Early Warning of Ischemic Stroke Based on Atherosclerosis Index Combined With Serum Markers

Zhou, Wenjie; Li, Shanze; Sun, Guijiang; Song, Lili; Feng, Wenjun; Li, Rui; Liu, Hui; Dong, Yanyan; Chen, Siyu; Yang, Shu; Li, Jing; Li, Yubo

doi:10.1210/clinem/dgac176

Cited by 13 publications

(6 citation statements)

References 30 publications

(28 reference statements)

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“…Particularly abdominal or visceral obesity, is associated with a host of metabolic abnormalities, including insulin resistance, dyslipidemia, and inflammation [27][28][29]. These metabolic disturbances contribute to the development and progression of atherosclerosis, a key contributor to stroke [30,31]. Individuals who are overweight or obese are more likely to develop insulin resistance indicating early impaired glucose metabolism [32].…”

Section: Discussionmentioning

confidence: 99%

Interacting and joint effects of triglyceride-glucose index (TyG) and body mass index on stroke risk and the mediating role of TyG in middle-aged and older Chinese adults: a nationwide prospective cohort study

Huo,

Liao,

Zhai

et al. 2024

Cardiovasc Diabetol

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Background Individuals who are overweight or obese often develop insulin resistance, mediation of the association between body mass index (BMI) and stroke risk through the triglyceride-glucose index (TyG) seems plausible but has not been investigated. This study aims to examine whether TyG mediates associations of BMI with stroke risk and the extent of interaction or joint relations of TyG and BMI with stroke outcome. Methods The China Health and Retirement Longitudinal Study, initiated in 2011, is a nationally representative, ongoing prospective cohort study involving 8 231 middle-aged and older Chinese adults without a stroke history at baseline. Exposures examined include BMI and the TyG, the latter being the logarithmized product of fasting triglyceride and glucose concentrations. The primary study outcome is stroke incidence, as determined through self-reports, with a follow-up period extending from June 1, 2011, to June 30, 2018. Results Of the 8 231 participants, 3 815 (46.3%) were men; mean (SD) age was 59.23 (9.32) years. During a median follow-up of 7.1 years, 585 (7.1%) participants developed stroke. The TyG was found to mediate the association between BMI and incident stroke, proportions mediated were 16.3% for BMI in the 24.0–27.9 kg/m2 group and 53.8% for BMI ≥ 28.0 kg/m2 group. No significant multiplicative and additive interactions were found between BMI and TyG on incident stroke (Additive: RERI = 1.78, 95% CI − 1.29–4.86; Multiplicative, HR = 1.40, 95% CI 0.86–2.27). HRs for individuals with BMI ≥ 28.0 kg/m2 and quartile 4 of TyG compared with those with BMI < 24.0 kg/m2 and quartile 1 of TyG were 2.05 (95% CI 1.37–3.06) for incident stroke. Combining BMI and TyG enhanced predictive performance for stroke when compared to their individual (AUCBMI+TyGvs AUCBMIvs AUCTyG, 0.602 vs 0.581 vs 0.583). Conclusions TyG appeared to be associated with stroke risk and mediates more than 50% of the total association between BMI and stroke in middle-aged and older Chinese adults. Public health efforts aiming at the reduction of body weight might decrease the stroke risk due to insulin resistance and the burden of stroke.

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Section: Discussionmentioning

confidence: 99%

Interacting and joint effects of triglyceride-glucose index (TyG) and body mass index on stroke risk and the mediating role of TyG in middle-aged and older Chinese adults: a nationwide prospective cohort study

Huo,

Liao,

Zhai

et al. 2024

Cardiovasc Diabetol

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“…Glycerophospholipids are an important part of the neuronal cell membrane structure and are involved in cell recognition and signal transduction. Therefore, the degradation of glycerophospholipids, which produces polyunsaturated fatty acids such as docosahexaenoicacid and arachidonic acid, may be a sign of brain damage [39,40]. A previous study has indicated that glycerophospholipid metabolism was signi cantly disrupted in stroke rats.…”

Section: Discussionmentioning

confidence: 99%

Lipid remodeling in serum and correlation with stroke in patients with leukoaraiosis

Lin,

Song,

Cao

et al. 2024

Preprint

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Background Despite the identification of many hub lipids for stroke, the underlying pathophysiology of stroke in elderly patients with leukoaraiosis (LA) remains poorly understood, which is important for the administration of antithrombotic therapy for LA patients. This study aims to illuminate the preliminary lipid metabolic process associated with stroke in LA patients (LS). Methods The study cohort consisted of 215 individuals undergoing magnetic resonance imaging(MRI), from which a subset 13 patients with stroke matched with a control group, and 48 LS patients matched with 40 LA patients were selected for further investigation after exclusion. Serum lipidome was profiled by UPLC-TOF. OPLS-DA was used for classification and identifying differential metabolites. Customizing structural equation (CSE) model was applied to assess the pathway weight of novel metabolites in stroke incidence. Linear regression and matrix correlation were used to investigate the relationships between differentiated metabolites and outcomes. Results Using lipid profiling and multivariate statistical analysis, we screened 168 different compounds between LA and LS. Based on the enrichment and Sankey diagram of pathway, 52 lipid molecules were regarded as differential metabolites associated with glycerolipid, glycerophospholipid, and sphingolipid metabolism. After CSE weighted the pathway node molecules, we finally identified 11 key metabolites achieving a prediction, in which DG(14:0/22:4) (OR = 5.33) and Cer(d18:1/24:1) (OR = 21.44) were significant risk factors for LS. All 11 metabolites exhibited correlations with the outcome (LS incidence), with particularly heightened metabolic disruption in the presence of high blood pressure. We conducted linear regression analysis and found changes in FA16:1; O, DG(12:0/17:2) and DG(14:0/22:4) out of 11 metabolites correlated with Fazekas scores between CK and LS group. Similarly, compared with LA group, DG(14:0/22:4) (OR = 5.33, p = 0.02) and Cer(d18:1/24:1) (OR = 21.44, p = 0.068) are risk factors for LS. Especially, Cer(d18:1/24:1) and PI(22:1/20:1) were significantly associated with the LS incidence. Conclusion This study identified 11 metabolites as key metabolites for stroke incidence in LA patients, including subgroups divided by Fazekas scores. This study provides novel insights into lipid metabolic process from LA to LS, in which the lipid disturbance in glycolipids and glycerophospholipids, as well as the regulatory role of Cer(18:1/24:1), which are valuable for further studies of LS.

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“…Zhou et al reported that five metabolic markers, such as sphingomyelin (18:0/14:0), 1-methylpyrrolinium, phosphatidylcholine (18:0/18:0), lysophosphatidylcholine (18:0/0:0), and phosphatidylcholine (18:2/18:2), have good diagnostic and predictive ability. The change level of these metabolites is significantly related to ischemic stroke and provides early warning for the diagnosis of atherosclerosis-induced ischemic stroke ( 19 ). In acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion, the asymmetrical prominent cortical vein sign might be a useful neuroimaging marker for predicting END ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits

et al. 2022

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BackgroundAlthough the PRISMS study did not demonstrate the benefit of intravenous alteplase administration in patients with mild stroke within 3 h, about 30% of patients presenting with mild symptoms showed unfavorable functional outcomes. We investigated the factors predictive of functional disability at 90 days in patients who were excluded from alteplase administration due to the National Institutes of Health Stroke Scale (NIHSS) scores of 0–5 and a score between 0 and 2 for each NIHSS score item.MethodsAll patients were diagnosed with acute ischemic stroke or transient ischemic attack within 4.5 h of admission to a tertiary hospital and did not receive alteplase due to a minor stroke between January 2013 and December 2020. Radiological data and clinical information were collected, including baseline and discharge NIHSS scores and modified Rankin Scale (mRS) scores at 90 days. Early neurological deterioration (END) was defined as an increase of two or more NIHSS scores. We defined moderate motor weakness as a NIHSS limb motor score of more than 3 and defined a favorable outcome as a mRS score at 90 days that was 0 or 1.ResultsDuring the investigation period, 400 patients did not receive alteplase. END occurred significantly more frequently in patients with large artery disease (LAD) than in those with other TOAST classifications. In the multivariate regression analysis, NIHSS per 1-point increase, presenting as moderate motor weakness, and LAD were independent predictors of poor functional outcome (OR, 1.811 NIHSS per 1-point increase; 95% confidence interval [CI], 1.503–2.182; P < 0.0001; OR, 2.173 moderate motor weakness; 95% CI 1.028–4.595; P = 0.042; OR, 2.033 LAD; 95% CI 1.099–3.762; P = 0.024, respectively).ConclusionModerate motor weakness presentation and LAD may be important factors associated with poor functional outcomes in patients with acute stroke excluded from alteplase administration due to mild symptoms.

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Early Warning of Ischemic Stroke Based on Atherosclerosis Index Combined With Serum Markers

Cited by 13 publications

References 30 publications

Interacting and joint effects of triglyceride-glucose index (TyG) and body mass index on stroke risk and the mediating role of TyG in middle-aged and older Chinese adults: a nationwide prospective cohort study

Interacting and joint effects of triglyceride-glucose index (TyG) and body mass index on stroke risk and the mediating role of TyG in middle-aged and older Chinese adults: a nationwide prospective cohort study

Lipid remodeling in serum and correlation with stroke in patients with leukoaraiosis

Factors associated with functional disability in patients with acute stroke excluded from alteplase administration due to minor non-disabling neurological deficits

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