Abstract
Objective To investigate the relationship between the decrease of plasma oxidized low-density lipoprotein (oxLDL) levels and clinical outcomes in patients with acute atherosclerosis-related ischemic stroke. Methods We recruited acute ischemic stroke patients within 3 days of onset consecutively. Plasma oxLDL levels were measured on the second day after admission and before discharge (10-14 days after stroke onset). Initial stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) scores, and infarct volume was measured using diffusion-weighted imaging (DWI) by the ITK-SNAP software. Clinical outcomes were evaluated by DWI volumes in the acute phase, neurological improvement at discharge, and favorable functional prognosis at 90 days. Logistic regression was performed to evaluate the association between oxLDL level decrease and clinical outcomes. Results 207 patients were enrolled in this study. Compared with the mild decrease of the oxLDL level group, patients with a significant decrease of the oxLDL level group were more likely to have a higher ratio of neurological improvement at discharge (55.07% vs. 14.49%, p < 0.01) and favorable functional prognosis at 90 days (91.30% vs. 55.07%, p < 0.01). In multivariable logistic regression, the degree of oxLDL level decrease was related to neurological improvement at discharge and favorable functional prognosis at 90 days (p < 0.01). Patients with significant decrease were more likely to have neurological improvement at discharge (OR = 7.92, 95% CI, 3.14-19.98, and p < 0.01) and favorable functional prognosis at 90 days (OR = 7.46, 95% CI, 2.40-23.23, and p < 0.01) compared to patients with mild decrease of oxLDL level. The DWI volumes in patients with different oxLDL level decrease groups had no statistical difference (p = 0.41), and the Spearman's rho between oxLDL level decrease and DWI infarct volumes was -0.03, but no statistical difference (p = 0.72). Conclusions The degree of oxLDL level decrease is related to neurological improvement at discharge and favorable functional prognosis at 90 days for patients with acute atherosclerosis-related ischemic stroke, but not with infarct volume in the acute phase.
Highlights
Atherosclerosis is the most common pathological mechanism of stroke [1,2,3]
Previous studies just focused on Oxidized low-density lipoprotein (oxLDL) at the acute stage of stroke [12, 13, 15], and only limited research has been conducted on the relationship between the decrease of oxLDL level and the prognosis of stroke, especially infarct volume
As the pathophysiological mechanisms of coronary and cerebrovascular atherosclerosis are considered similar, in the cerebrovascular field, recent studies have shown that oxLDL level in the acute phase was related to poor functional outcome after stroke [4, 12] and can predict recurrent stroke in patients with minor stroke or transient ischemic attack independently
Summary
Atherosclerosis is the most common pathological mechanism of stroke [1,2,3]. Oxidized low-density lipoprotein (oxLDL) is the major product of lipid oxidative stress, with proinflammatory properties, that has been identified to mediate vascular endothelial cell dysfunction, activate platelet, and accelerate foam cell formation, resulting in the development of vulnerable atherosclerotic plaques eventually [2,3,4,5,6,7]. Previous studies just focused on oxLDL at the acute stage of stroke [12, 13, 15], and only limited research has been conducted on the relationship between the decrease of oxLDL level and the prognosis of stroke, especially infarct volume. For this purpose, we analyzed acute infarct volumes using diffusion-weighted imaging (DWI) by the ITK-SNAP software and measured oxLDL level at different stages, to investigate the relationship between its level change with the infarct volume and the prognosis of stroke in patients with acute atherosclerosis-related ischemic stroke
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