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Published on: October 12, 2017
HDL cholesterol efflux capacity and phospholipid content are associated with the severity of acute ischemic stroke
Achilleas Papagiannis1, Christina Gkolfinopoulou2, Konstantinos Tziomalos1
1First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
Insights
High-density lipoprotein (HDL) function and composition, not just concentration, are linked to ischemic stroke severity and outcomes. Impaired cholesterol efflux capacity and altered HDL composition predict worse stroke outcomes and mortality.
Area of Science:
- Cardiovascular Research
- Neuroscience
- Biochemistry
Background:
- High-density lipoprotein (HDL) concentration is a poor indicator of cardiovascular risk.
- HDL function and composition are more strongly associated with cardiovascular morbidity.
- The predictive value of HDL function and composition for ischemic stroke severity and outcome remains unclear.
Purpose of the Study:
- To investigate the association between HDL function and composition with ischemic stroke severity.
- To evaluate the predictive value of HDL function and composition for stroke outcome.
- To identify potential biomarkers for risk stratification in acute ischemic stroke patients.
Main Methods:
- Prospective study of 199 acute ischemic stroke patients.
- Stroke severity assessed using the National Institutes of Health Stroke Scale (NIHSS).
- HDL cholesterol efflux capacity (CEC), phospholipid levels, LCAT-phospholipase activity, PON1-arylesterase activity, and SAA1 content were measured.
Main Results:
- Severe stroke patients exhibited lower HDL CEC, phospholipid levels, and LCAT activity, with higher SAA1 content.
- Poorer outcomes (dependency, mortality) were associated with reduced HDL CEC, PON1 activity, phospholipid, and LCAT activity, and increased HDL SAA1.
- HDL CEC and HDL-associated PON1 activity independently predicted dependency at discharge.
Conclusions:
- Alterations in HDL cholesterol efflux capacity and composition are linked to ischemic stroke severity and patient outcomes.
- These HDL characteristics may serve as valuable biomarkers for risk stratification.
- Findings suggest potential for improved management strategies in acute ischemic stroke based on HDL profiles.
Background/Aims:
Impaired high-density lipoprotein (HDL) function and composition are more strongly related to cardiovascular morbidity than HDL concentration. However, it is unclear whether HDL function and composition predict ischemic stroke severity and outcome. We aimed to evaluate these associations.
Methods:
We prospectively studied 199 consecutive patients who were admitted with acute ischemic stroke. The severity of stroke was evaluated at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥ 5. The outcome was assessed with dependency at discharge (modified Rankin scale 2-5) and in-hospital mortality. Cholesterol efflux capacity (CEC), phospholipid levels, lecithin:cholesterol acyl transferase (LCAT)-phospholipase activity, paraoxonase-1 (PON1)-arylesterase activity and serum amyloid A1 (SAA1) content of HDL were measured.
Results:
CEC, phospholipid levels and LCAT-phospholipase activity of HDL were lower and SAA1 content of HDL was higher in patients with severe stroke. Patients who were dependent at discharge had lower CEC, PON1-arylesterase activity, phospholipid content and LCAT-phospholipase activity of HDL and higher HDL-SAA1 content. Independent predictors of dependency at discharge were the NIHSS at admission (RR 2.60, 95% CI 1.39-4.87), lipid-lowering treatment (RR 0.17, 95% CI 0.01-0.75), HDL-CEC (RR 0.21, 95% CI 0.05-0.87) and HDL-associated PON1-arylesterase activity (RR 0.95, 95% CI 0.91-0.99). In patients who died during hospitalization, phospholipids, LCAT-phospholipase and PON1-arylesterase activities of HDL were lower.
Conclusions:
Changes in CEC and composition of HDL appear to be associated with the severity and outcome of acute ischemic stroke and could represent biomarkers that may inform risk stratification and management strategies in these patients.
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