Hyperlipidemia and Reduced White Matter Hyperintensity Volume in Patients With Ischemic Stroke

Jiménez‐Conde, Jordi; Biffi, Alessandro; Rahman, Rosanna; Kanakis, Allison; Butler, Christi; Sonni, Shruti; Massasa, Efi E.; Cloonan, Lisa; Gilson, Aaron J.; Capozzo, Karen; Cortellini, Lynelle; Ois, Ángel; Cuadrado-Godia, Elisa; Rodríguez-Campello, Ana; Furie, Karen L.; Roquer, Jaume; Rosand, Jonathan; Rost, Natalia S.

doi:10.1161/strokeaha.109.563502

Cited by 117 publications

(101 citation statements)

References 40 publications

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“…28 The relatively frequent use of statin may also explain the positive association between cholesterol level and log WMHv in these patients. The associations of log WMHv with hyperlipidemia and cholesterol level lost significance after an additional adjustment for statin use.…”

Section: December 2014mentioning

confidence: 97%

Grading and Interpretation of White Matter Hyperintensities Using Statistical Maps

Ryu

Woo

Schellingerhout

et al. 2014

Stroke

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Background and Purpose-We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke. Methods-We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.0 years) enrolled consecutively from 11 nationwide stroke centers, from patient (fluid-attenuated-inversion-recovery) MRIs onto a standard brain template set. Using multivariable analyses, we assessed the impact of major (age/hypertension) and minor risk factors on WMH variability. Results-We have produced a large reference data library showing the location and quantity of WMHs as topographical frequency-volume maps. This easy-to-use graphical reference data set allows the quantitative estimation of the severity of WMH as a percentile rank score. For all patients (median age=69 years), multivariable analysis showed that age, hypertension, atrial fibrillation, and left ventricular hypertrophy were independently associated with increasing WMH (0-9.4%, median=0.6%, of the measured brain volume). For younger (≤69) hypertensives (n=819), age and left ventricular hypertrophy were positively associated with WMH. For older (≥70) hypertensives (n=944), age and cholesterol had positive relationships with WMH, whereas diabetes mellitus, hyperlipidemia, and atrial fibrillation had negative relationships with WMH. For younger nonhypertensives (n=578), age and diabetes mellitus were positively related to WMH. For older nonhypertensives (n=328), only age was positively associated with WMH. Conclusions-We have generated a novel graphical WMH grading (Kim statistical WMH scoring) system, correlated to risk factors and adjusted for age/hypertension. Further studies are required to confirm whether the combined data set allows grading of WMH burden in individual patients and a tailored patient-specific interpretation in ischemic stroke-related clinical practice. Other risk factors such as diabetes mellitus, hyperlipidemia, atrial fibrillation, and smoking were inconsistently reported in the literature and seem less strongly associated with WMHs (Table I in the online-only Data Supplement). 3,[6][7][8][9][10] Despite a rapidly growing body of knowledge from population studies, substantial variability in WMH volume among individuals with similar cerebrovascular risk factors complicates a tailored interpretation of patient-specific implications of WMHs in daily clinical practice. [10][11][12] What is lacking is a comprehensive, quantitative study with substantial numbers, and robust methodology, which correlates WMHs to stroke risk factors so that the associations and interplay between risk factors can be better understood. Clinically, there have been no rigorous graphical and statistical reference data available for the individualized estimation of the relative severity (expressed as percentile ranks) of WMH burden adjusted for major risk factors (age/hypertension).In this study, we have combined (1) a la...

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Section: December 2014mentioning

confidence: 97%

Grading and Interpretation of White Matter Hyperintensities Using Statistical Maps

Ryu

Woo

Schellingerhout

et al. 2014

Stroke

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“…Diabetes was defined as a fasting blood glucose level ≥7.0 mmol/L or a diagnosis of diabetes requiring diet or anti-diabetic therapy. Hyperlipidemia was defined as a total cholesterol (TC) level of ≥5.72 mmol/L and/or a triglyceride (TG) level of ≥1.70 mmol/L, or treatment with a lipid-lowering medication [27]. Individuals who formerly or currently smoked ≥10 cigarettes per day for at least 2 years were defined as smokers.…”

Section: Methodsmentioning

confidence: 99%

Circulating MiR-146a May be a Potential Biomarker of Coronary Heart Disease in Patients with Subclinical Hypothyroidism

Xiaohui

Zhang

et al. 2018

Cell Physiol Biochem

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Background/Aims: Subclinical hypothyroidism (SCH) plays a crucial role in the development and progression of coronary heart disease (CHD). However, any associated changes in the circulating microRNAs (miRNAs) levels and slightly elevated thyroid stimulating hormone (TSH) levels in CHD patients are unknown. miR-146a is a well known miRNA associated with inflammatory autoimmune diseases. Here, we evaluated miR-146a expression in patients, with the goal of re-evaluating the effect of SCH on CHD. Methods: A total of 192 study subjects who underwent coronary angiography for either suspected or confirmed CHD were enrolled in 3 groups: CHD with SCH, CHD alone, and healthy controls. The circulating levels of miR-146a were quantified using qRT-PCR. Results: Levels of miR-146a were positively correlated with CHD severity, as indicated by the Gensini score (r=0.354). The relative expression of miR-146a in the CHD+SCH, CHD and healthy control groups was 2.223±0.827, 1.588±0.726 and 0.632±0.309, respectively. Plasma TSH levels were positively correlated with miR-146a levels (r=0.321). According to multivariate logistic regression analyses, miR-146a levels were associated with the incidence of CHD in patients with SCH. For diagnosing CHD, the area under the ROC curve (AUC) of miR-146a and TSH was 0.779 and 0.752, respectively. When the TSH and miR-146a levels were combined to form a composite panel, the AUC of the panel was 0.858. Conclusion: Plasma miR-146a levels correlated with the severity of coronary atherosclerosis and increased with TSH slightly elevated in patients with CHD. Thus, miR-146a may have good predictive value for CHD among individuals with elevated TSH levels.

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“…Further, in 1,135 acute IS patients hypercholesterolaemia, hypertriglyceridaemia or use of lipid-lowering medication was associated with decreased WMH severity [59]. Unfortunately, the authors were unable to assess the contribution of statin therapy to the association seen, which may have confounded their findings.…”

Section: Lipid Effects On Vascular Dementiamentioning

confidence: 96%

Hypercholesterolaemia and vascular dementia

et al. 2017

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Correspondence: Philip Bath (Philip.bath@nottingham.ac.uk) Vascular dementia (VaD) is the second commonest cause of dementia. Stroke is the leading cause of disability in adults in developed countries, the second major cause of dementia and the third commonest cause of death. Traditional vascular risk factors -diabetes, hypercholesterolaemia, hypertension and smoking -are implicated as risk factors for VaD. The associations between cholesterol and small vessel disease (SVD), stroke, cognitive impairment and subsequent dementia are complex and as yet not fully understood. Similarly, the effects of lipids and lipid-lowering therapy on preventing or treating dementia remain unclear; the few trials that have assessed lipid-lowering therapy for preventing (two trials) or treating (four trials) dementia found no evidence to support the use of lipid-lowering therapy for these indications. It is appropriate to treat those patients with vascular risk factors that meet criteria for lipid-lowering therapy for the primary and secondary prevention of cardiovascular and cerebrovascular events, and in line with current guidelines. Managing the individual patient in a holistic manner according to his or her own vascular risk profile is recommended. Although the paucity of randomized controlled evidence makes for challenging clinical decision making, it provides multiple opportunities for on-going and future research, as discussed here.

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Hyperlipidemia and Reduced White Matter Hyperintensity Volume in Patients With Ischemic Stroke

Cited by 117 publications

References 40 publications

Grading and Interpretation of White Matter Hyperintensities Using Statistical Maps

Grading and Interpretation of White Matter Hyperintensities Using Statistical Maps

Circulating MiR-146a May be a Potential Biomarker of Coronary Heart Disease in Patients with Subclinical Hypothyroidism

Hypercholesterolaemia and vascular dementia

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