Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-06-01 Epub Date: 2024-01-26 DOI:10.1177/23969873231221619

Lilian Kriemler, Salome Rudin, Joanna Gawinecka, Felix Gross, Markus Arnold, Juliane Schweizer, Laura Westphal, Corinne Inauen, Thomas Pokorny, Tolga Dittrich, Anna Toebak, Marcel Arnold, Mirjam Christ-Crain, Arnold von Eckardstein, Katharina Rentsch, Mira Katan, Gian Marco De Marchis

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Abstract

Background and aims: Low density lipoprotein (LDL-C) and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). The correlation between LDL-C and apoB is usually thight, but in some cases LDL-C underestimates apoB levels and residual cardiovascular risk. We aimed to assess if a discordance of LDL-C-levels with apoB levels is associated with LAA stroke.

Methods: We included patients with an acute ischemic stroke from two prospective studies enrolled at the University Hospital Bern, Basel and Zurich, Switzerland. LDL-C and apoB were measured within 24 h of symptom onset. By linear regression, for each LDL-C, we computed the expected apoB level assuming a perfect correlation. Higher-than-expected apoB was defined as apoB level being in the upper residual tertile.

Results: Overall, we included 1783 patients, of which 260 had a LAA stroke (15%). In the overall cohort, higher-than-expected apoB values were not associated with LAA. However, a significant interaction with age was present. Among the 738 patients ⩽70 years of age, a higher-than-expected apoB was more frequent in patients with LAA- versus non LAA-stroke (48% vs 36%, p = 0.02). In multivariate analysis, a higher-than-expected apoB was associated with LAA stroke (aOR = aOR 2.48, 95%CI 1.14-5.38). Among those aged ⩽70 years and with LAA, 11.7% had higher than guideline-recommended apoB despite LDL-C ⩽ 1.8 mmol/L (<70 mg/dl), compared to 5.9% among patients with other stroke etiologies (p = 0.04). A triglyceride cut-off of ⩾0.95 mmol/L had, in external validation, a sensitivity of 71% and specificity of 52% for apoB ⩾ 0.65 g/L among patients with LDL-C <1.8 mmol/L.

Conclusions: Among patients aged ⩽70 years, a higher-than-expected apoB was independently associated with LAA stroke. Measuring apoB may help identify younger stroke patients potentially benefiting from intensified lipid-lowering therapy.

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低密度脂蛋白胆固醇与载脂蛋白 B 的不一致与 70 岁以上患者的大动脉动脉粥样硬化缺血性中风有关。

背景和目的：低密度脂蛋白（LDL-C）和其他致动脉粥样硬化脂蛋白由载脂蛋白 B100（apoB）包被。低密度脂蛋白胆固醇（LDL-C）和载脂蛋白 B 之间的相关性通常很高，但在某些情况下，低密度脂蛋白胆固醇（LDL-C）会低估载脂蛋白 B 水平和残余心血管风险。我们的目的是评估 LDL-C 水平与载脂蛋白 B 水平不一致是否与 LAA 中风有关：我们纳入了瑞士巴塞尔和苏黎世伯尔尼大学医院两项前瞻性研究中的急性缺血性中风患者。低密度脂蛋白胆固醇（LDL-C）和载脂蛋白胆固醇（apoB）是在症状出现后 24 小时内测定的。通过线性回归，我们计算出了每个 LDL-C 的预期载脂蛋白 B 水平，并假设两者之间存在完美的相关性。结果：我们共纳入了 1783 例患者，其中 260 例为 LAA 中风（15%）。在整个队列中，载脂蛋白B值高于预期与LAA无关。但是，与年龄存在明显的交互作用。在 738 名年龄在 70 岁以下的患者中，LAA 患者的载脂蛋白B高于预期值的比例高于非 LAA 患者（48% vs 36%，P = 0.02）。在多变量分析中，载脂蛋白 B 高于预期与 LAA 中风相关（aOR = aOR 2.48，95%CI 1.14-5.38）。在年龄⩽70 岁的 LAA 患者中，尽管 LDL-C ⩽ 1.8 mmol/L，但 11.7% 的患者的载脂蛋白高于指南推荐值（p = 0.04）。在外部验证中，甘油三酯临界值⩾0.95 mmol/L对低密度脂蛋白胆固醇患者中载脂蛋白B ⩾ 0.65 g/L的敏感性为71%，特异性为52%：在年龄 ⩽70 岁的患者中，载脂蛋白B 高于预期与 LAA 中风有独立关联。测量载脂蛋白B有助于识别可能受益于强化降脂治疗的年轻卒中患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.