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Evaluation of lipid levels and LDL-C/HDL-C ratio as possible risk markers of intracerebral hemorrhage

Year 2022, Volume: 47 Issue: 1, 120 - 127, 31.03.2022
https://doi.org/10.17826/cumj.1030321

Abstract

Purpose: The aim of this study is to analyze the utility of lipid parameters individually and the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio as a possible risk marker for intracerebral hemorrhages (ICH).
Materials and Methods: This was a multicenter, retrospective case-control study that included 226 patients with ICH and 226 controls. Lipid parameters were evaluated after 12 h of fasting in patients whose ICH was confirmed by brain computed tomography, and no underlying vascular, traumatic, or metabolic cause could be found.
Results: The mean LDL-C levels and mean total cholesterol (TC) levels did not differ in in the patient and control groups. The mean HDL-C levels in the patient groups were significantly lower whereas triglyceride (TG) levels were significantly higher. In the patient and control groups, LDL-C/HDL-C ratio was 2.65±1.10 and 2.94±1.13 (p=0.006), TG/HDL-C ratio was 3.60±2.72 and 4.47±3.25 (p=0.002), and TC/HDL-C ratio was 4.37±1.49 and 4.83 ± 1.56 (p=0.002), respectively.
Conclusion: Increased TG and decreased HDL-C levels were found to be associated with ICHs. However LDL-C/HDL-C, TC/HDL-C, and TG/HDL-C ratios were low in the patient group. Therefore, we can conclude that these lipid ratios give clearer and more significant results in determining the risk of hemorrhage.

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References

  • Gu X, Li Y, Chen S, Yang X, Liu F, Li Y et al. Association of lipids with ischemic and hemorrhagic stroke: a prospective cohort study among 267500 Chinese. Stroke. 2019;50:3376-84.
  • Ariesen M, Claus S, Rinkel G, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. J Stroke. 2003;34:2060-65.
  • Rist PM, Buring JE, Ridker PM, Kase CS, Kurth T, Rexrode KM. Lipid levels and the risk of hemorrhagic stroke among women. Neurology. 2019;92:2286-94.
  • Meschia JF, Bushnell C, Boden-Albala B, Braun L, Bravata DM, Chaturvedi S et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. J Stroke. 2014;45:3754-32.
  • Wieberdink RG, Poels MM, Vernooij MW, Koudstaal PJ, Hofman A, Lugt A et al. Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study. Arterioscler Thromb Vasc Bio. 2011;31:2982-89.
  • Ma Y, Li Z, Chen L, Li X. Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage. Lipids Health Dis. 2016;15:1-9.
  • Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Salman R, Warach S et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 2009;8:165-74.
  • Vernooij M, Heeringa J, de Jong GJ, van der Lugt A, Breteler M. Cerebral microbleed preceding symptomatic intracerebral hemorrhage in a stroke-free person. Neurology. 2009;72:763-65.
  • Quispe R, Elshazly MB, Zhao D,Toth PP, Puri R, Virani SS et al. Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study. Euro J Prev Cardiol. 2020;27:1597-05.
  • Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D et al. 2020 International society of hypertension global hypertension practice guidelines. Hypertension. 2020;75:1334-57.
  • Karr S. Epidemiology and management of hyperlipidemia. Am J Manag Care. 2017;23:139-48.
  • Heit JJ, Iv M, Wintermark M. Imaging of intracranial hemorrhage. J Stroke. 2017;19:11-27
  • Tirschwell D, Smith N, Heckbert S, Lemaitre R, Longstreth W, Psaty B. Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups. Neurology. 2004;63:1868-75.
  • Konishi M, Iso H, Komachi Y, Lida M, Shimamoto T, Jacobs Jr DR et al. Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries. The Akita Pathology Study. J Stroke. 1993;24:954-64.
  • Puddey IB. Low serum cholesterol and the risk of cerebral haemorrhage. Atherosclerosis. 1996;119:1-6.
  • Iso H, Jacobs Jr DR, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N England J Med. 1989;320:904-10.
  • Collaborative ESCHD. Blood pressure, cholesterol, and stroke in eastern Asia. Lancet. 1998;352:1801-07.
  • Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. J Stroke. 2013;44:1833-39.
  • Ozturk PA, Öztürk Ü, Öztürk Ö. The relationship between aortic stiffness index and stroke severity in patients with acute ischemic stroke. Cukurova Medical Journal. 2021;46:1336-43.
  • Hankey GJ. Nutrition and the risk of stroke.Lancet Neurol. 2012;11:66-81.
  • Bonaventure A, Kurth T, Pico F, Barberger-Gateau P, Ritchie K, Stapf C et al. Triglycerides and risk of hemorrhagic stroke vs. ischemic vascular events: The Three-City Study. Atherosclerosis. 2010;210:243-48.
  • Çetin EHÖ, Cetin MS, Könte HC, Yaman NM, Tak BT, Ekizler FA et al. The predictive value of triglyceride to HDL ratio in determining coronary artery disease and plaque morphology. Turk J Clin Lab. 2019;10:467-73.
  • Kinosian B, Glick H, Garland G. Cholesterol and coronary heart disease: predicting risks by levels and ratios. Ann. Intern. Med. 1994;121:641-47.

Lipid düzeylerinin ve LDL-C/HDL-C oranının intraserebral hemorajilerde olası bir risk belirteci olarak değerlendirilmesi

Year 2022, Volume: 47 Issue: 1, 120 - 127, 31.03.2022
https://doi.org/10.17826/cumj.1030321

Abstract

Amaç: Bu çalışmanın amacı lipid parametrelerinin tek tek ve düşük dansiteli lipoprotein kolesterol/yüksek dansiteli lipoprotein kolesterol (LDL-C/HDL-C) oranına bakarak intraserebral hemoraji (ISH) için bir olası risk belirteci olarak kullanılabilirliğini analiz etmektir.
Gereç ve Yöntem: Çok merkezli, retrospektif vaka-kontrol çalışmasıdır. İntraserebral hemorajisi olan 226 hasta ve 226 kontrol çalışmaya dahil edilmiştir. İntraserebral hemorajisi beyin bilgisayarlı tomografide teyit edilen ve altta yatan vasküler, travmatik ve metabolik bir neden bulunamayan hastalardan 12 saatlik açlık sonrası lipid parametreleri değerlendirildi.
Bulgular: Yaptığımız araştırmada LDL-C ve total kolesterol (TC) ortalaması hasta ve kontrol gruplarında anlamlı farklılık göstermedi. Hasta gruplarında HDL-C ortalamaları anlamlı düzeyde düşükken, trigliserid (TG) düzeyleri yüksekti. Hasta ve kontrol grupları arasında LDL-C/HDL-C oranı sırasıyla 2,65 ± 1,10 ve 2,94 ± 1.13 (p=0,006), TG/HDL-C oranı 3,60 ± 2,72 ve 4,47 ± 3,25 (p=0,002) son olarak TC/HDL-C oranı 4,37 ± 1,49 ve 4,83 ± 1,56 (p=0,002) tespit edildi.
Sonuç: Artan TG ve azalan HDL-C düzeylerinin ISH ile ilişkili olduğu görülmüştür. Bununla beraber LDL-C, TC ve TG’nin HDL-C ile arasındaki oranlarının hasta grubunda daha düşük olduğu analiz edildi. Bu nedenle hemoraji riskini belirlemede bu lipid oranlarının daha net ve anlamlı sonuçlar verdiğini önerebiliriz.

Project Number

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References

  • Gu X, Li Y, Chen S, Yang X, Liu F, Li Y et al. Association of lipids with ischemic and hemorrhagic stroke: a prospective cohort study among 267500 Chinese. Stroke. 2019;50:3376-84.
  • Ariesen M, Claus S, Rinkel G, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. J Stroke. 2003;34:2060-65.
  • Rist PM, Buring JE, Ridker PM, Kase CS, Kurth T, Rexrode KM. Lipid levels and the risk of hemorrhagic stroke among women. Neurology. 2019;92:2286-94.
  • Meschia JF, Bushnell C, Boden-Albala B, Braun L, Bravata DM, Chaturvedi S et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. J Stroke. 2014;45:3754-32.
  • Wieberdink RG, Poels MM, Vernooij MW, Koudstaal PJ, Hofman A, Lugt A et al. Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study. Arterioscler Thromb Vasc Bio. 2011;31:2982-89.
  • Ma Y, Li Z, Chen L, Li X. Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage. Lipids Health Dis. 2016;15:1-9.
  • Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Salman R, Warach S et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 2009;8:165-74.
  • Vernooij M, Heeringa J, de Jong GJ, van der Lugt A, Breteler M. Cerebral microbleed preceding symptomatic intracerebral hemorrhage in a stroke-free person. Neurology. 2009;72:763-65.
  • Quispe R, Elshazly MB, Zhao D,Toth PP, Puri R, Virani SS et al. Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study. Euro J Prev Cardiol. 2020;27:1597-05.
  • Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D et al. 2020 International society of hypertension global hypertension practice guidelines. Hypertension. 2020;75:1334-57.
  • Karr S. Epidemiology and management of hyperlipidemia. Am J Manag Care. 2017;23:139-48.
  • Heit JJ, Iv M, Wintermark M. Imaging of intracranial hemorrhage. J Stroke. 2017;19:11-27
  • Tirschwell D, Smith N, Heckbert S, Lemaitre R, Longstreth W, Psaty B. Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups. Neurology. 2004;63:1868-75.
  • Konishi M, Iso H, Komachi Y, Lida M, Shimamoto T, Jacobs Jr DR et al. Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries. The Akita Pathology Study. J Stroke. 1993;24:954-64.
  • Puddey IB. Low serum cholesterol and the risk of cerebral haemorrhage. Atherosclerosis. 1996;119:1-6.
  • Iso H, Jacobs Jr DR, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N England J Med. 1989;320:904-10.
  • Collaborative ESCHD. Blood pressure, cholesterol, and stroke in eastern Asia. Lancet. 1998;352:1801-07.
  • Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. J Stroke. 2013;44:1833-39.
  • Ozturk PA, Öztürk Ü, Öztürk Ö. The relationship between aortic stiffness index and stroke severity in patients with acute ischemic stroke. Cukurova Medical Journal. 2021;46:1336-43.
  • Hankey GJ. Nutrition and the risk of stroke.Lancet Neurol. 2012;11:66-81.
  • Bonaventure A, Kurth T, Pico F, Barberger-Gateau P, Ritchie K, Stapf C et al. Triglycerides and risk of hemorrhagic stroke vs. ischemic vascular events: The Three-City Study. Atherosclerosis. 2010;210:243-48.
  • Çetin EHÖ, Cetin MS, Könte HC, Yaman NM, Tak BT, Ekizler FA et al. The predictive value of triglyceride to HDL ratio in determining coronary artery disease and plaque morphology. Turk J Clin Lab. 2019;10:467-73.
  • Kinosian B, Glick H, Garland G. Cholesterol and coronary heart disease: predicting risks by levels and ratios. Ann. Intern. Med. 1994;121:641-47.
There are 23 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Ahmet Adıgüzel 0000-0001-5197-7063

Sibel Çıplak 0000-0002-2304-8125

Ünal Öztürk 0000-0002-8341-5070

Project Number -
Publication Date March 31, 2022
Acceptance Date January 2, 2022
Published in Issue Year 2022 Volume: 47 Issue: 1

Cite

MLA Adıgüzel, Ahmet et al. “Evaluation of Lipid Levels and LDL-C/HDL-C Ratio As Possible Risk Markers of Intracerebral Hemorrhage”. Cukurova Medical Journal, vol. 47, no. 1, 2022, pp. 120-7, doi:10.17826/cumj.1030321.