The frequency and pattern of deranged lipid profile in patients with ischemic stroke: a retrospective study Dyslipidemia frequency and pattern in Ischemic Stroke

Main Article Content

Naresh Kumar Seetlani
Geeta Kumari
Farah Yasmin
Choudhary Ahmed Hasan
Maheen Hussaini
Sana Awan
Khalid Imran Mubeen
Rakshinda Jabeen
Sadia Ansari
Sarush Siddiqui
Momin Aziz
Umer Farooque

Keywords

Cerebrovascular accident, CVA, stroke, dyslipidemia, triglyceride, TG, LDL

Abstract

Background and aim: Ischemic Stroke has been recognized as the principal cause of disability and the third leading cause of mortality worldwide. The aim of this study was to determine the frequency and pattern of dyslipidemia in patients presenting with ischemic stroke at a tertiary care hospital in Karachi, Pakistan and to evaluate the effect of demographic and clinical factors on the frequency and pattern of dyslipidemia in ischemic stroke subjects.


 


Methods: A cross-sectional study carried on a sample size of 235 patients presenting to the out-patient clinic with paralysis, difficulty in speech, and/or loss of consciousness lasting for one hour or more. Blood samples were analyzed for total cholesterol (TC), triglycerides (TG), low-density lipoproteins (LDL), very low-density lipoproteins (VLDL) and high-density lipoproteins (HDL) by the enzymatic colorimetric methodology. These values were recorded on the pre-defined proforma by the investigators. All analysis was performed using SPSS version 23.0.


 


Results: The average age of the patients was 50.84±11.51 years and 62.1% of them were males. The frequency of dyslipidemia was observed in more than half (n=134/235, 57.02%) of ischemic stroke patients. Regarding the dyslipidemia pattern, TC, VLDL-C and TG levels were deranged in more than 50% of the cases. The most commonly deranged values were of TC and VLDL-C, followed by TG levels. It was observed that patients with a previous history of DM (73.9%, p=0.002) and HTN (81.3%, p=0.001) had significantly higher rates of deranged lipid profiles. Lipid values were found to be more deranged in patients aged 41-50 years (p=0.002) however, no statistically significant differences were observed with respect to BMI (p=0.192) and symptoms duration (p=0.334).


 


Conclusions: Dyslipidemia is an important risk factor for ischemic stroke, and elevated LDL-C is usually the lipid fraction implicated in the pathologic mechanism of stroke.

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References

1. Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bulletin of the World Health Organization. 2016; 94(9):634. Available from: https://www.who.int/bulletin/volumes/94/9/16-181636/en/ [last accessed October 1st 2020]
2. Global Stroke Fact Sheet 2019. World Stroke Organization (WSO). Available from: https://www.world-stroke.org/assets/downloads/WSO_Fact-sheet_15.01.2020.pdf [last accessed ]
3. Truelsen T, Begg S, Mathers C. The global burden of cerebrovascular disease. Geneva: World Health Organisation (WHO). 2000. Available from: https://www.who.int/healthinfo/statistics/bod_cerebrovasculardiseasestroke.pdf
4. Jafar TH. Blood pressure, diabetes, and increased dietary salt associated with stroke--results from a community-based study in Pakistan. J Hum Hypertens. 2006;20(1):83-85. doi:10.1038/sj.jhh.1001929
5. Khealani BA, Hameed B, Mapari UU. Stroke in Pakistan. J Pak Med Assoc. 2008;58(7):400-403. https://jpma.org.pk/article-details/1444?article_id=1444
6. Nirmala AC, Hrishikesh S. A cross sectional study of lipid profile in stroke patients. Int J Adv Med. 2020; 7(4):687-693. DOI: http://dx.doi.org/10.18203/2349-3933.ijam20201124
7. Mahmood A, Sharif MA, Khan MN, Ali UZ. Comparison of serum lipid profile in ischaemic and haemorrhagic stroke. J Coll Physicians Surg Pak. 2010;20(5):317-320. https://www.jcpsp.pk/archive/2010/May2010/08.pdf
8. Demchuk AM, Hess DC, Brass LM, Yatsu FM. Is cholesterol a risk factor for stroke?: Yes. Arch Neurol. 1999;56(12):1518-1524. doi:10.1001/archneur.56.12.1518
9. Dayton S, Chapman JM, Pearce ML, Popják GJ. Cholesterol, atherosclerosis, ischemic heart disease, and stroke. Ann Intern Med. 1970;72(1):97-109. doi:10.7326/0003-4819-72-1-97
10. Khan NI, Naz L, Mushtaq S, Rukh L, Ali S, Hussain Z. Ischemic stroke: prevalence of modifiable risk factors in male and female patients in Pakistan. Pak J Pharm Sci. 2009;22(1):62-67. http://www.pjps.pk/wp-content/uploads/pdfs/CD-PJPS-22-1-09/Paper-12.pdf
11. Benfante R, Yano K, Hwang LJ, Curb JD, Kagan A, Ross W. Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk. Stroke. 1994; 25(4):814-820. doi:10.1161/01.str.25.4.814
12. Shahar E, Chambless LE, Rosamond WD, et al. Plasma lipid profile and incident ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) study. Stroke. 2003;34(3):623-631. doi:10.1161/01.STR.0000057812.51734.FF
13. Bowman TS, Sesso HD, Ma J, et al. Cholesterol and the risk of ischemic stroke. Stroke. 2003;34(12):2930-2934. doi:10.1161/01.STR.0000102171.91292.DC



14. Khealani BA, Khan M, Tariq M, et al. Ischemic strokes in Pakistan: observations from the national acute ischemic stroke database. J Stroke Cerebrovasc Dis. 2014;23(6):1640-1647. doi:10.1016/j.jstrokecerebrovasdis.2014.01.009
15. Xu T, Zhang JT, Yang M, et al. Dyslipidemia and outcome in patients with acute ischemic stroke. Biomed Environ Sci. 2014; 27(2):106-110. doi:10.3967/bes2014.023
16. Mi T, Sun S, Zhang G, et al. Relationship between dyslipidemia and carotid plaques in a high-stroke-risk population in Shandong Province, China. Brain Behav. 2016; 6(6):e00473. Published 2016 Apr 22. doi:10.1002/brb3.473
17. Murphy SJ, McCullough LD, Smith JM. Stroke in the female: role of biological sex and estrogen. ILAR J. 2004; 45(2):147-159. doi:10.1093/ilar.45.2.147
18. Yahya S, Rehan N. Age, pattern and symptoms of menopause among rural women of Lahore. J Ayub Med Coll Abbottabad. 2002; 14(3):9-12. http://www.ayubmed.edu.pk/jamc/index.php/jamc/article/view/3888
19. Sim JH, Hwang S, Song CS. Hyperlipidemia as a predictor of physical functioning for stroke. Physical Therapy Rehabilitation Science. 2018; 7(2):88-93. https://doi.org/10.14474/ptrs.2018.7.2.88
20. Ni WQ, Liu XL, Zhuo ZP, et al. Serum lipids and associated factors of dyslipidemia in the adult population in Shenzhen. Lipids Health Dis. 2015; 14:71. doi:10.1186/s12944-015-0073-7
21. Opoku S, Gan Y, Fu W, et al. Prevalence and risk factors for dyslipidemia among adults in rural and urban China: findings from the China National Stroke Screening and prevention project (CNSSPP). BMC Public Health. 2019;19(1):1500. doi:10.1186/s12889-019-7827-5
22. Parini P, Angelin B, Rudling M. Cholesterol and lipoprotein metabolism in aging: reversal of hypercholesterolemia by growth hormone treatment in old rats. Arterioscler Thromb Vasc Biol. 1999; 19(4):832-839. doi:10.1161/01.atv.19.4.832
23. Nemes K, Åberg F, Gylling H, Isoniemi H. Cholesterol metabolism in cholestatic liver disease and liver transplantation: From molecular mechanisms to clinical implications. World J Hepatol. 2016;8(22):924-932. doi:10.4254/wjh.v8.i22.924
24. Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci. 2016;351(4):380-386. doi:10.1016/j.amjms.2016.01.011
25. Chen GY, Li L, Dai F, Li XJ, Xu XX, Fan JG. Prevalence of and Risk Factors for Type 2 Diabetes Mellitus in Hyperlipidemia in China. Med Sci Monit. 2015;21:2476-2484. Published 2015 Aug 22. doi:10.12659/MSM.894246
26. Dalal JJ, Padmanabhan TN, Jain P, Patil S, Vasnawala H, Gulati A. LIPITENSION: Interplay between dyslipidemia and hypertension. Indian J Endocrinol Metab. 2012;16(2):240-245. doi:10.4103/2230-8210.93742
27. Dubow J, Fink ME. Impact of hypertension on stroke. Curr Atheroscler Rep. 2011;13(4):298-305. doi:10.1007/s11883-011-0187-y
28. Flueckiger P, Longstreth W, Herrington D, Yeboah J. Revised Framingham Stroke Risk Score, Nontraditional Risk Markers, and Incident Stroke in a Multiethnic Cohort. Stroke. 2018;49(2):363-369. doi:10.1161/STROKEAHA.117.018928
29. Wolf PA, D'Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991;22(3):312-318. doi:10.1161/01.str.22.3.312
30. Turin TC, Okamura T, Afzal AR, et al. Hypertension and lifetime risk of stroke. J Hypertens. 2016;34(1):116-122. doi:10.1097/HJH.0000000000000753
31. Otsuka T, Takada H, Nishiyama Y, et al. Dyslipidemia and the Risk of Developing Hypertension in a Working-Age Male Population. J Am Heart Assoc. 2016;5(3):e003053. Published 2016 Mar 25. doi:10.1161/JAHA.115.003053
32. Basit A, Tanveer S, Fawwad A, Naeem N; NDSP Members. Prevalence and contributing risk factors for hypertension in urban and rural areas of Pakistan; a study from second National Diabetes Survey of Pakistan (NDSP) 2016-2017. Clin Exp Hypertens. 2020; 42(3):218-224. doi:10.1080/10641963.2019.1619753
33. Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin. 2008;26(4):871-vii. doi:10.1016/j.ncl.2008.07.003

Figure Legends:
1) Distribution of ischemic stroke subjects based on pattern of deranged lipid profile
2) Distribution of subjects (diabetics and non-diabetics) based on lipid profile
3) Distribution of subjects (hypertensive and non-hypertensive) based on lipid profile