The Relationship Between Blood Lipid Parameters and Development of Intracerebral Hemorrhage in Ischemic Stroke Patients

Abstract

Objective: The aim of this study was to investigate the relationship between the development of hemorrhagic transformation (HT) and blood lipid parameters in patients with ischemic stroke. Material and Methods: For the study, patients with acute ischemic stroke who received inpatient treatment in the neurology clinic between 2015-2020 were evaluated retrospectively. The patients were divided into 2 groups as patients with and without hemorrhagic transformation in ischemic tissue. The lipid profile of the patients (triglyceride, total cholesterol, LDL cholesterol and HDL cholesterol) was evaluated with blood samples taken between 5:00 and 7:00 hours after 12 hours of fasting. Results: In the study, 100 patients who developed HT in ischemic tissue (40) and did not develop HT (60) were included. There was no difference between the groups in terms of DM (p: 0.229) and hypertension (p: 0.698). While there was no significant difference between the groups in terms of triglycerides (p: 0.266) and HDL (p: 0.718), the levels of total cholesterol (p: 0.017) and LDL cholesterol (p: 0.015) were higher in the patient group who developed HT compared to the non-developed patient group, and the difference was significant. Conclusion In our study, no relationship was observed between blood lipid parameters and prognosis. However, we found that LDL cholesterol and total cholesterol levels were significantly higher in stroke patients with hemorrhagic transformation compared to ischemic stroke patients without hemorrhagic transformation. However, to determine whether this has had a clinically significant effect, our findings need to be confirmed by expanding the sample size.

Keywords

• Hemorrhagic transformation
• ischemic stroke
• lipids
• risk factors

İskemik İnme Hastalarında Kan Lipid Parametreleri ve İntraserebral Hemoraji Gelişimi Arasındaki İlişki

Öz

Giriş ve Amaç: Çalışmada iskemik inme hastalarında hemorajik transformasyon (HT) gelişimi ile kan lipid parametrelerinin ilişkisinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışma için 2015-2020 yılları arasında nöroloji kliniğinde yatarak tedavi alan akut iskemik inme hastaları retrospektif olarak değerlendirildi. Hastalar iskemik dokuda hemorajik transformasyon olan ve olmayan hastalar olarak 2 gruba ayrıldı. Hastaların lipid profili (trigliserid, total kolesterol, LDL kolesterol ve HDL kolesterol) 12 saat açlık sonrası, saat 5:00-07:00 arası alınan kan örnekleri ile değerlendirildi. Bulgular: Çalışmada iskemik dokuda HT gelişen (40) ve HT gelişmeyen (60) 100 hasta dahil edildi. Gruplar arasında DM (p: 0.229) ve hipertansiyon (p: 0.698) açısından farklılık yoktu. Gruplar arasında trigliserit (p: 0.266) ve HDL (p: 0.718) açısından anlamlı fark yokken, HT gelişen hasta gurubunda total kolesterol (p: 0.017) ve LDL kolesterol (p: 0.015) seviyeleri gelişmeyen hasta gurubuna göre yüksekti ve aradaki fark anlamlıydı. Sonuç: Çalışmamızda kan lipid parametreleri ve prognoz arasında bir ilişki gözlenmedi. Fakat hemorajik transformasyon gelişen inme hastalarında LDL kolesterol ve total kolesterol düzeylerinin hemorajik transformasyon gelişmeyen iskemik inme hastalarına göre anlamlı yüksek olduğunu bulduk. Ancak bunun klinik olarak önemli bir etkiye yol açıp açmadığını belirlemek için bulgularımızın, örneklem büyüklüğünün genişletilerek doğrulanması gerekmektedir.

Anahtar Kelimeler

• Hemorajik transformasyon
• iskemik inme
• lipidler
• risk faktörleri

Kaynakça

1. Utku, U, Çelik, Y, İnmede etyoloji, sınıflandırma ve risk faktörleri, Serebrovasküler Hastalıklar, Balkan S (Ed.). 3th ed. Ankara, Güneş Kitabevi, 2009, 85-96.
2. Yew, K.S, Cheng, E, Acute stroke diagnosis, American family physician, 2009, 80,33-40.
3. Rowland, L.P, Pedley, T.A, Serebrovasküler hastalığın patogenezi, sınıflandırılması ve epidemiyolojisi, Doğu O (Çeviri Ed.). Merritt’s Neurology Türkçe 12. Baskı, Güneş Tıp Kitabevleri, İstanbul, Türkiye, 250-263, 2012.
4. Deng, Q, Li, S, Zhang, H, Wang, H, Gu, Z, Zuo, L, Wang, L, Yan, F, Association of serum lipids with clinical outcome in acute ischaemic stroke, Journal of clinical neuroscience, 2019, 59, 236-244.
5. Feigin, V.L, Stroke epidemiology in the developing world, Lancet, 2005, 365, 2160-2161.
6. Dhamija, R.K, Arora, S, Jais, P.G, Kaintura, A, Kumar, M, Bhattacharjee, J, Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke, Indian Journal of Clinical Biochemistry, 2008, 23, 136-143.
7. Appelros, P, Stegmayr, B, Terent, A, Sex differences in stroke epidemiology: a systematic review, Stroke, 2009, 40, 1082-1090.
8. Banerjee, C, Moon, Y.P, Paik, M.C, Rundek, T, Mclaughlin, CM, Vieria, JR, Duration of diabetes and risk of ischemic stroke The Northern Manhattan Study, Stroke, 2012, 43, 1212-1217.

9. Jauch, E.C at al, Guidelines for early management of patients with acute ischemic stroke (AHA/ASA), Stroke, 2013, 44, 870-947.
10. Gang, L.V, Gou-qiang, W, Zhen-xi, X, Hai-xia, W, Nan, L, Wei, W, Influences of blood lipids on the occurrence and prognosis of hemorrhagic transformation after acute cerebral infarction: a case-control study of 732 patients, Military Medical Research, 2019, 6, 1-11.
11. Krueger, M, Bechmann, I, Immig, K, Reichenbach, A, Härtig, W, Michalski, D, Blood-brain barrier breakdown involves four distinct stages of vascular damage in various models of experimental focal cerebral ischemia, Journal of cerebral blood flow and metabolism, 2015, 35, 292-303.
12. Khatri, R, McKinney, AM, Swenson, B, Janardhan, V, Blood-brain barrier, reperfusion injury, and hemorrhagic transformation in acute ischemic stroke, Neurology, 2012, 79, 52-57.
13. Paciaroni, M, Agnelli, G, Corea, F, Ageno, W, Alberti, A, Lanari, A, et al., Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study, Stroke, 2008, 39, 2249 2256.
14. Wang, B.G, Yang, N, Lin, M, Lu, B, Analysis of risk factors of hemorrhagic transformation after acute ischemic stroke: cerebral microbleeds do not correlate with hemorrhagic transformation, Cell biochemistry and biophysics, 2014, 70, 135-142.
15. Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, The seven report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, Journal of the American Medical Association, 2003, 289, 2560-2572.
16. American Diabetes Association. Standarts of medical care in diabetes, Diabetes Care, 2004, 27: 15.
17. Deng, Q.W, Liu, Y.K, Zhang, Y.Q, Chen, X.L, Jiang, T, Hou, J.K, Low triglyceride to high-density lipoprotein cholesterol ratio predicts hemorrhagic transformation in large atherosclerotic infarction of acute ischemic stroke, Aging, 2019, 10, 1589-1601.
18. Yang, N, Lin, M, Wang, B.G, Zeng, W.Y, He, Y.F, Peng, HY, Low level of lowdensity lipoprotein cholesterol is related with increased hemorrhagic transformation after acute ischemic cerebral infarction, European review for medical and pharmacological sciences, 2016, 20, 673-678.
19. Xing, Y, Guo, Z.N, Yan, S, Jin, H, Wang, S, Yang, Y, Increased globulin and its association with hemorrhagic transformation in patients receiving intra-arterial thrombolysis therapy, Neuroscience bulletin, 2014, 30, 469-476.
20. Ntaios, G, Egli, M, Faouzi,, M, Michel P.J, Shaped association between serum glucose and functional outcome in acute ischemic stroke, Stroke, 2010, 41, 2366-2370.
21. Tapia-Pérez, J.H, Gehring, S, Zilke, R, Schneider, T, Effect of increased glucose levels on short-term outcome in hypertensive spontaneous intracerebral hemorrhage, Clinical neurology and neurosurgery, 2014, 118, 37-43.
22. Zheng, J, Sun, Z, Zhang, X, Li, Z, Guo, X, Xie, Y, Sun, Y, Non-traditional lipid profiles associated with ischemic stroke not hemorrhagic stroke in hypertensive patients: results from an 8.4 years follow-up study, Lipids in health and disease, 2019, 18, 9.
23. Wang, Q, Wang, D, Liu, M, Is diabetes a predictor of worse outcome for spontaneous intracerebral hemorrhage? Clinical neurology and neurosurgery, 2015, 134, 67-71.
24. Kuusito, J, Mykkannen, L, Laasko, M, Non-insulin dependent diabetes and it’s metabolic control are important predictors of stroke in elderly subjects, Stroke, 1994, 25, 1157-1164.
25. Nomani, AZ, Nabi, S, Ahmed, S, Iqbal, M, Rajput, H.M, Rao, S, High HbA1c is associated with higher risk of ischaemic stroke in Pakistani population without diabetes, Stroke and vascular neurology, 2016,5;1(3),133-139.
26. Beheshti, S, Madsen, C.M, Varbo, A, Benn, M, Nordestgaard, B.G, Relationship of familial hypercholesterolemia and high LDL Cholesterol to ischemic stroke: the Copenhagen general population study, Circulation, 2018, 138, 578-589.
27. Bots, M.L, Elwood, P.C, Nikitin, Y, Total and HDL cholesterol and risk of stroke. EUROSTROKE: a collaborative study among research centres in Europe, Journal of Epidemiology and Community Health, 2002, 56, 19–24.
28. Zhang, Y, Tuomilehto, J, Jousilahti, P, Wang, Y, Antikainen, R, Hu, G, Total and high density lipoprotein cholesterol and stroke risk, Stroke, 2012, 43, 1768-1774.
29. Bang, O.Y, Saver, J.L, Liebeskind, D.S, Starkman, S, Villablanca, P, Salamon, N, Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis, Neurology, 2007, 68, 737-742.
30. Dayton, S, Chapman, J.M, Pearce, M.L, Popjak, G.J, Cholesterol, atherosclerosis, ischemic heart disease, and stroke, Annals of internal medicine, 1970, 72, 97-109.
31. Kim, B.J, Lee, S.H, Ryu, W.S, Kang, B.S, Kim, C.K, Yoon, B.W, Low Level of Low-Density Lipoprotein Cholesterol Increases Hemorrhagic Transformation in Large Artery Atherothrombosis but Not in Cardioembolism, Stroke, 2009, 40, 1627-1632.
32. Olsen, T.S, Christensen, R.H, Kammersgaard, L.P, Andersen, K.K, Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen stroke study, Stroke, 2007, 38, 2646-2651.
33. Uyttenboogaart, M, Koch, M.W, Koopman, K, Vroomen, P.C, Luıjckx, G.J, Dekeyser, J, Lipid profile, statin use, and outcome after intravenous thrombolysis for acute ischaemic stroke, Jornal of Neurology, 2008, 255, 875-880.
34. Rocco, A, Sykora, M, Ringleb, P, Diedler, J, Impact of statin use and lipid profile on symptomatic intracerebral haemorrhage, outcome and mortality after intravenous thrombolysis in acute stroke, Cerebrovascular Disease, 2012, 33, 362-368.