Comparison of Blood Lipid Parameters in Patients with Ischemic and Hemorrhagic Stroke and Its Relationship with Mortality

Abstract

Objective: The aim of this study is to evaluate blood lipid parameters in patients with ischemic and hemorrhagic stroke and its relationship with mortality. Materials and Methods: For the study, patients with acute ischemic stroke and hemorrhagic stroke who received inpatient treatment in the neurology clinic between January 2017 and October 2020 were retrospectively analyzed. In-hospital ischemic and hemorrhagic stroke mortality rates were calculated. The lipid profile of the patients (triglyceride, total cholesterol, HDL cholesterol and LDL cholesterol) was evaluated with blood samples taken after 12 hours of fasting. Results: There were 60 ischemic and 50 hemorrhagic stroke patients in the study. The frequency of diabetes mellitus (DM) and coronary artery disease (CAD) were similar in groups with ischemic and hemorrhagic stroke (p: 0,649, p: 0,919, respectively). Hypertension was higher in the hemorrhagic stroke group (p: 0,006). Mortality rates were 10% (n: 6) in ischemic stroke and 36% (n: 18) in hemorrhagic stroke. Comparison of serum lipid levels in ischemic stroke and hemorrhagic stroke; Total cholesterol was higher in ischemic stroke group (p: 0,003). Triglyceride, HDL, and LDL cholesterol levels were similar in groups (p: 0,929, p: 0,443, p: 0,133, respectively). Serum triglyceride and total cholesterol levels were lower in all stroke patients with mortality (p: 0,047, p: 0,002). Other parameters were similar. Conclusion Serum total cholesterol level is higher in patients with ischemic stroke. Hypertension is more common in hemorrhagic stroke. Low triglycerides and low total cholesterol are associated with short-term mortality in patients with stroke.

Keywords

• Hemorrhagic stroke
• ischemic stroke
• lipids
• prognosis
• risk factors

İskemik ve Hemorajik İnme Hastalarında Kan Lipid Parametrelerinin Karşılaştırılması ve Mortalite ile İlişkisi

Abstract

Amaç: Çalışmada iskemik ve hemorajik inme hastalarında kan lipid parametrelerinin değerlendirilmesi ve mortalite ile ilişkisinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Retrospektif özellikte, kesitsel ve hastane temelli klinik bir çalışma olarak planlandı. İskemik ve hemorajik inme tanısı klinik bulgular, beyin difüzyon ağırlıklı manyetik rezonans görüntüleme (MRG) ve bilgisayarlı tomografi (BT) ile konfirme edildi. Hastane içi inme mortalite oranları hesaplandı. Hastaların serum lipid profili (trigliserid, total kolesterol, yüksek dansiteli lipoprotein (HDL) kolesterol ve düşük dansiteli lipoprotein (LDL) kolesterol) incelendi. Bulgular: Çalışmada 60 iskemik ve 50 hemorajik inme hastası dahil edildi. İskemik ve hemorajik inme guruplarında diyabetes mellitüs (DM) ve koroner arter hastalığı (KAH) sıklığı benzerdi (sırasıyla p: 0,649, p: 0,919). Hipertansiyon hemorajik inme gurubunda daha sıktı (p: 0,006). Mortalite oranları iskemik inmede %10 (n: 6), hemorajik inmede %36 (n: 18) idi. İskemik inme ve hemorajik inmede serum lipid seviyeleri karşılaştırıldığında, total kolesterol iskemik inme gurubunda yüksekti (p: 0,003). Trigliserit, HDL ve LDL kolesterol seviyesi benzerdi (sırasıyla, p: 0,929, p: 0,443, p: 0,133). Mortalite ile seyreden tüm inme hastalarında serum trigliserid ve total kolesterol seviyesi daha düşüktü (p=0,047, p=0,002). Diğer parametreler benzerdi. Sonuç: Çalışmamızda serum total kolesterol seviyesi iskemik inme hastalarında daha yüksektir. Hipertansiyon hemorajik inmede daha sıktır. Trigliserit ve total kolesterol düşüklüğü inme hastalarında kısa dönem mortalite ile ilişkilidir.

Keywords

• Hemorajik inme
• iskemik inme
• lipidler
• prognoz
• risk faktörleri

References

1. Evci ED, Memis S, Ergin F, Beser E: A population-based study on awareness of stroke in Turkey. Eur J Neurol 2007;14:517-522.
2. Rowland LP, Pedley TA. Serebrovasküler hastalığın patogenezi, sınıflandırılması ve epidemiyolojisi. Doğu O (Çeviri Ed.). Merritt’s Neurology Türkçe 12. Baskı. ss.250-263, Güneş Tıp Kitabevleri, İstanbul, Türkiye, 2012.
3. Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, et al. A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. J Intern Med 2002;252:121-129.
4. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics 2011 update: A report from the American Heart Association. Circulation 2011;123(4):18-209.
5. Özdemir G, Özkan S, Uzuner N, Mzdenir AÖ, Gücünyener D. Türkiye’de beyin damar hastalıkları için major risk faktörleri. Türk Çok Merkezli Strok Çalışması. Türk Beyin Damar Hastalıkları Dergisi 2000; 2: 31-35.)
6. Ferket BS, van Kempen BJ, Wieberdink RG, Steyerberg EW, Koudstaal PJ, Hofman A, et al. Separate prediction of intracerebral hemorrhage and ischemic stroke. Neurology. 2014;20;82(20):1804-1812.
7. Kim BJ & Kim JS. Ischemic stroke subtype classification: an Asian viewpoint. J Stroke. 2014:16(1); 8-14.
8. Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009;40(2):394-399.

9. Wolf ME, Alonso A, Ebert AD, Szabo K, Chatzikonstantinou A. Etiologic and clinical characterization of patients with recurrent spontaneous intracerebral hemorrhage. Eur Neurol. 2016;76:295-301.
10. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110
11. Rist PM, Buring JE, Ridker PM, Kase CS, Kurth T, Rexrode KM. Lipid levels and the risk of hemorrhagic stroke among woman. Neurology. 2019;92:2286-2294.
12. Shadi Y, Elkind MSV. Lipids and cerebrovascular disease: Research and practice. Stroke. 2015;46(11):3322-3328.
13. Utku U, Çelik Y. İnmede etyoloji, sınıflandırma ve risk faktörleri. Serebrovasküler Hastalıklar. Balkan S (Ed.). 3th ed. Ankara, Güneş Kitabevi 2009, 85-96.
14. Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, et al. The reasons for geographic and racial differences in stroke study: Objectives and design. Neuroepidemiology. 2005; 25:135–143.
15. Kurth T, Kase CS, Berger K, Gaziano JM, Cook NR, Buring JE. Smoking and risk of hemorrhagic stroke in women. Stroke 2003;34: 2792–2795.
16. Tziomalos K, Spanou M, Bouziana SD, Papadopoulou M, Kostaki S, Dourliou V, et al. Type 2 diabetes is associated with a worse functional outcome of ischemic stroke. World J Diabetes 2014; 5: 939-944.
17. Zhang CE, Wong SM, van de Haar HJ, Staals J, Jansen JF, Jeukens CR, et al. Blood-brain barrier leakage is more widespread in patients with cerebral small vessel disease. Neurology. 2017; 88: 426-432.
18. Balkan S, Topçuğlu MA. İnme ve hipertansiyon. T Klin J Neur 2004, 2: 41-47.
19. Eliyahu H, Mizrahi, Shlomo N, Sela BA, Fleissing Y, Arad M, Adunsky A. Furter evidance of interrelation betwen homocysteine and hypertension in stroke patients. A cross sectiniol study IMAJ. 2003;791-794.
20. Glasser SP, Mosher A, Howard G, Banach M. What is the association of lipid levels and incident stroke? Int J Cardiol. 2016;1;220:890-894.
21. Hindy G, Engström G, Larsson SC, Traylor M, Markus H, Melander O, et al. Role of blood lipids in the development of ischemic stroke and its subtypes: A mendelian randomization study. Stroke. 2018;49:820-827.
22. Lu D, Li P, Zhou Y, Xu X, Zhang H, Liu L, et al. Association between serum non-highdensity lipoprotein cholesterol and cognitive impairment in patients with acute ischemic stroke. BMC Neurol. 2016:26;16(1):154.
23. Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. High triglyceride/HDL cholesterol ratio is associated with silent brain infarcts in a healthy population. BMC Neurology 2019: 19:147.
24. Kuusisto J, Mykkanen L, Pyorala K, Laakso M. Non–insulin-dependent diabetes and its metabolic control are important predictors of stroke in elderly subjects. Stroke. 1994; 25: 1157- 1164.
25. Snarska KK, Bachórzewska-Gajewska H, Kapica-Topczewska K, Drozdowski W, Chorąży M, Kułakowska A, et al. Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke. Arch Med Sci. 2017;13(1):100-108.
26. Bang OY, Saver JL, Liebeskind DS, Starkman S, Villablanca P, Salamon N. Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis. Neurology. 2007;68:737-742.
27. Iribarren C, Jacobs DR, Sadler M, Claxton AJ, Sidney S. Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program. Stroke. 1996;27(11):1993-1998.
28. Dayton S, Chapman JM, Pearce ML, Popjak GJ. Cholesterol, atherosclerosis, ischemic heart disease, and stroke. Ann Intern Med. 1970;72:97-109.
29. Appleyard M, Hansen AT, Schnohr P, Jensen G, Nyboe J. The Copenhagen City Heart Study. Øster- broundersøgelsen. A book of tables with data from the first examination (1976–78) and a five year follow-up (1981–83). Scand J SocMed. 1989;170(41):1-160.
30. Hachinski V, Graffagnino C, Beaudry M, Bernier G, Buck C, Donner A, et al. Lipids and stroke: a paradox resolved. Arch Neurol 1996; 53(4): 303-308.
31. Pedro-Botet J, Senti M, Nogues X, Rubies-Prat J, Roquer J, D'Olhaberriague L, et al. Lipoprotein and apolipoprotein profile in men with ischemic stroke. Role of lipoprotein (a), triglyceride-rich lipoproteins, and apolipoprotein E polymorphism. Stroke 1992; 23(11): 1556-1562.
32. Pandey A, Shrivastava A, Solanki A. Study of atherogenic lipid profile, high sensitive C-reactive protein neurological deficit and short-term outcome in stroke subtypes. Iran J Neurol. 2016:6;15(3):146-152.
33. Bharosay A, Bharosay VV, Bandyopadhyay D, Sodani A, Varma M, Baruah H. Effect of lipid profile upon prognosis in ischemic and haemorrhagic cerebrovascular stroke. Indian J Clin Biochem 2014;29(3):372-376.
34. 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(19):2286-2294.
35. Kotan D, Yılıkoglu Y, Kızıltunç A, Ulvi H, Aygül R, Yanmaz V. Serum adinopektin düzeylerinin iskemik inmedeki rolü. Sakarya Tıp Dergisi 2013;3(2):80-84.
36. Papademetriou V, Narayan P, Rubins H, Collins D, Robins S. Influence of risk factors on peripheral and cerebrovascular disease in men with coronary artery disease, low high-density lipoprotein cholesterol levels, and desirable low-density lipoprotein cholesterol levels. HIT Investigators. Department of Veterans Affairs HDL Intervention Trial. Am Heart J 1998;136:734-740.
37. Barter PJ, Connor WE. The transport of triglyceride in the high-density lipoproteins of human plasma. J Lab Clin Med 1975;85(2):260-72.