Prognostic Role of Hypertriglyceridemia in Patients With Stroke of Atherothrombotic Origin
Prognostic Role of Hypertriglyceridemia in Patients With Stroke of Atherothrombotic Origin
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DOI：
10.1212/wnl.0000000000200112
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发表时间：
2022-04-19
期刊：
影响因子：
9.9
通讯作者：
Kitagawa, Kazuo
中科院分区：
文献类型：
--
作者：
Hoshino, Takao;Ishizuka, Kentaro;Kitagawa, Kazuo
背景和目的高甘油三酯血症被认为促进动脉粥样硬化的病理，但其在卒中中的作用尚未很好地确定。我们的目的是评估高甘油三酯血症对动脉粥样硬化性中风患者残余血管风险的贡献。方法东京女子医科大学卒中登记处是一个持续的前瞻性观察性登记，其中870名发病1周内的急性缺血性卒中或短暂性脑缺血发作患者连续登记并随访1年。高甘油三酯血症定义为禁食条件下血清甘油三酯水平=150 mg/dL。颈头动脉显著狭窄定义为<gt；=50%狭窄或闭塞。主要不良心血管事件包括非致命性中风、非致命性急性冠状动脉综合征和血管死亡。结果870例患者(平均年龄70.1岁，男性60.9%)中，217例(24.9%)有高甘油三酯血症。高甘油三酯水平与颅内动脉狭窄的发生率显著相关，尤其是在前循环，而不是颅外动脉狭窄。即使在调整了包括基线低密度脂蛋白胆固醇和他汀类药物使用在内的潜在混杂因素后，有高甘油三酯血症的患者发生主要心血管事件的风险也比没有高甘油三酯血症的患者更高(年率20.9%比9.7%；p<；0.001)(调整后的风险比为2.46，95%可信区间为1.62-3.74)。高甘油三酯血症患者发生血管事件的风险高于非高甘油三酯血症患者(n=0.001，年率35.1%vs 14.2%；p=0.001)、颅内动脉明显狭窄患者(n=247，年率29.9%vs 14.7%；p=0.006)和颈动脉颅外段明显狭窄患者(n=123，年率23.0%vs 9.4%；p=0.042)。相反，高甘油三酯血症不能预测心栓性卒中患者的血管复发事件(n=221，年率19.1%比10.5%；p=0.18)。讨论高甘油三酯血症是一个重要的可改变的危险因素，即使在他汀类药物治疗的情况下，高甘油三酯血症也是导致动脉粥样硬化性血栓形成的卒中患者残余血管风险的重要因素。
Background and ObjectivesHypertriglyceridemia is perceived to promote atherosclerotic pathology, but its role in stroke has not been well defined. Our aim was to assess the contribution of hypertriglyceridemia to residual vascular risk in patients with atherothrombotic stroke.MethodsThe Tokyo Women's Medical University Stroke Registry is an ongoing prospective, observational registry in which 870 patients with acute ischemic stroke or TIA within 1 week of onset were consecutively enrolled and followed up for 1 year. Hypertriglyceridemia was defined as serum triglycerides levels of >= 150 mg/dL under fasting conditions. Significant stenosis of the cervicocephalic arteries was defined as having >= 50% stenosis or occlusion. The primary outcome was major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death.ResultsOf 870 patients (mean age 70.1 years, male 60.9%), 217 (24.9%) had hypertriglyceridemia. High triglycerides levels were significantly associated with an increased prevalence of intracranial artery stenosis, particularly in the anterior circulation, rather than extracranial artery stenosis. Patients with hypertriglyceridemia had a greater risk of major adverse cardiovascular events than those without (annual rate 20.9% vs 9.7%; p < 0.001), even after adjustment for potential confounders, including baseline low-density lipoprotein cholesterol and statin use (adjusted hazard ratio 2.46, 95% CI 1.62-3.74). The higher risk of vascular events in patients with hypertriglyceridemia vs without hypertriglyceridemia was observed among patients with stroke of atherothrombotic origin (n = 174, annual rate 35.1% vs 14.2%; p = 0.001), those with significant intracranial artery stenosis (n = 247, annual rate 29.9% vs 14.7%; p = 0.006), and those with significant extracranial carotid artery stenosis (n = 123, annual rate 23.0% vs 9.4%; p = 0.042). In contrast, hypertriglyceridemia was not predictive of recurrent vascular events in patients with cardioembolic stroke (n = 221, annual rate 19.1% vs 10.5%; p = 0.18).DiscussionHypertriglyceridemia is an important modifiable risk factor that drives residual vascular risk in patients with stroke of atherothrombotic origin, even while on statin therapy.