Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE)
Issued Date
2022-06-01
Resource Type
ISSN
22876391
eISSN
22876405
Scopus ID
2-s2.0-85131863063
Journal Title
Journal of Stroke
Volume
24
Issue
2
Start Page
224
End Page
235
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Stroke Vol.24 No.2 (2022) , 224-235
Suggested Citation
O’donnell M.J., McQueen M., Sniderman A., Pare G., Wang X., Hankey G.J., Rangarajan S., Chin S.L., Rao-Melacini P., Ferguson J., Xavier D., Lisheng L., Zhang H., Pais P., Lopez-Jaramillo P., Damasceno A., Langhorne P., Rosengren A., Dans A.L., Elsayed A., Avezum A., Mondo C., Judge C., Diener H.C., Ryglewicz D., Czlonkowska A., Pogosova N., Weimar C., Iqbal R., Diaz R., Yusoff K., Yusufali A., Oguz A., Penaherrera E., Lanas F., Ogah O.S., Ogunniyi A., Iversen H.K., Malaga G., Rumboldt Z., Oveisgharan S., Hussain F.A., Nilanont Y., Yusuf S. Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE). Journal of Stroke Vol.24 No.2 (2022) , 224-235. 235. doi:10.5853/jos.2021.02152 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/87296
Title
Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE)
Author(s)
O’donnell M.J.
McQueen M.
Sniderman A.
Pare G.
Wang X.
Hankey G.J.
Rangarajan S.
Chin S.L.
Rao-Melacini P.
Ferguson J.
Xavier D.
Lisheng L.
Zhang H.
Pais P.
Lopez-Jaramillo P.
Damasceno A.
Langhorne P.
Rosengren A.
Dans A.L.
Elsayed A.
Avezum A.
Mondo C.
Judge C.
Diener H.C.
Ryglewicz D.
Czlonkowska A.
Pogosova N.
Weimar C.
Iqbal R.
Diaz R.
Yusoff K.
Yusufali A.
Oguz A.
Penaherrera E.
Lanas F.
Ogah O.S.
Ogunniyi A.
Iversen H.K.
Malaga G.
Rumboldt Z.
Oveisgharan S.
Hussain F.A.
Nilanont Y.
Yusuf S.
McQueen M.
Sniderman A.
Pare G.
Wang X.
Hankey G.J.
Rangarajan S.
Chin S.L.
Rao-Melacini P.
Ferguson J.
Xavier D.
Lisheng L.
Zhang H.
Pais P.
Lopez-Jaramillo P.
Damasceno A.
Langhorne P.
Rosengren A.
Dans A.L.
Elsayed A.
Avezum A.
Mondo C.
Judge C.
Diener H.C.
Ryglewicz D.
Czlonkowska A.
Pogosova N.
Weimar C.
Iqbal R.
Diaz R.
Yusoff K.
Yusufali A.
Oguz A.
Penaherrera E.
Lanas F.
Ogah O.S.
Ogunniyi A.
Iversen H.K.
Malaga G.
Rumboldt Z.
Oveisgharan S.
Hussain F.A.
Nilanont Y.
Yusuf S.
Author's Affiliation
Siriraj Hospital
Dubai Health Authority
Fundación Oftalmológica de Santander
National Medical Research Center for Therapy and Preventive Medicine
Istanbul Medeniyet University
UCSI University
Estudios Clínicos Latinoamérica, Argentina
University of Western Australia, School of Medicine and Pharmacology
Military Institute of Aviation Medicine
School of Medicine, University of Split
Universidad de la Frontera, Facultad de Medicina
Universidade Eduardo Mondlane
Institute of Psychiatry and Neurology, Warszawa
Hospital Luis Vernaza
University of the Philippines College of Medicine
Universidad Peruana Cayetano Heredia
The Aga Khan University Hospital
Sahlgrenska Universitetssjukhuset
Københavns Universitet
Hospital Alemao Oswaldo Cruz
University College Hospital, Ibadan
Universität Duisburg-Essen
King Saud University
Rush Alzheimer’s Disease Center
University of Galway
Hamilton Health Sciences
Centre Universitaire de Santé McGill
St. John's Medical College
University of Glasgow
Kiruddu National Referral Hospital
National Center for Cardiovascular Diseases
Alshaab Teaching Hospital
Beijing Hypertension League Institute
Dubai Health Authority
Fundación Oftalmológica de Santander
National Medical Research Center for Therapy and Preventive Medicine
Istanbul Medeniyet University
UCSI University
Estudios Clínicos Latinoamérica, Argentina
University of Western Australia, School of Medicine and Pharmacology
Military Institute of Aviation Medicine
School of Medicine, University of Split
Universidad de la Frontera, Facultad de Medicina
Universidade Eduardo Mondlane
Institute of Psychiatry and Neurology, Warszawa
Hospital Luis Vernaza
University of the Philippines College of Medicine
Universidad Peruana Cayetano Heredia
The Aga Khan University Hospital
Sahlgrenska Universitetssjukhuset
Københavns Universitet
Hospital Alemao Oswaldo Cruz
University College Hospital, Ibadan
Universität Duisburg-Essen
King Saud University
Rush Alzheimer’s Disease Center
University of Galway
Hamilton Health Sciences
Centre Universitaire de Santé McGill
St. John's Medical College
University of Glasgow
Kiruddu National Referral Hospital
National Center for Cardiovascular Diseases
Alshaab Teaching Hospital
Beijing Hypertension League Institute
Other Contributor(s)
Abstract
Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.