High Triglycerides Up CV Risk After Atherothrombotic Stroke

March 23, 2022

Patients who have had a stroke or transient ischemic attack (TIA) of atherothrombotic origin and have high triglyceride levels are at increased risk of having further cardiovascular events, including a recurrent stroke, even if they are taking statins, a new study shows

"Hypertriglyceridemia drives the residual risk of further vascular events in patients with stroke or TIA of atherothrombotic origin, even while they are on statin therapy. Triglyceride-related residual risk should be addressed by targeted treatments in future clinical trials," the authors conclude.

"More research is needed, but for people who have had an atherothrombotic stroke, triglyceride levels may emerge as a key target for preventing future strokes and other cardiovascular problems," lead author Takao Hoshino, MD, Tokyo Women's Medical University Hospital, commented.

"Statin therapy is still an effective treatment for people with high triglyceride levels, but our study highlights how important it is to look at all the tools a person can use to lower their triglycerides, including diet modifications, exercise, and taking omega-3 fatty acids," he added.

The study was published online on March 16 in Neurology.

The researchers explain that atherosclerotic stenosis of the major cervicocephalic artery is a common cause of ischemic stroke, and patients with stroke of atherothrombotic origin carry the highest risk for further vascular events, compared with those with strokes of other etiologic subtypes, suggesting that better, novel, or tailored approaches are needed for this subgroup.

They point out that lipid management for secondary stroke prevention primarily aims to lower LDL-cholesterol levels using statins, but even at the recommended LDL level, the residual risk for further vascular events remains substantial after an atherothrombotic stroke.

Recently, high triglyceride levels have emerged as a predictor and novel therapeutic target for atherosclerotic cardiovascular diseases, but the association between hypertriglyceridemia and atherothrombotic stroke has been poorly studied, the researchers note.

For the current study, they aimed to assess the contribution of hypertriglyceridemia to residual vascular risk in patients with atherothrombotic stroke.

They analyzed data from an ongoing stroke registry on consecutive patients with acute ischemic stroke or TIA within 1 week of onset who were hospitalized at the Tokyo Women's Medical University Hospital.

Of 870 patients (mean age, 70 years; 61% male), 217 (25%) had hypertriglyceridemia, defined as fasting triglyceride levels of 150 mg/dL or higher. High triglyceride levels were significantly associated with an increased prevalence of intracranial artery stenosis, particularly in the anterior circulation, rather than extracranial artery stenosis.

Results showed that patients with hypertriglyceridemia had a greater risk for major adverse cardiovascular events than those without (annual rate, 20.9% vs 9.7%; P < .001), even after adjustment for potential confounders, including baseline LDL cholesterol and statin use (adjusted hazard ratio, 2.46; 95% CI, 1.62 - 3.74).

The higher risk for vascular events in patients with hypertriglyceridemia, compared with those without, was observed among patients with stroke of atherothrombotic origin (n = 174; annual rate, 35.1% vs 14.2%; P = .001), those with significant intracranial artery stenosis (n = 247; annual rate, 29.9% vs 14.7%; P = .006), and those with significant extracranial carotid artery stenosis (n = 123; annual rate, 23.0% vs. 9.4%; P = .042).

In patients who had had an atherothrombotic stroke, high triglyceride levels were associated with increased rates of both recurrent stroke, compared with normal triglyceride levels (16% vs 12%), and acute coronary syndrome events (8% vs 0.9%).

In contrast, hypertriglyceridemia was not predictive of recurrent vascular events in patients with cardioembolic stroke (n = 221; annual rate, 19.1% vs 10.5%; P = .18).

The researchers note that a limitation of the study was that triglyceride levels were measured under fasting conditions, and "non-fasting TG levels are more representative of a person's lipemia state through an entire day and may provide an improved measure for risk assessment than fasting levels."

Commenting on the study for Medscape Medical News, Kausik Ray, MD, professor of public health at Imperial College London and president of the European Atherosclerosis Society, said these data are in line with previous studies showing higher rates of major adverse cardiac events in patients with atherosclerotic cardiovascular disease and raised triglyceride levels, which formed the basis of the REDUCE-IT trial of high-dose eicosapentaenoic acid, among others.

Hoshino reports no disclosures.

Neurology. Published online March 16, 2022. Abstract

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