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Published on: January 28, 2020
The Prognostic Impact of Remnant Cholesterol on Myocardial Infarction and Coronary Revascularization Following Acute
Amir Aker1, Razi Khoury2, Barak Zafrir3
1Department of Cardiology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Elevated remnant cholesterol (RC) after ischemic stroke increases the risk of heart attack or revascularization. This finding highlights RC as a potential target for managing residual cardiovascular risk in stroke patients.
Area of Science:
- Cardiology
- Neurology
- Lipid Metabolism
Background:
- Remnant cholesterol (RC) is an emerging risk factor for atherosclerotic cardiovascular disease.
- Limited data exist on the prognostic significance of RC after ischemic stroke.
Purpose of the Study:
- To investigate the association between remnant cholesterol (RC) and the risk of cardiac events following hospitalization for an ischemic stroke.
Main Methods:
- A cohort of 5697 patients hospitalized for acute ischemic stroke was analyzed.
- Adjusted Cox-regression models assessed the association between RC percentiles and risk for myocardial infarction (MI) or coronary revascularization.
- RC was calculated from routine post-discharge lipid profiles.
Main Results:
- Higher RC percentiles (≥50th, ≥75th, ≥90th, ≥95th) were significantly associated with increased risk of MI or revascularization.
- Hazard ratios ranged from 1.42 to 1.93 for higher RC percentiles compared to the lowest.
- RC levels better reflected risk than non-HDL-C when discordant.
Conclusions:
- Elevated RC is an independent risk factor for MI or coronary revascularization post-ischemic stroke.
- RC may serve as a residual cardiovascular risk marker in ischemic stroke patients.
- RC represents a potential treatment target for improving outcomes after stroke.
Background:
Remnant cholesterol (RC), the cholesterol content of triglyceride-rich lipoproteins, is an emerging residual risk factor for atherosclerotic cardiovascular disease. Data on the prognostic significance after an ischemic stroke are limited.
Objectives:
To investigate the association between RC and risk for cardiac events following hospitalization for an ischemic stroke.
Methods:
Data were collected for 5697 patients (39.5% women) affiliated with Clalit Health Services and hospitalized with an acute ischemic stroke. Adjusted Cox-regression models were used to estimate the association between RC percentiles, calculated using a routine post-discharge lipid profile, and risk for future myocardial infarction (MI) or coronary revascularization.
Results:
Mean age was 69 ± 10 years; 78% were treated by lipid-lowering therapies. During median follow-up of 22 months, a MI or coronary revascularization event occurred in 243 patients. After multivariable adjustment including lipid-lowering therapies and non-HDL-C, RC was associated with higher MI or revascularization risk: hazard ratio (95% confidence interval): 1.42 (1.10-1.85), 1.50 (1.11-2.02), 1.62 (1.09-2.40), and 1.93 (1.22-3.06), in those with RC percentiles ≥ 50th (23.3 mg/dl), ≥ 75th (31.8 mg/dl), ≥ 90th (42.1 mg/dl), and ≥ 95th (49.1 mg/dl), compared to < 50th percentile. When RC and non-HDL-C levels were discordant, the level of RC better reflected higher risk for adverse cardiac events.
Conclusions:
Elevated RC following acute ischemic stroke is a risk factor for MI or coronary revascularization, independent of lipid-lowering therapies and non-HDL-C and may serve as a residual cardiovascular risk marker and potential treatment target in patients with ischemic stroke.
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