular disease were also reviewed. Results: Among 117 TIA patients, 106 patients who had available results were included to the analysis. Mean age was 64 years (± 13), and 48 were men (42.1%). Atherosclerotic vascular lesion was shown in 56 patients (52.8%). Presence of atherosclerotic vascular lesions was associated with age, diabetes, low density lipoprotein (LDL) cholesterol concentrations, and level of CRP. Atherogenic dyslipidemia was not related to vascular lesions. Among 106 patients, only 18 patients (17.0%) were diagnosed as TIA with a new lesion. Presence of acute cerebral infarction was associated with presence of atherosclerosis. Diabetes and current smoking were associated with new ischemic lesion related TIA. Conclusions: In TIA patients, concentrations of LDL cholesterol were related atherosclerotic vascular lesion which is known to be associated with recurrent stroke after TIA. It might be helpful to screen high risk TIA patient.

Early risk and predictors of cerebrovascular and cardiovascular events in transient ischemic attack and minor ischemic stroke

2012 ◽  
Vol 60 (2) ◽  
pp. 165 ◽  
Author(s):  
PN Sylaja ◽  
Raghunath Balakrishnan ◽  
Kesavadas Chandrasekharan ◽  
Mahesh Kate ◽  
JeyarajD Pandian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Cardiovascular Events ◽  
Early Risk ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

scholarly journals Clinical, Laboratory, and Imaging Characteristics of Transient Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and Intracranial Arteries

2015 ◽  
Vol 5 (3) ◽  
pp. 115-123 ◽  
Author(s):  
Toshiyuki Uehara ◽  
Tomoyuki Ohara ◽  
Kazunori Toyoda ◽  
Kazuyuki Nagatsuka ◽  
Kazuo Minematsu
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Clinical Laboratory ◽  
Stroke Care ◽  
Large Artery ◽  
Intracranial Artery ◽  
Imaging Characteristics ◽  
Artery Disease ◽  
Ischemic Attack

Background/Aims: The aims of this study were to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 h of TIA onset between April 2008 and December 2013, 85 patients (63 men, mean age 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared with those in the extracranial group. Eleven patients in the extracranial group and none in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2 vs. 0%, p = 0.044) and the 90-day risk (17.1 vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Among our patients with TIA caused by large artery disease, patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

Incidence, predictors, and etiology of subsequent ischemic stroke within one year after transient ischemic attack

2016 ◽  
Vol 12 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Toshiyuki Uehara ◽  
Kazuo Minematsu ◽  
Tomoyuki Ohara ◽  
Kazumi Kimura ◽  
Yasushi Okada ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Large Artery ◽  
Intracranial Artery ◽  
Vessel Occlusion ◽  
Artery Disease ◽  
One Year ◽  
Ischemic Attack ◽  
The One ◽  
First 90 Days

Background Incidence and predictors of ischemic stroke in patients with transient ischemic attack (TIA) have not been fully clarified outside Europe and North America. Aims We undertook the present prospective, multicenter study to clarify the incidence, predictors, and etiology of ischemic stroke within one year of TIA onset in Japan. Methods The study subjects were patients within seven days of TIA onset who were enrolled in a prospective register from 57 hospitals between June 2011 and December 2013. The primary endpoint was occurrence of ischemic stroke. Results Of 1365 consecutive patients, 1245 were followed for one year after TIA onset; 101 (8.1%) experienced ischemic stroke during follow-up. The leading subtype of ischemic stroke was small-vessel occlusion (SVO) followed by large-artery atherosclerosis (LAA) attributable to intracranial artery diseases. When dividing ischemic stroke events between those occurring within the first 90 days after TIA onset and those occurring after the first 90 days, the leading subtype of ischemic stroke within the first 90 days after TIA onset was SVO, followed by LAA attributable to intracranial artery diseases. In comparison, the subtypes most commonly seen beyond the first 90 days after TIA onset were cardioembolic and LAA attributable to intracranial artery disease. The one-year risk of ischemic stroke increased significantly as ABCD2 score increased, at 6.2% for 0–3 points, 7.2% for 4–5 points, and 11.6% for 6–7 points. Conclusions The one-year ischemic stroke risk after TIA was about 8% and was associated with the ABCD2 score. The most common subtype of subsequent ischemic stroke was SVO.

scholarly journals Association of sleep duration and cardiovascular events

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W.T Wang ◽  
C.C Huang ◽  
P.F Hsu ◽  
C.C Lin ◽  
Y.J Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Stroke ◽  
Sleep Duration ◽  
Cardiovascular Events ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Major Adverse Cardiovascular Events ◽  
P Value ◽  
Short Sleep Duration ◽  
Long Sleep

Abstract Background/Purpose Sleep duration have been associated with cardiovascular (CV) risk in general population. Nevertheless, their impact in real-world large cohort data remains unclear. Methods 4861 healthy Taiwanese subjects (mean age 68 years, 3535 males, 72.7%) were enrolled. Three groups were defined: short sleep duration &lt;6 h, reference sleep duration 7 to 8 h, and long sleep duration &gt;8h. Multivariate Cox proportional hazard models were used to examine the associations between sleep duration and major adverse cardiovascular events (MACE), composite of acute myocardial infarction, ischemic stroke, and CV death. Results Sleep duration of short, reference, and long were reported by 37.7%, 30.3%, 32.0% of the cohort, respectively. 165 (3.4%), 502 (10.3%), 108 (2.2%) suffered from CV death, MACE, ischemic stroke, respectively. After adjusting for age, sex, systolic blood pressure, diabetes, body mass index, low density lipoprotein, and numbers of involved coronary artery, only long sleep was associated with higher MACE (hazard ratio (HR): 1.317, 95% confidence interval (CI): [1.052 to 1.648], p value = 0.016), ischemic stroke (HR: 1.858, 95% CI: [1.162 to 2.969], p value = 0.010), and lower rate of MACE plus heart failure (HR: 1.228, 95% CI: [1.034 to 1.459], p value = 0.019). Conclusions Our study addressed long sleep duration was independently associated with higher rate of MACE, ischemic stroke and MACE plus heart failure in adult Chinese population in Taiwan. Funding Acknowledgement Type of funding source: None

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