Highlights
- •Recurrent infarcts on brain magnetic resonance imaging are common 6-8 weeks after index presentation in patients with symptomatic intracranial stenosis despite relatively high adherence to aggressive medical management.
- •Low-density lipoprotein and triglyceride levels at time of index stroke or transient ischemic attack predict recurrent infarcts independent of other clinical and imaging factors.
- •More aggressive and rapid reduction of lipid levels may be required to reduce the burden of early clinical and subclinical recurrence in patients with symptomatic intracranial stenosis.
Abstract
Objectives
Hyperlipidemia is a strong risk factor for intracranial atherosclerotic disease (ICAD)
and clinical stroke recurrence. We explored the effect of serum lipid levels on subclinical
infarct recurrence in the Mechanisms of earlY Recurrence in Intracranial Atherosclerotic
Disease (MYRIAD) study.
Materials and Methods
We included enrolled MYRIAD patients with lipid measurements and brain MRI at baseline
and brain MRI at 6-8 weeks. Infarct recurrence was defined as new infarcts in the
territory of the symptomatic artery on brain MRI at 6-8 weeks compared to baseline
brain MRI. We assessed the association between baseline total cholesterol (TC), low-density
lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and
triglyceride (TG) levels and recurrent infarct at 6-8 weeks using multivariable logistic
regression.
Results
Among 74 patients (mean age 64.2±12.9 years, 59.5% were white, 60.8% men), 20 (27.0%)
had new or recurrent infarcts. Mean HDL-C (37.2 vs. 43.9 mg/dL, P=0.037) was lower and TG (113.5 vs. 91.3 mg/dL, P=0.008) was higher while TC (199.8
vs. 174.3 mg/dL, P=0.061) and LDL-C (124.3 vs. 101.2 mg/dL, P=0.053) were nominally higher among those with recurrent infarcts than those without.
LDL-C (adj. OR 1.022, 95% CI 1.004-1.040, P=0.015) and TG (adj. OR 1.009, 95% CI 1.001-1.016, P=0.021) were predictors of recurrent infarct at 6-8 weeks adjusting for other clinical
and imaging factors.
Conclusions
Baseline cholesterol markers can predict early infarct recurrence in patients with
symptomatic ICAD. More intensive and rapid lipid lowering drugs may be required to
reduce risk of early recurrence.
Key Words
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Article info
Publication history
Published online: October 26, 2021
Accepted:
September 20,
2021
Received in revised form:
September 5,
2021
Received:
July 15,
2021
Footnotes
Grant Support: MYRIAD is supported through a grant by the NIH/NINDS (R01 NS084288). The institutional review board/ethics committee at each participating institution approved this study, which is registered at ClinicalTrials.gov (NCT02121028).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106141
Copyright
© 2021 Elsevier Inc. All rights reserved.
