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Effects of low serum triglyceride on stroke mortality: a prospective follow-up study
Wi-Sun Ryu1, Seung-Hoon Lee, Chi Kyung Kim
1Clinical Research Center for Stroke, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
Insights
Low serum triglyceride (TG) levels predict mortality after non-cardioembolic ischemic stroke. Low TG is linked to higher death rates in this stroke group, but not in cardioembolic stroke patients.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Epidemiology
Background:
- Low serum triglyceride (TG) levels are associated with mortality post-cardiovascular disease.
- The prognostic value of TG levels after ischemic stroke requires further investigation.
- Stroke etiology (cardioembolic vs. non-cardioembolic) may modify the TG-mortality relationship.
Purpose of the Study:
- To investigate the association between serum triglyceride levels and post-stroke mortality.
- To determine if stroke mechanism influences the relationship between TG levels and mortality.
Main Methods:
- Prospective enrollment of 1067 patients with first-ever acute ischemic stroke.
- Classification of stroke into cardioembolic (CE) and non-CE groups.
- Analysis of TG quartiles and mortality (all-cause and vascular death) using Cox regression.
Main Results:
- Inverse relationship between TG levels and mortality observed in all patients and the non-CE group.
- Lowest TG quartile associated with significantly higher all-cause and vascular death HRs in non-CE stroke.
- No significant association found between TG levels and mortality in the CE stroke group.
Conclusions:
- Low serum triglyceride levels are an independent predictor of mortality in patients with non-cardioembolic ischemic stroke.
- Stroke mechanism is a critical factor in the TG-mortality relationship.
- Findings highlight the importance of considering stroke etiology in risk stratification.
Background:
Low serum triglyceride (TG) has been suggested as a predictor of mortality after cardiovascular disease. However, the relationship between the level of TGs and the outcome after stroke remains to be elucidated. We hypothesized that the influence of TG levels on post-stroke mortality varies according to stroke mechanism: cardioembolic (CE) vs. non-CE causes.
Methods:
We prospectively enrolled a consecutive series of patients with first-ever acute ischemic stroke for 5 years (n=1067), and followed them until the end of 2007 to obtain information on mortality and cause of death. We divided the level of TG into the quartiles, and classified the patients into CE (n=226) and non-CE stroke groups (n=841). The influence of TG level on mortality (all-cause death and vascular death) was examined by univariate and multivariate analyses using Cox regression.
Result:
All-cause death and vascular death rates showed inverse relationships to the quartiles of TG levels in all patients (p<0.001, both) and also in non-CE stroke group (p<0.001, both), but not in CE stroke group (p=0.17 and p=0.37, respectively). In the Cox-regression analysis, compared with the highest quartile, the adjusted hazard ratio (HR) of the lowest quartile for all-cause death was 2.58 [95% confidence interval (CI), 1.38-4.82] and that for vascular death was 3.50 (95% CI, 1.39-8.82) in non-CE stroke group. These same associations, however, were not significant in CE stroke group.
Conclusion:
Our results indicate that low serum TG is an independent predictor of mortality after ischemic stroke brought on by non-CE causes.
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