Fasting versus post-challenge triglycerides and pre-existing cavitating lacunes: a Berlin “Cream &amp; Sugar” substudy

Christopher Leonards

doi:10.3389/fneur.2013.00092

Abstract

Background and Purpose: Although the presence of cavitating lacunes on brain imaging may have prognostic implications, the modifiable risk factors underlying these frequently observed lesions are not completely understood. We sought to determine if fasting and post-challenge triglycerides associate with cavitating lacunes.Methods: All first ischemic stroke patients who completed a novel combined oral triglyceride and glucose tolerance test and MRI between January 2009 and June 2012 were included. Fluid-attenuated inversion recovery or T2 MRI sequences were used to visualize cavitating lacunes and white matter hyperintensities, which were graded using the Wahlund visual scale.Results: One hundred and ninety patients were included (median age 66, IQR 52–73; 33% female; median National Institute of Health Stroke Scale 2, IQR 1–4). A forward stepwise binary logistical regression analysis applying the Hosmer–Lemeshow goodness of fit test adjusted for parameters significant in univariate analyses (at the p < 0.10 level) revealed that Wahlund scores (Wahlund 0–4: reference; Wahlund 5–10: adjusted odds ratio, 5.1; 95% confidence interval, 1.3–20.0, p = 0.019; Wahlund>10: adjusted odds ratio 9.6; 95% CI, 1.55–59.35; p = 0.015) and the highest quartile of post-challenge triglycerides (>295 mg/dL; adjusted odds ratio, 7.36; 95% confidence interval 1.24–43.70; p = 0.028) independently associated with the presence of cavitating lacunes.Conclusion: Post-challenge serum triglycerides are independently associated with the presence of cavitating lacunes.

Highlights

IntroductionCavitating lacunes (small, deep 3–20 mm cerebrospinal fluid containing “holes”) [1] often appear “silently” (without stroke-like symptoms) on brain imaging [2], their presence is thought to more than double the risk of stroke and dementia [3]
Cavitating lacunes [1] often appear “silently” on brain imaging [2], their presence is thought to more than double the risk of stroke and dementia [3]
A forward stepwise binary logistical regression analysis applying the Hosmer–Lemeshow goodness of fit test adjusted for parameters significant in univariate analyses revealed that Wahlund scores (Wahlund 0–4: reference; Wahlund 5–10: adjusted odds ratio, 5.1; 95% confidence interval, 1.3–20.0, p = 0.019; Wahlund >10: adjusted odds ratio 9.6; 95% CI, 1.55–59.35; p = 0.015) and the highest quartile of post-challenge triglycerides (>295 mg/dL; adjusted odds ratio, 7.36; 95% confidence interval 1.24–43.70; p = 0.028) independently associated with the presence of cavitating lacunes

Summary

Introduction

Cavitating lacunes (small, deep 3–20 mm cerebrospinal fluid containing “holes”) [1] often appear “silently” (without stroke-like symptoms) on brain imaging [2], their presence is thought to more than double the risk of stroke and dementia [3]. Histopathology studies have identified fat-laden macrophages surrounding the small vessels in areas of cavitating lacunes [5] similar to that of the lipid-laden monocytes observed in the “fatty streak” of muscular arteries affected by atherosclerosis [6]. Studies have determined that vessels supplying cavitating lacunes are frequently affected by “lipohyalinosis” (fatty hyaline build-up within the vessel wall), a specific subgroup of the broader “small vessel disease” term [8]. The presence of cavitating lacunes on brain imaging may have prognostic implications, the modifiable risk factors underlying these frequently observed lesions are not completely understood. We sought to determine if fasting and post-challenge triglycerides associate with cavitating lacunes

Methods

Results

Conclusion