İskemik inmede koruyucu olan HDL hemorajik inme için tetikliyici mi?

Year 2021, Volume: 4 Issue: 2, 83 - 91, 01.07.2021

Zeynep Baştuğ Gül , Figen Varlıbaş

Abstract

Giriş ve Amaç: Lipitler endotel hücre membran yapısında önemli rol oynar. Hiperlipidemi özelikle iskemik inme için bilinen bir risk faktörüdür. Bu çalışmada lipit parametrelerinin (özellikle HDL) hemorajik inmedeki etkisini belirlemek üzere iskemik inmeli hastalar ile karşılaştırıldı.

Gereç ve Yöntem: Çalışmamızda Nöroloji kliniğinde serebrovasküler hastalık tanısıyla yatan 1500 hasta tarandı. Dışlanma kriterleri sonucunda, 148 hemorajik inmeli ve 152 iskemik inme hastası alındı. Hastaların risk faktörleri ve lipit parametreleri bilgileri dosyalarından retrospektif olarak tarandı. Hastaların 12 saatlik açlık sonrası lipit parametreleri incelendi. Hastaların hastane içi ölümleri kaydedildi.
Bulgular: Hemorajik grupta HDL değerleri daha yüksek, trigliserit ve VLDL değerleri ise düşük saptandı (p<0,001). Çoklu regrasyon analizinde hemorajik inme için bağımsız risk faktörü olarak HDL saptandı (p<0,001). Hemorajik inme ile HDL arasında pozitif korelasyon, hemorajik inme ile VLDL ve trigliserit arasında negatif korelasyon izlendi. Hastane içi ölümü öngören bağımsız değişkenler, hemorajik inme ve yaşın 72 den yüksek olmasıdır.

Sonuç: Bu çalışmada hemorajik inme için bağımsız risk faktörü olarak HDL saptandı. Lipitler hücre membranların yapısında önemli rol oynar. HDL aracılı ters kolesterol taşınması olayında damar endotelindeki kolesterol karaciğere taşınır, bunun sonucunda beyin damar endotelindeki hücrelerinin yapısının etkilediği düşünülmektedir. Düşük trigliserit seviyeleriyle birlikte damar endoteli daha da zayıflar. Sonuç olarak, özellikle yüksek HDL düzeyleri ile birlikte düşük trigliserit seviyeleri hemorajik inme etiyolojisinde rol oynayabilir.

Keywords

HDL, Hemorajik inme, Triglisrit, İskemik inme

HDL Cholesterol Being Protective Against Ischemic Stroke, Is It Triggering For Hemorrhagic Stroke?

Abstract

Introduction: Lipids play an important role in endothelial cell membrane structure. Hyperlipidemia is a known risk factor, especially for ischemic stroke. We compared patients with ischemic stroke to determine the effect of lipid parameters (especially HDL) in hemorrhagic stroke.

Methods: In our study, 1500 patients with a diagnosis of cerebrovascular disease were scanned in the Neurology clinic. As a result of exclusion criteria, 148 hemorrhagic stroke and 152 ischemic stroke patients were included. The risk factors and lipid parameters of the patients were retrospectively reviewed from their files. Lipid parameters of the patients were evaluated after 12 hours of fasting.
Results: HDL values were higher and triglyceride and VLDL values were lower in the hemorrhagic group (p<0.001). In multiple regression analysis, HDL was determined as an independent risk factor for hemorrhagic stroke (p<0.001). There was positive correlation between hemorrhagic stroke and HDL, and negative correlation between hemorrhagic stroke and VLDL and triglyceride. Independent variables predicting in-hospital death are hemorrhagic stroke and age higher than 72.

Conclusion: In this study, HDL was determined as an independent risk factor for hemorrhagic stroke. Lipids play an important role in the structure of cell membranes. In the case of HDL-mediated reverse cholesterol transport, cholesterol in the vascular endothelium is transported to the liver, as a result, it is thought to affect the structure of cells in the brain vessel endothelium. With low triglyceride levels, the vascular endothelium becomes even weaker. As a result, low triglyceride levels, especially with high HDL levels, may play a role in the etiology of hemorrhagic stroke.

Keywords

HDL, Hemorrhagic stroke, Triglyceride, Ischemic stroke

References

• 1. Feigin VL, Abajobir AA, Abate KH, et al. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16(11): 877–97.
• 2. Bastug Gul Z, Akkaya E, Vuruskan E, et al. Comparison of periprocedural and long term outcomes of proximal versus distal cerebral protection method during carotid artery stenting. Vasa. 2015;44(4): 297-04.
• 3. Jayaraj RL, Azimullah S, Beiram R, et al. Neuroinflammation: friend and foe for ischemic stroke. J Neuroinflammation. 2019;16(1):142.
• 4.Willey J.Z, Xu Q, Boden-Albala B. Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS) Arch Neurol. 2009; 66: 1400-06.
• 5. Cholesterol Treatment Trialists' Collaborators. Mihaylova B. Emberson J, Blackwell L, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380(9841):581-90.
• 6. Holmes MV, Millwood IY, Kartsonaki C, et al. China Kadoorie Biobank Collaborative Group. Lipids, Lipoproteins, and Metabolites and Risk of Myocardial Infarction and Stroke. J Am Coll Cardiol. 2018 Feb 13;71(6): 620-32.
• 7. Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke. 1999; 30(12): 2535-40.
• 8. Zhang X, Patel A, Horibe H, et al. Asia Pacific Cohort Studies Collaboration. Cholesterol, coronary heart disease, and stroke in the Asia Pacific region. Int J Epidemiol. 2003; 32(4): 563–72.
• 9. Bots ML, Elwood PC, Nikitin Y, et al. Total and HDL cholesterol and risk of stroke. EUROSTROKE: a collaborative study among research centres in Europe. J Epidemiol Community Health. 2002; 56(suppl 1): i19–i24.
• 10. Shahar E, Chambless LE, Rosamond WD, et al. Atherosclerosis Risk in Communities Study. Plasma lipid profile and incident ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 2003; 34(3): 623–31.
• 11.Soyama Y, Miura K, Morikawa Y, et al. Oyabe Study. High-density lipoprotein cholesterol and risk of stroke in Japanese men and women: the Oyabe Study. Stroke. 2003; 34(4): 863–68.
• 12. Lindenstrom E, Boysen G, Nyboe J. Influence of total cholesterol, high density lipoprotein cholesterol, and triglycerides on risk of cerebrovascular disease: the Copenhagen City Heart Study. BMJ. 1994;309(6946):11-15.
• 13. Chang JJ, Katsanos AH, Khorchid Y, et al. Higher low-density lipoprotein cholesterol levels are associated with decreased mortality in patients with intracerebral hemorrhage. Atherosclerosis. 2018; 269:14-20.
• 14. Saliba W, Rennert HS, Barnett-Griness O, et al. Association of statin use with spontaneous intracerebral hemorrhage: A cohort study. Neurology.2018; 91(5):e400-e409.
• 15. Noda H, Iso H, Irie F, et al. Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study. Circulation. 2009;119(16):2136-45.
• 16. Ma C, Gurol ME, Huang Z, et al. Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study. Neurology. 2019; 93(5):e445-e457.
• 17. Saito I, Yamagishi K, Kokubo Y, et al. Association of high-density lipoprotein cholesterol concentration with different types of stroke and coronary heart disease: The Japan Public Health Center-based prospective (JPHC) study. Atherosclerosis.2017; 265:147-54.
• 18. Zheng J, Sun Z, Zhang X, et al. Non-traditional lipid profiles associated with ischemic stroke not hemorrhagic stroke in hypertensive patients: results from an 8.4 years follow-up study. Lipids Health Dis. 2019;18:9.
• 19.Wieberdink RG, Poels MM, Vernooij MW, et al. Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study. Arterioscler Thromb Vasc Biol. 2011; 31(12): 2982-9.
• 20. Orken DN, kenangil G. Celik M, et al. Association of low cholesterol with primary intracerebral haemorrhage: a case control study. Acta Neurol Scand. 2009;119(3):151-4.
• 21. Dey SK, Ahmed S, Rahman KM, et al. Lipid profile among ischemic and haemorrhagic stroke patients. Mymensingh Med J. 2010; 19(2): 176-80.
• 22. Valappil AV, Chaudhary NV, Praveenkumar R, et al. Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case-control study. Ann Indian Acad Neurol. 2012; 15(1): 19-22.
• 23. Iso H, Jacobs DR, Wentworth D, et al. Serum cholesterol levels and six year mortality from stroke in 350,977 men screened for the Multiple Risk Factor Intervention Trial. N Engl J Med.1989; 320(14):904–10.
• 24. Yano K, Reed DM, Maclean CJ. Serum cholesterol and hemorrhagic stroke in Honolulu Heart Program. Stroke.1989; 20(11):1460–5.
• 25. Konishi M, Iso H, Komachi Y, et al. Associations of serum cholesterol, different types of stroke and stenosis distribution of cerebral arteries. The Akita Pathology Study. Stroke. 1993;24(7):954–64.
• 26. Ooneda G, Yoshida Y, Suzuki K, et al. Morphogenesis of plasmatic arterionecrosis as the cause of hypertensive intracerebral hemorrhage. Virchows Arch A Pathol Anat. 1973; 361:31-38.
• 27. Yamori Y, Horie R, Nara Y, et al. Prophylactic trials for stroke-prone SHR, II: effects of fat, protein, and amino acid. Jpn Heart J.1977; 18:551-53.
• 28. Girona J, Amigó N, Ibarretxe D, et al. HDL Triglycerides: A New Marker of Metabolic and Cardiovascular Risk..Int J Mol Sci. 2019; 20 (13):3151.
• 29. Wu Q, Wang Q, Fu J, Ren R. Polysaccharides derived from natural sources regulate triglyceride and cholesterol metabolism: a review of the mechanisms. Food Funct. 2019;10(5):2330-39.