Association between serum triglycerides and stroke type, severity, and prognosis. Analysis in 6558 patients

Abstract

Background and objectives: Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller in patients with HT. We explored the relationship between triglyceride levels and stroke risk factors, severity and outcome in a large prospective database.

Design: Prospective Cross-sectional study.

Setting: We retrospectively interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between triglyceride, diabetes, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with HT.

Participants: Six thousand five hundred fifty-eight patients ≥20 years were included in this study RESULTS: Six thousand five hundred fifty-eight patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) were included. Triglyceride levels upon admission were low-normal (≤1.1 mmol/L) in 2019 patients, high-normal (1.2-1.7 mmol/L) in 2142 patients, borderline-high (1.8-2.2 mmol/L) in 1072 patients and high (≥2.3 mmol/L) in 1325 patients. Higher triglyceride levels were associated with stroke and increased likelihood of having diabetes, obesity, active smoking, and small vessel/lacunar stroke type. An inverse relationship was noted whereby higher triglyceride levels were associated with lower stroke severity and reduced likelihood of poorer outcome (mRS 3-6) at discharge and 90 days. Long-term MACE events were less frequent in patients with higher triglyceride levels. After adjusting age, gender, diabetes, prior stroke, CAD, and obesity, multivariate analysis showed that hypertension and triglyceride levels were higher in mild ischemic strokes patients.

Conclusions: Increasing triglycerides are associated with higher risk of small vessel disease and requires further prospective cohort studies for confirmation.

Keywords: Ischemic stroke; Major adverse cardiovascular events; Outcome; Small vessel disease; Triglyceride.

Fig. 1

Histograms and corresponding kernel density estimates of the age distribution of subjects based on triglyceride level (low-normal <1.1 mmol/L; borderline high 1.2-1.7 mmol/L; high-normal 1.8-2.2 mmol/L or high >2.3 mmol/L)

Fig. 2

A Linear regression indicating a significant negative relationship between NIH stroke scale and serum triglycerides (lower NIHSS associated with higher triglycerides) in all subjects (n=6558), controlling for age, sex and diabetes status. B Split violin plot showing the median, interquartile range and spread of NIH stroke scales when subjects are divided into groups based on triglyceride level (x axis) and diabetes status (left and right half of each violin)

Fig. 3

Scatterplots and linear regression dividing the sample into groups based on diabetes status (top row: non-diabetics, bottom row: diabetics) and stroke type based on the TOAST classification system

Fig. 4

Combined strip and box-plots of modified Rankin scales (mRS) versus triglyceride levels at discharge (A) and 90 days post stroke (B), as well as stacked bar charts indicating the proportion of patients with each mRS score (0-6) by triglyceride group at discharge and 90 days post stroke (C). At both discharge and 90 days the participants with mRS scores of 5 or 6 (indicating the poorest outcome) had the lowest triglyceride levels. Likewise, highest proportion of subjects with mRS scores indicating a poor outcome (3-6) were in the low-normal triglyceride group