Background: Recent data have shown an unexpected association between poor outcome after acute stroke and lower serum cholesterol. Triglyceride concentration has been linked to coronary heart disease and stroke; however, there are currently no data on the relationship between triglyceride and stroke outcome. Such information may yield further mechanistic information on the relationship between lipids and stroke outcome. Methods: We studied 1,310 nondiabetic patients presenting to our acute stroke unit with computed tomography-confirmed acute stroke. Fasting blood samples were drawn within 24 h of admission for glucose, lipids and a standard battery of biochemistry and hematological tests. Information on age, stroke type, admission blood pressure, smoking status, presence of atrial fibrillation, resolution time of symptoms and Oxfordshire Community Stroke Project clinical classification was collated. Stepwise proportional hazards regression was used to estimate the effect of the above variables on survival following stroke. Results: Increased age (p < 0.0001), presence of atrial fibrillation (p = 0.009), hyperglycemia (p = 0.0005) and lower triglyceride level (p < 0.0001) independently predicted higher mortality; early resolution of symptoms (p = 0.005) independently predicted lower mortality. Although serum cholesterol level predicted outcome after adjusting for other prognostic factors, it did not remain significant when triglyceride level was entered into the model. The relative hazard per additional quartile of triglyceride was 0.84 (95% confidence interval 0.77–0.91). Conclusions: Low triglyceride concentration strongly predicts higher mortality following stroke, whereas serum cholesterol level is not an independent predictor. Outcome following stroke is thus related more strongly to triglyceride-rich than to cholesterol-rich lipoprotein concentrations. The mechanisms explaining this require further investigation.

Keywords:
Triglycerides, Stroke, Outcome
1.
Dyker AG, Weir CJ, Lees KR: Influence of cholesterol on survival after stroke. BMJ 1997;314:1584–1588.
2.
Marini C, Di Napoli M, Carolei A: Influence of cholesterol on survival after stroke. Effect of cholesterol on prognosis may rely on negative association with atrial fibrillation. BMJ 1997;315:1159.
3.
Eryurek FG, Surmen E, Oner P, et al: Gamma-glutamyl transpeptidase and acetylcholinesterase activities in brain capillaries of cholesterol-fed rabbits. Res Commun Chem Pathol Pharmacol 1990;69:245–248.
4.
Butterworth RJ, Marshall WJ, Bath PMW: Changes in serum lipid measurements following acute ischaemic stroke. Cerebrovasc Dis 1997;7:10–13.
5.
Sattar N, Petrie J, Packard CJ: Triglycerides and coronary heart disease. BMJ 1998;317:553–554.
6.
Hokanson JE, Austin MA: Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: A meta-analysis of population-based prospective studies. J Cardiovasc Risk 1996;3:213–219.
7.
Haffner SM, Stern MP, Hazuda HP, et al: Cardiovascular risk factors in confirmed prediabetic individuals: Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990;263:2893–2898.
8.
Weir CJ, Dyker AG, Lees KR: Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow-up study. BMJ 1997;314:1303–1306.
9.
Widana IGR, Wiyono P, Rahardjo P, et al: Hypertension in a stroke patient: Relationship with hyperinsulinaemia. Nephrology 1997;3:163–168.
10.
Bamford J, Sandercock P, Dennis M, et al: Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526.
11.
Isles CG, Walker LM, Beevers GD, et al: Mortality in patients at the Glasgow Blood Pressure Clinic. J Hypertens 1986;4:141–146.
12.
Computerised record linkage compared with traditional patient follow-up methods in clinical trials and illustrated in a prospective epidemiological study. The West of Scotland Coronary Prevention Study Group. J Clin Epidemiol 1995;48:1441–1452.
13.
Cox DR: Regression models and life tables. J R Stat Soc B 1972;34:187–220.
14.
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348:1329–1339.
15.
Tan CE, Squires L, Caslake MJ, et al: Relationship between very low and low density lipoprotein subfractions in normolipaemic men and women. Arterioscler Thromb Vasc Biol 1995;13:1839–1848.
16.
Verdery RB, Walford RL: Changes in plasma lipids and lipoproteins in humans during a 2-year period of dietary restriction in Biosphere 2. Arch Intern Med 1998;158:900–906.
17.
Kempf M: Effect of nutrition on combined hyperlipidaemia. Ann Endocrinol 1997;58:292–296.
18.
Adlouni A, Ghalim N, Benslimane A, et al: Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol. Ann Nutr Metab 1997;41:242–249.
19.
Gillman MW, Cupples LA, Millen BE, et al: Inverse association of dietary fat with development of ischaemic stroke in men. JAMA 1997;278:2145–2150.
20.
Sattar N, Tan CE, Han T, et al: Associations of indices of adiposity with atherogenic lipoprotein subfractions. Int J Obes Relat Metab Disord 1998;22:432–439.
21.
Henon H, Godefroy O, Leys D, et al: Early predictors of death and disability after acute cerebral ischemic event. Stroke 1995;26:392–398.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.