Triglycerides best lipid risk marker for ischemic stroke
MedWire News: Nonfasting triglyceride levels are strongly associated with risk for ischemic stroke, whereas total cholesterol levels are not, shows an analysis of the Copenhagen City Heart Study.
Marianne Benn (Copenhagen University Hospital, Denmark) and colleagues say this is most likely because high triglyceride levels reflect elevated lipoprotein remnant cholesterol, and thus a particularly atherogenic lipid profile.
"Our findings suggest that levels of nonfasting triglycerides should be included in guidelines as a marker of elevated levels of remnant lipoprotein cholesterol," they write in the Annals of Neurology.
During up to 33 years of follow-up, 837 of 7579 women and 837 of 6372 men from the Copenhagen City Heart Study developed an ischemic stroke.
Ischemic stroke risk rose with increasing baseline triglyceride levels in both women and men. Compared with those who had baseline levels lower than 1.0 mmol/l (88.6 mg/dl), women and men with triglyceride levels of 5.0 mmol/l (443.0 mg/dl) or higher had respective 3.9- and 2.3-fold increases in stroke risk.
In contrast, increasing baseline levels of total cholesterol did not significantly predict stroke risk in women, and only very high levels raised stroke risk among men (a 4.4-fold increase for men with levels of ≥9.0 versus <5.0 mmol/l [348.3 vs 193.5 mg/dl]).
Each 1.0-mmol/l (88.6 mg/dl) rise in triglycerides was associated with a 28% increase in ischemic stroke risk in women and a 12% increase in men.
The study participants had a second set of lipid measurements taken about 15 years after baseline. On analyzing these, the team found that levels of triglycerides and cholesterol within individuals tracked each other over time, meaning that the disparate effects of the lipid measures on stroke risk could not be explained by, for example, larger increases in triglycerides than cholesterol during follow-up.
The researchers highlight that their findings are based on nonfasting triglyceride levels.
"Most people are in the nonfasting state during most of the day because fasting implies not eating for at least 8 hours," they say.
"For most people this is only the case early in the morning before breakfast. Therefore, measuring triglyceride levels in the fasting state may overlook a large group of individuals with increased nonfasting levels for whom lipid-lowering treatment could be beneficial."
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By Eleanor McDermid