Plasma lipoproteins in cortical versus lacunar infarction.

Adams, Robert J.; Carroll, Richard; Nichols, Fenwick T.; McNair, Nancy; Feldman, Daniel S.; Feldman, Elaine B.; Thompson, William O.

doi:10.1161/01.str.20.4.448

Cited by 45 publications

(27 citation statements)

References 31 publications

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“…In the present analysis, LDL cholesterol level was not clearly associated with the risks of stroke and ischemic stroke, but these associations were heterogeneous across ischemic stroke subtypes. Because LI and CEI seem to have a less potent relation with elevated LDL cholesterol, 21,22 inclusion of those subtypes may mask the positive association between LDL cholesterol and ATI. This heterogeneity in the associations of LDL cholesterol level and ischemic stroke subtypes may be a reason for the controversial results obtained from previous studies that investigated the outcome of "total" ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Our previous report showed that multiple risk factors were related to the occurrence of LI, 14 and case-control studies on the relation between LDL cholesterol level and LI have reported varied associations. 21,22,25 One study reported a significant association between elevated LDL cholesterol and the risk of LI, 25 another study observed lower LDL cholesterol levels in LI cases, 22 and another study found no significant association. 21 Lacunar infarcts occur as a result of multiple mechanisms, such as (1) lipohyalinosis and/or fibrinoid necrosis, (2) microatheroma, (3) atherosclerosis of the basilar and middle cerebral artery stem or proximal division of large vessels, or (4) cardioembolic occlusion.…”

Section: Imamura Et Al Ldl Cholesterol and Cvd Risk In Japanesementioning

confidence: 99%

“…21,22,25 One study reported a significant association between elevated LDL cholesterol and the risk of LI, 25 another study observed lower LDL cholesterol levels in LI cases, 22 and another study found no significant association. 21 Lacunar infarcts occur as a result of multiple mechanisms, such as (1) lipohyalinosis and/or fibrinoid necrosis, (2) microatheroma, (3) atherosclerosis of the basilar and middle cerebral artery stem or proximal division of large vessels, or (4) cardioembolic occlusion. 26 Lipohyalinosis is a vasculopathy caused by hypertension, 26 whereas large-vessel atherosclerosis is affected by risk factors including LDL cholesterol, 23,24 but cardioembolism seems less related to elevated LDL cholesterol.…”

Section: Imamura Et Al Ldl Cholesterol and Cvd Risk In Japanesementioning

confidence: 99%

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LDL Cholesterol and the Development of Stroke Subtypes and Coronary Heart Disease in a General Japanese Population

Imamura

Doi

Arima

et al. 2009

Stroke

200

125

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Background and Purpose-Although the relation between serum LDL cholesterol level and coronary heart disease (CHD) is well established, its relation with stroke subtypes is less clear. Methods-A total of 2351 inhabitants age Ն40 years in a Japanese community were followed up for 19 years. Results-During follow-up, 271 subjects developed stroke and 144 developed CHD. Whereas the age-and sex-adjusted incidences of CHD significantly increased with increasing LDL cholesterol levels (P for trend Ͻ0.001), the associations between LDL cholesterol level and the incidences of ischemic or hemorrhagic stroke were not significant. The age-and sex-adjusted incidences of atherothrombotic infarctions (ATIs) and lacunar infarctions (LIs) significantly increased with increasing LDL cholesterol level (P for trendϭ0.03 for ATIs andϭ0.02 for LIs), but no such association was observed for cardioembolic infarction. After multivariate adjustment, the positive associations of LDL cholesterol level with the risks of ATI and CHD remained significant (P for trendϭ0.02 for ATIs andϭ0.03 for CHD), whereas the association with LIs was not significant. The risk of ATI significantly increased in the fourth quartile of LDL cholesterol compared with the first quartile (multivariate-adjusted hazard ratioϭ2.84; 95% CI, 1.17 to 6.93). The multivariate-adjusted risks for developing nonembolic infarction (ATIs and LIs) and CHD were significantly elevated in the groups with elevated LDL cholesterol values with and without the metabolic syndrome. Conclusions-Our findings suggest that an elevated LDL cholesterol level is a significant risk factor for developing ATI as well as CHD, and these associations are independent of the metabolic syndrome. (Stroke. 2009;40:382-388.)

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Section: Discussionmentioning

confidence: 99%

Section: Imamura Et Al Ldl Cholesterol and Cvd Risk In Japanesementioning

confidence: 99%

Section: Imamura Et Al Ldl Cholesterol and Cvd Risk In Japanesementioning

confidence: 99%

See 1 more Smart Citation

LDL Cholesterol and the Development of Stroke Subtypes and Coronary Heart Disease in a General Japanese Population

Imamura

Doi

Arima

et al. 2009

Stroke

200

125

View full text Add to dashboard Cite

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“…23 Failure to adjudicate stroke subtypes and confounding variables could also cloud the interpretation of observational data. 11,28,29 There appears to be a strong association between cholesterol levels and documented atherothrombosis. 30 In the Framingham Heart Study, moderate carotid stenosis (Ն25%) in men was associated with elevations in systolic blood pressure (Ն20 mm Hg) and total-cholesterol level (Ն0.26 mmol/L [10 mg/dL]) and a 5 pack-year history of smoking compared with minimal stenosis (Ͻ25%).…”

Section: Statins and Stroke Prevention: Pending Questionsmentioning

confidence: 99%

Statins for Stroke Prevention

Amarenco

Tonkin

2004

Circulation

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Abstract-The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nonetheless, large, long-term statin trials in patients with established CHD or at high risk for CHD have shown that statins decrease stroke incidence in these populations. Combined data from 9 trials including 70 070 patients indicated relative and absolute risk reductions for stroke of 21% and 0.9%, respectively, with statins. Key Words: cardiovascular risk Ⅲ prevention Ⅲ statins Ⅲ stroke I n the past decade, the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or "statins," have been proven to significantly decrease coronary events in primary and secondary prevention of coronary heart disease (CHD). [1][2][3][4][5][6][7][8] In patients with known CHD 1-3,6 and high-risk patients (eg, those with hypertension 8 or diabetes mellitus 9 ), stroke, a secondary end point, was also reduced by statin treatment. The neutral effect on stroke in older patients in the recent 3-year Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial 7 may have related to the relatively short period of follow-up, but has led some experts to again question whether stroke reduction by statins results from reductions in cardiac events and, therefore, systemic thromboembolism rather than from a direct effect on the cerebral arteries. Cholesterol as a Risk Factor for StrokeWhether increased serum cholesterol levels are a risk factor for stroke remains controversial. A meta-analysis of 45 prospective cohorts that included 450 000 subjects (total of 7.3 million patient-years; average follow-up: 16 years) and 13 000 incident strokes found no association between total cholesterol levels and stroke. 10 The Multiple Risk Factor Intervention Trial (MRFIT), however, showed that the risk of death from nonhemorrhagic stroke increased with increasing serum cholesterol in 351 000 men aged 35 to 57 years. 11 Conversely, in the same study, there was a negative association with hemorrhagic stroke for cholesterol levels Ͻ5.2 mmol/L (Ͻ201 mg/dL): the lower the total cholesterol level, the higher the risk of hemorrhagic stroke, suggesting a possible U-shaped relationship between cholesterol and stroke. The association between low cholesterol levels and hemorrhagic stroke was notable particularly in men with hypertension. The link between low cholesterol concentration and hemorrhagic stroke also was shown in a meta-analysis of 13 Chinese and Japanese cohorts, including 125 000 subjects and 1800 strokes, in which there was a tendency for increased risk of hemorrhagic stroke and decreased risk of ischemic stroke as cholesterol levels decreased. 12 Finally, in the Copenhagen City Heart Study, total cholesterol was positively associated with risk of nonhemorrhagic stroke, but only for levels Ͼ8 mmol/L (Ͼ309 mg/dL), corresponding to levels ...

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“…Yamagishi et al (18) showed that the risk of coronary heart disease was four times higher in current smokers than in never-smokers. Smoking causes direct injury of endothelial cells (19), atheroma formation through low high-density lipoprotein (HDL)-cholesterol levels (20), and acceleration of thrombus formation through increased plasma fibrinogen (21), increased platelet aggregability (22), and decreased fibrinolytic activity (23).…”

Section: Coronary Risk Factors With Ami and Uapmentioning

confidence: 99%

Increased Cardiac Mortality in Women Compared with Men in Patients with Acute Myocardial Infarction

et al. 2004

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Objective It has been reported that women with acute myocardial infarction (AMI) have a higher short-term mortality rate than men, but the reason is not known. The profile in relation to age, gender and risk factors was evaluated to compare AMI and unstable angina pectoris (UAP).Methods Findings from 984 patients including 580 patients with AMI (129 women, 451 men) and 404 patients with UAP (131 women, 273 men) were analyzed by the South Osaka Acute Coronary Syndrome Study Group (SACS). The primary endpoint of the study was in-hospital death. The primary endpoints of interest (cardiac death) were fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death.Results Cardiac death during hospitalization within 30 days in AMI was higher in women than in men (12.4% vs 6.7%, p<0.05). On the other hand, in UAP there was no significant difference between women and men (1.5% vs 0.7%, NS). The incidence of cardiac death in AMI was significantly higher for patients 75 years old and older (19.0%) than for patients less than 55 years old (4.2%), 55-64 years old (3.5%) and 65-74 years old (4.7%) (p<0.001, respectively).Conclusions Cardiac death was higher for women compared with men in patients with AMI. The worse prognosis for the AMI women patients was likely to be derived from less performance of percutaneous coronary intervention, and a high incidence of severe myocardial infarction. Further research should be focused on the analysis of various clinical backgrounds.

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Plasma lipoproteins in cortical versus lacunar infarction.

Cited by 45 publications

References 31 publications

LDL Cholesterol and the Development of Stroke Subtypes and Coronary Heart Disease in a General Japanese Population

LDL Cholesterol and the Development of Stroke Subtypes and Coronary Heart Disease in a General Japanese Population

Statins for Stroke Prevention

Increased Cardiac Mortality in Women Compared with Men in Patients with Acute Myocardial Infarction

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