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Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional Dependence
Background: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and p...
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| Published in: | Journal of stroke and cerebrovascular diseases 2019-04, Vol.28 (4), p.1040-1047 |
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| cites | cdi_FETCH-LOGICAL-c404t-69980e74ac7947a1374e690fb9b8ed758d04e3b344810574935886ff729fe40a3 |
| container_end_page | 1047 |
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| container_title | Journal of stroke and cerebrovascular diseases |
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| creator | Lung, Yen-Ju Weng, Wei-Chieh Wu, Chia-Lun Huang, Wen-Yi |
| description | Background: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence.
Methods: One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2018.12.030 |
| format | article |
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Methods: One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups. Results: 117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio) = 1.88, 95% CI (confidence interval) = 1.09-3.23, P = .023). Conclusions: Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some stroke patients.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.030</identifier><identifier>PMID: 30642665</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Biomarkers - blood ; carotid artery stenosis ; Carotid Stenosis - blood ; Carotid Stenosis - diagnosis ; Carotid Stenosis - mortality ; Carotid Stenosis - physiopathology ; Cholesterol - blood ; Comorbidity ; Disability Evaluation ; Female ; functional dependence ; Humans ; Hyperlipidemias - blood ; Hyperlipidemias - diagnosis ; Hyperlipidemias - mortality ; ischemic stroke ; lower cholesterol ; Male ; Middle Aged ; mortality ; Prevalence ; Prospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke - blood ; Stroke - diagnosis ; Stroke - mortality ; Stroke - physiopathology ; stroke outcome ; Taiwan - epidemiology ; Time Factors ; Total cholesterol</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2019-04, Vol.28 (4), p.1040-1047</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c404t-69980e74ac7947a1374e690fb9b8ed758d04e3b344810574935886ff729fe40a3</citedby><cites>FETCH-LOGICAL-c404t-69980e74ac7947a1374e690fb9b8ed758d04e3b344810574935886ff729fe40a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30642665$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lung, Yen-Ju</creatorcontrib><creatorcontrib>Weng, Wei-Chieh</creatorcontrib><creatorcontrib>Wu, Chia-Lun</creatorcontrib><creatorcontrib>Huang, Wen-Yi</creatorcontrib><title>Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional Dependence</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Background: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence.
Methods: One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups. Results: 117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio) = 1.88, 95% CI (confidence interval) = 1.09-3.23, P = .023). Conclusions: Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some stroke patients.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>carotid artery stenosis</subject><subject>Carotid Stenosis - blood</subject><subject>Carotid Stenosis - diagnosis</subject><subject>Carotid Stenosis - mortality</subject><subject>Carotid Stenosis - physiopathology</subject><subject>Cholesterol - blood</subject><subject>Comorbidity</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>functional dependence</subject><subject>Humans</subject><subject>Hyperlipidemias - blood</subject><subject>Hyperlipidemias - diagnosis</subject><subject>Hyperlipidemias - mortality</subject><subject>ischemic stroke</subject><subject>lower cholesterol</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mortality</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Stroke - blood</subject><subject>Stroke - diagnosis</subject><subject>Stroke - mortality</subject><subject>Stroke - physiopathology</subject><subject>stroke outcome</subject><subject>Taiwan - epidemiology</subject><subject>Time Factors</subject><subject>Total cholesterol</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNqVUctuEzEUtRAVLYVfQF4ipBn8HHuWaUoBKaiVWtaWx3NHdZjYwXZa5Q_4bJymsGLD6lq653GPD0IfKGkpod3HdbvOJcUf4CDBkOKDzaPPLSNUt5S1hJMX6IxKzhotKX1Z30SyhhOpTtHrnNeEUCq1fIVOOekE6zp5hn4tco7O2-JjwBdQHgECvovFznh5H2fIBVKcsQ0jlngPNuFvMdWtL3vsA76pRAgl40df7vHSplj8iBepsvb4tkCI2ecn9k3M5Xg9vtoFd_CrHpewhTBCcPAGnUx2zvD2eZ6j71ef7pZfmtX156_LxapxgojSdH2vCShhneqFspQrAV1PpqEfNIxK6pEI4AMXQtf0SvRcat1Nk2L9BIJYfo7eH3W3Kf7c1Xxm47ODebYB4i4bRlXPBVWMVujFEepSzDnBZLbJb2zaG0rMoRGzNv9qxBwaMZSZ2kgVeffstxs2MP6V-FNBBayOAKipHzwkk50__MjoE7hixuj_x-83SzWtAw</recordid><startdate>201904</startdate><enddate>201904</enddate><creator>Lung, Yen-Ju</creator><creator>Weng, Wei-Chieh</creator><creator>Wu, Chia-Lun</creator><creator>Huang, Wen-Yi</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201904</creationdate><title>Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional Dependence</title><author>Lung, Yen-Ju ; Weng, Wei-Chieh ; Wu, Chia-Lun ; Huang, Wen-Yi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-69980e74ac7947a1374e690fb9b8ed758d04e3b344810574935886ff729fe40a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers - blood</topic><topic>carotid artery stenosis</topic><topic>Carotid Stenosis - blood</topic><topic>Carotid Stenosis - diagnosis</topic><topic>Carotid Stenosis - mortality</topic><topic>Carotid Stenosis - physiopathology</topic><topic>Cholesterol - blood</topic><topic>Comorbidity</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>functional dependence</topic><topic>Humans</topic><topic>Hyperlipidemias - blood</topic><topic>Hyperlipidemias - diagnosis</topic><topic>Hyperlipidemias - mortality</topic><topic>ischemic stroke</topic><topic>lower cholesterol</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Stroke - blood</topic><topic>Stroke - diagnosis</topic><topic>Stroke - mortality</topic><topic>Stroke - physiopathology</topic><topic>stroke outcome</topic><topic>Taiwan - epidemiology</topic><topic>Time Factors</topic><topic>Total cholesterol</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lung, Yen-Ju</creatorcontrib><creatorcontrib>Weng, Wei-Chieh</creatorcontrib><creatorcontrib>Wu, Chia-Lun</creatorcontrib><creatorcontrib>Huang, Wen-Yi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lung, Yen-Ju</au><au>Weng, Wei-Chieh</au><au>Wu, Chia-Lun</au><au>Huang, Wen-Yi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional Dependence</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2019-04</date><risdate>2019</risdate><volume>28</volume><issue>4</issue><spage>1040</spage><epage>1047</epage><pages>1040-1047</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Undefined-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>Background: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence.
Methods: One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups. Results: 117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio) = 1.88, 95% CI (confidence interval) = 1.09-3.23, P = .023). Conclusions: Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some stroke patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30642665</pmid><doi>10.1016/j.jstrokecerebrovasdis.2018.12.030</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Biomarkers - blood carotid artery stenosis Carotid Stenosis - blood Carotid Stenosis - diagnosis Carotid Stenosis - mortality Carotid Stenosis - physiopathology Cholesterol - blood Comorbidity Disability Evaluation Female functional dependence Humans Hyperlipidemias - blood Hyperlipidemias - diagnosis Hyperlipidemias - mortality ischemic stroke lower cholesterol Male Middle Aged mortality Prevalence Prospective Studies Risk Assessment Risk Factors Severity of Illness Index Stroke - blood Stroke - diagnosis Stroke - mortality Stroke - physiopathology stroke outcome Taiwan - epidemiology Time Factors Total cholesterol |
| title | Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional Dependence |
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