Atherogenic Dyslipidemia Is Critically Related to Aortic Complicated Lesions in Cryptogenic Stroke

Abstract

Aims: Atherogenic dyslipidemia (AD) is regarded as a residual risk of cardiovascular diseases characterized by low high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG) levels and related to the intracranial stenosis of atheromatous thrombotic brain infarction (ATBI). Further, atherosclerosis is possibly related to another stroke subtype, including cryptogenic stroke (CS). In particular, an aortic complicated lesion (ACL) is a notable embolic source of CS, since recurrence of aortogenic brain embolism is not rare. This study aimed to clarify the underlying association between AD and CS.

Methods: CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) had extensive data from CS patients who underwent transesophageal echocardiography (TEE). AD was defined as HDL-C ≤ 40 mg/dl and TG ≥ 150 mg/dl. Based on these criteria, patients were divided into an AD group and a non-AD group to compare the clinical features.

Results: Of 664 CS patients (446 men, 68.7±12.8 years), 68 (10.2%) met the criteria of AD (AD group), and 596 (89.8%) were in the non-AD group. On multiple logistic regression analysis, body mass index (unit OR 1.11, 95%CI 1.04-1.19, p=0.002), diabetes mellitus (OR 2.23, 95%CI 1.28-3.87, p=0.004), ACL in the arch (OR 1.89, 95%CI 1.09-3.31, p=0.025), and deterioration during hospitalization (OR 3.96, 95%CI 1.32-10.68, p=0.009) were independently associated with AD.

Conclusion: AD was not rare in the present CS population. Moreover, AD was crucially related to ACL in CS. Therefore, intensive and pleiotropic lipid-modifying therapy would be efficacious for further treatment of aortogenic brain embolism.

Keywords: Aortic complicated lesion; Atherogenic dyslipidemia; Cryptogenic stroke; Embolic stroke of undetermined source; Transesophageal echocardiography.

Fig.1. Study flow chart

The cryptogenic stroke (CS) patients inspected with transesophageal echocardiography (TEE) in the present study were divided into atherogenic dyslipidemia (AD) group and non-AD group. Furthermore, non-AD group were classified into high-density lipoprotein cholesterol (HDL-C) group, triglyceride (TG) group, and normal group, respectively.

Fig.2. Univariate analyses with four groups

Regarding the significant associated factors on multiple logistic regression analysis, body mass index (A), diabetes (B), aortic complicated lesion in arch (C), deterioration during hospitalization (D), univariate analyses with four groups were also performed. The four cohorts were atherogenic dyslipidemia (AD) group, high-density lipoprotein cholesterol (HDL-C) group, triglyceride (TG) group, and normal group, respectively.

Fig.3. Frequency of atherogenic dyslipidemia by final diagnosis of cryptogenic stroke subtype

CS=cryptogenic stroke, RLS=right-to-left shunt, AF=atrial fibrillation, ACL=aortic complicated lesion. The frequency of atherogenic dyslipidemia by definite diagnosis of CS subtype is compared (A). The frequency of each embolic source in CS with multiple etiologies is shown (B).