Small dense low-density lipoprotein cholesterol is strongly associated with NIHSS score and intracranial arterial calcification in acute ischemic stroke subjects

Tao Yao,Yanbin Ding,Gang Li,Zhichao Liu,Qi Long,Qin Cui,Jing Li

doi:10.1038/s41598-020-64715-9

Abstract

Intracranial artery calcification (IAC) is an important risk factor for cerebral infarction and a key biomarker for intracranial artery stenosis. Small dense low-density lipoprotein cholesterol (sd-LDL-c) was independently associated with increased cardiovascular events and coronary calcification. Our study assessed whether sd-LDL-c is an independent factor for IAC in acute ischemic stroke (AIS) patients. This cross-sectional study involved a total of 754 patients with AIS (mean age: 65 ± 13.2 years). All the patients had received brain computed tomography angiography (CTA) examination to evaluate IAC. Serum sd-LDL-c levels and other biochemical parameters were analyzed. Admission NIHSS score and mRS score at discharge were collected. After 60-days 85 patients died during hospitalization and follow-up. Partial correlation analysis showed that serum sd-LDL-c levels were associated with admission NIHSS score and IAC score after adjusted age and gender. Logistic regression analysis showed that serum sd-LDL-c levels independently predicted NIHSS scores (β = 1.537, 95%CI: 0.134-2.878, p = 0.042) and IAC scores (β = 1.355, 95%CI: 0.319-2.446, p = 0.015). The average level of sd-LDL-c in patients who died was also significantly increased compared to survival patients (1.04 ± 0.59 vs 0.88 ± 0.44 mmol/L, p = 0.017). However, multivariate logistic regression analysis showed serum sd-LDL-c levels could not predict all-cause mortality and prognosis in AIS patients. Our study found that sd-LDL-c as a strong atherogenic lipid particle can independently predict admission NIHSS scores and the severity of cerebral artery calcification in AIS patients. However, its prognostic value in AIS patients still needs further study in the future.

Highlights

Zeljkovic et al showed that increased sd-low-density lipoprotein cholesterol (LDL-c) level was related to increased morbidity and mortality in AIS12
After adjusting for age and sex, partial correlation analysis showed that sd-LDL-c was correlated with Intracranial artery calcification (IAC) score (r = 0.131, P = 0.006) and admission National Institutes of Health Stroke Scale (NIHSS) score (r = 0.316, P < 0.001, Fig. 1)
Univariate linear logistic regression analysis showed that the level of sd-LDL-c predicted admission NIHSS score (β = 2.248, 95%CI: 1.136-3.519, p < 0.001)and IAC score (β = 1.209, 95%CI: 0.498-1.766, p < 0.001)

Summary

Materials and Methods

This cross-sectional study was performed at the Department of Neurology of the Renmin Hospital, Wuhan University in China. According to AHA/ASA stroke guidelines[14, 913] patients with initial diagnosis of AIS were admitted to the Wuhan University affiliated Renmin Hospital. These patients were enrolled in the study: 18-85 years old, duration of onset of symptoms to hospital less than 48 hours, patients or their guardians signed the informed consent. To assess the association between serum sd-LDL-c and severe IAC, binary logistic regression analysis was used. Www.nature.com/scientificreports sd-LDL-C Age(years) BMI(kg/m2) Smoking,n(%) Drinking, n(%) HT,n(%) DM, n(%) CHD, n(%) Hyperlipidemia,n(%) AF, n(%) SBP,mmHg DBP, mmHg Cr (umol/L) UA (umol/L) TC (mmol/L) TG (mmol/L) HDL-C (mmol/L) LDL-C (mmol/L) ApoA1 (g/L) ApoB (g/L) TC/HDL TG/HDL ApoB/ ApoA1 HbA1c (%) D-dimer (mg/L) Hcys (umol/L) IAC score Death,n (%) NIHSS score mRS score Severe IAC, n (%)

Result

Discussion

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Conclusion