Original Article| Volume 24, ISSUE 8, P1873-1878, August 2015

Association between Hypertriglyceridemia and Lacunar Infarction in Type 2 Diabetes Mellitus


      Although recent studies have shown that the elevation of serum triglyceride (TG) is related to the increased incidence of ischemic stroke, the relationship between hypertriglyceridemia and subtypes of ischemic stroke is largely unknown. This study attempted to evaluate whether hypertriglyceridemia is associated with lacunar stroke in diabetes mellitus (DM).


      A total of 2141 consecutive patients with acute ischemic stroke were enrolled from March 2005 to April 2014, excluding the subjects with undetermined/other determined etiology or no lipid data. We compared the lipid profiles among stroke subtypes. The estimated serum TG levels and the interaction between DM and stroke subtypes were determined by analysis of covariance (ANCOVA) and Tukey's multiple comparison.


      In ANCOVA test, the difference of estimated TG between DM and non-DM patients was largest in small-vessel occlusion (SVO; 159.7 [95% confidence interval {CI}, 143.2-176.2] versus 122.4 [95% CI, 106.1-138.7]), and a significant interaction was observed between DM and stroke subtypes for TG levels (P = .013) but not for total cholesterol (P = .363), low-density lipoprotein cholesterol (P = .171), or high-density lipoprotein cholesterol (P = .231). By Tukey's multiple comparison, SVO was consistently associated with DM for serum TG levels (P < .001).


      In acute ischemic stroke with DM, serum TG level was significantly associated with lacunar infarction adjusting for other lipid profiles and vascular risk factors. Further studies are warranted to reveal the pathophysiologic implication of hypertriglyceridemia for lacunar infarction in type 2 DM.

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        • Adams R.J.
        • Carroll R.M.
        • Nichols F.T.
        • et al.
        Plasma lipoproteins in cortical versus lacunar infarction.
        Stroke. 1989; 20: 448-452
        • Dziedzic T.
        • Slowik A.
        • Gryz E.A.
        • Szczudlik A.
        Lower serum triglyceride level is associated with increased stroke severity.
        Stroke. 2004; 35: e151-e152
        • Pikija S.
        • Milevčić D.
        • Trkulja V.
        • et al.
        Higher serum triglyceride level in patients with acute ischemic stroke is associated with lower infarct volume on CT brain scans.
        Eur Neurol. 2006; 55: 89-92
        • Sacco R.L.
        • Adams R.
        • Albers G.
        • et al.
        Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.
        Circulation. 2006; 113: e409-e449
        • Sacks F.M.
        • Hermans M.P.
        • Fioretto P.
        • et al.
        Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case-control study in 13 countries.
        Circulation. 2014; 129: 999-1008
        • Zoppini G.
        • Negri C.
        • Stoico V.
        • et al.
        Triglyceride-high-density lipoprotein cholesterol is associated with microvascular complications in type 2 diabetes mellitus.
        Metabolism. 2012; 61: 22-29
        • Caplan L.R.
        Lacunar infarction and small vessel disease: pathology and pathophysiology.
        J Stroke. 2015; 17: 2-6
        • Palacio S.
        • McClure L.A.
        • Benavente O.R.
        • et al.
        Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study.
        Stroke. 2014; 45: 2689-2694
        • Hong K.S.
        • Bang O.Y.
        • Kang D.W.
        • et al.
        Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean Stroke Society and clinical research center for stroke.
        J Stroke. 2013; 15: 2-20
        • Seo J.Y.
        • Lee K.B.
        • Lee J.G.
        • et al.
        Implication of left ventricular diastolic dysfunction in cryptogenic ischemic stroke.
        Stroke. 2014; 45: 2757-2761
        • Ko Y.
        • Lee S.
        • Chung J.W.
        • et al.
        MRI-based algorithm for acute ischemic stroke subtype classification.
        J Stroke. 2014; 16: 161-172
        • Collaborators NASCET
        Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
        N Engl J Med. 1991; 325: 445
        • Group W-ASIDS
        Prognosis of patients with symptomatic vertebral or basilar artery stenosis.
        Stroke. 1998; 29: 1389-1392
        • Adams H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.
        Stroke. 1993; 24: 35-41
        • Amarenco P.
        • Labreuche J.
        • Elbaz A.
        • et al.
        Blood lipids in brain infarction subtypes.
        Cerebrovasc Dis. 2006; 22: 101-108
        • Benfante R.
        • Yano K.
        • Hwang L.-J.
        • et al.
        Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk.
        Stroke. 1994; 25: 814-820
        • Hachinski V.
        • Graffagnino C.
        • Beaudry M.
        • et al.
        Lipids and stroke: a paradox resolved.
        Arch Neurol. 1996; 53: 303
        • Schulz U.
        • Rothwell P.
        Differences in vascular risk factors between etiological subtypes of ischemic stroke importance of population-based studies.
        Stroke. 2003; 34: 2050-2059
        • Laloux P.
        • Galanti L.
        • Jamart J.
        Lipids in ischemic stroke subtypes.
        Acta Neurol Belg. 2004; 104: 13-19
        • Willey J.Z.
        • Xu Q.
        • Boden-Albala B.
        • et al.
        Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS).
        Arch Neurol. 2009; 66: 1400-1406
        • Tirschwell D.
        • Smith N.
        • Heckbert S.
        • et al.
        Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups.
        Neurology. 2004; 63: 1868-1875
        • Giroud M.
        • Boutron M.
        • Gras P.
        • et al.
        Plasma lipoproteins in cortical versus lacunar infarction with or without cardiac arrhythmia, and in transient ischaemic attacks: a case control study.
        Neurol Res. 1992; 14: 315-320
        • Boutron M.
        • Giroud M.
        • Gras P.
        • et al.
        Plasma lipoproteins in cortical infarction versus transient ischaemic attacks: a case control study.
        J Neurol. 1993; 240: 133-138
        • Unit E.S.
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins.
        Lancet. 2005; 366: 1267-1278
        • Briel M.
        • Studer M.
        • Glass T.R.
        • et al.
        Effects of statins on stroke prevention in patients with and without coronary heart disease: a meta-analysis of randomized controlled trials.
        Am J Med. 2004; 117: 596-606
        • Elkind M.S.
        • Flint A.C.
        • Sciacca R.R.
        • et al.
        Lipid-lowering agent use at ischemic stroke onset is associated with decreased mortality.
        Neurology. 2005; 65: 253-258
        • Lindenstrom E.
        • Boysen G.
        • Nyboe J.
        Influence of total cholesterol, high density lipoprotein cholesterol, and triglycerides on risk of cerebrovascular disease: the Copenhagen City Heart Study.
        BMJ. 1994; 309: 11-15
        • Koren-Morag N.
        • Tanne D.
        • Graff E.
        • et al.
        Low-and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: the bezafibrate infarction prevention registry.
        Arch Intern Med. 2002; 162: 993-999
        • Sacco R.L.
        • Benson R.T.
        • Kargman D.E.
        • et al.
        High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study.
        JAMA. 2001; 285: 2729-2735
        • Tanne D.
        • Yaari S.
        • Goldbourt U.
        High-density lipoprotein cholesterol and risk of ischemic stroke mortality. A 21-year follow-up of 8586 men from the Israeli Ischemic Heart Disease Study.
        Stroke. 1997; 28: 83-87
        • Wannamethee S.G.
        • Shaper A.G.
        • Ebrahim S.
        HDL-cholesterol, total cholesterol, and the risk of stroke in middle-aged British men.
        Stroke. 2000; 31: 1882-1888
        • Schilling S.
        • Tzourio C.
        • Dufouil C.
        • et al.
        Plasma lipids and cerebral small vessel disease.
        Neurology. 2014; 83: 1844-1852
        • Wu M.
        • Chen Y.
        • Wilson K.
        • et al.
        Intraretinal leakage and oxidation of LDL in diabetic retinopathy.
        Invest Ophthalmol Vis Sci. 2008; 49: 2679-2685
        • Rossing P.
        Prediction, progression and prevention of diabetic nephropathy. The Minkowski Lecture 2005.
        Diabetologia. 2006; 49: 11-19
        • Mohamed Q.
        • Gillies M.C.
        • Wong T.Y.
        Management of diabetic retinopathy: a systematic review.
        ∖. 2007; 298: 902-916