Risk factors for ischemic stroke: differences between cerebral small vessel and large artery atherosclerosis
Yan Shi1,2, Li Guo2, Yangkun Chen3
1Department of Rehabilitation Medicine, Xingtai People's Hospital, Xingtai, Hebei Province, China.
Insights
Identifying risk factors for ischemic stroke subtypes is crucial. Large artery atherosclerosis (LAA) stroke risk factors include hypertension, high LDL, and smoking. Cerebral small vessel disease (SVD) stroke risk factors include hypertension, high total cholesterol, and smoking.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Epidemiology
Background:
- Large artery atherosclerosis (LAA) stroke and cerebral small vessel disease (SVD) are distinct ischemic stroke subtypes.
- Understanding their unique risk factor profiles is essential for targeted treatment and prevention strategies.
Purpose of the Study:
- To identify risk factors for ischemic cerebral SVD.
- To compare the risk factor profiles of ischemic cerebral SVD and LAA stroke.
Main Methods:
- A cohort of 353 acute ischemic stroke patients was classified into SVD or LAA groups using TOAST criteria.
- A control group of 70 non-stroke patients was included.
- Multivariate logistic regression (MLR) analyzed clinical variables including demographics, blood pressure, lipids, glucose, and lifestyle factors.
Main Results:
- LAA stroke risk factors identified: hypertension, diabetes mellitus, high LDL, hypertriglyceridemia, and smoking.
- Cerebral SVD stroke risk factors identified: hypertension, diabetes mellitus, high total cholesterol (TC), hypertriglyceridemia, and smoking.
- High TC was a distinguishing factor for cerebral SVD, with SVD patients exhibiting higher TC levels compared to LAA patients.
Conclusions:
- Hypertension, diabetes mellitus, high total cholesterol, hypertriglyceridemia, and smoking are independent risk factors for cerebral SVD stroke.
- High total cholesterol is particularly prominent in cerebral SVD, differentiating it from LAA stroke.
- These findings aid in differentiating stroke subtypes and informing personalized risk management.
Abstract:
The treatment for large artery atherosclerosis (LAA) stroke is also important for patients with cerebral small vessel disease (SVD). Our aim is to clarify the risk factors for ischemic cerebral SVD and to evaluate the different risk factor profiles of the two ischemic stroke subtypes, namely, ischemic cerebral SVD and LAA. A total of 353 patients with acute ischemic stroke were assigned to two groups according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria: the ischemic cerebral SVD group and the LAA group. A total of 70 non-stroke patients admitted during the same period served as the control group. Clinical variables were collected, including age, sex, blood pressure, blood glucose, triglycerides, low-density lipoprotein, total cholesterol (TC), smoking history, drinking history, coronary atherosclerotic heart disease and family history of a high-risk disease. Multivariate logistic regression (MLR) analyses were performed. MLR analysis showed that risk factors for LAA stroke included hypertension, diabetes mellitus, high low-density lipoprotein, hypertriglyceridemia and smoking compared with the control group. The analysis also showed that the risk factors for cerebral SVD stroke were hypertension, diabetes mellitus, high TC, hypertriglyceridemia and smoking. In terms of the factors distinguishing LAA and cerebral SVD, MLR demonstrated that high TC played prominent roles in cerebral SVD. Hypertension, diabetes mellitus, high total cholesterol, hypertriglyceridemia and smoking are independent risk factors for cerebral SVD stroke. Compared with the LAA stroke group, patients with cerebral SVD stroke were more likely to have a high level of TC.
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