J Korean Med Sci.  2022 Apr;37(13):e100. 10.3346/jkms.2022.37.e100.

Fasting and Non-Fasting Triglycerides in Patients With Acute Ischemic Stroke

• Kim JY
• Lee KJ
• Kang J
• Kim BJ
• Han MK
• Kang K
• Park JM
• Park TH
• Park HK
• Cho YJ
• Hong KS
• Lee KB
• Jang MS
• Lee JS
• Lee J
• Bae HJ

• KMID: 2527827
• DOI: http://doi.org/10.3346/jkms.2022.37.e100

Abstract

Background
Clinical implications of elevated fasting triglycerides (FTGs) and non-fasting triglycerides (NFTGs) in acute ischemic stroke (AIS) remain unknown. We aimed to elucidate the correlation and clinical significance of FTG and NFTG levels in AIS patients.
Methods
Using a multicenter prospective stroke registry, we identified AIS patients hospitalized within 24 hours of onset with available NFTG results. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to one year.
Results
This study analyzed 2,176 patients. The prevalence of fasting and non-fasting hypertriglyceridemia was 11.5% and 24.6%, respectively. Multivariate analysis revealed that younger age, diabetes, higher body mass index and initial systolic blood pressure were independently associated with both fasting and non-fasting hypertriglyceridemia (all P < 0.05). Patients with higher quartiles of NFTG were more likely to be male, younger, eversmokers, diabetic, and have family histories of premature coronary heart disease and stroke (all P < 0.05). Similar tendencies were observed for FTG. The composite outcome was not associated with FTG or NFTG quartiles.
Conclusion
The fasting and non-fasting hypertriglyceridemia were prevalent in AIS patients and showed similar clinical characteristics and outcomes. High FTG and NFTG levels were not associated with occurrence of subsequent clinical events up to one year.

Keyword

Triglycerides; Postprandial; Fasting Triglycerides; Non-fasting Triglycerides; Ischemic Stroke

Figure

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  Fig. 1 Correlation analyses between fasting and non-fasting lipid profiles. Fasting and non-fasting lipid profiles were well correlated for total cholesterol, TG, HDL, and LDL. Pearson’s correlation coefficients were 0.88 for total cholesterol, 0.70 for TG, 0.60 for HDL, and 0.85 for LDL (all P < 0.001).TG = triglycerides, HDL = high-density lipoprotein, LDL = low-density lipoprotein.

• 

  Fig. 2 Cox’s proportional hazard model according to the quartiles of FTG and NFTG for the composite outcome. HRs were adjusted for age, sex, history of stroke or transient ischemic attack, history of coronary heart disease, hypertension, diabetes mellitus, atrial fibrillation, ever-smoking, history of statin use, and Trial of Org 10172 in Acute Stroke Treatment classification. The composite outcome consisted of stroke recurrence, myocardial infarction, and all-cause mortality up to one year after the index stroke.HR = hazard ratio, CI = confidence interval, NFTG = non-fasting triglyceride, FTG = fasting triglyceride.

Reference

1. Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. Lancet. 2014; 384(9943):626–635. PMID: 25131982.

2. Cohn JS, McNamara JR, Cohn SD, Ordovas JM, Schaefer EJ. Postprandial plasma lipoprotein changes in human subjects of different ages. J Lipid Res. 1988; 29(4):469–479. PMID: 3392464.

3. Schaefer EJ, Audelin MC, McNamara JR, Shah PK, Tayler T, Daly JA, et al. Comparison of fasting and postprandial plasma lipoproteins in subjects with and without coronary heart disease. Am J Cardiol. 2001; 88(10):1129–1133. PMID: 11703957.

4. Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA. 2007; 298(3):309–316. PMID: 17635891.

5. Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007; 298(3):299–308. PMID: 17635890.

6. Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction. Circulation. 2008; 118(20):2047–2056. PMID: 18955664.

7. Kwon HM, Lim JS, Park HK, Lee YS. Hypertriglyceridemia as a possible predictor of early neurological deterioration in acute lacunar stroke. J Neurol Sci. 2011; 309(1-2):128–130. PMID: 21784458.

8. Park JH, Lee J, Ovbiagele B. Nontraditional serum lipid variables and recurrent stroke risk. Stroke. 2014; 45(11):3269–3274. PMID: 25236873.

9. Bang OY, Saver JL, Liebeskind DS, Pineda S, Ovbiagele B. Association of serum lipid indices with large artery atherosclerotic stroke. Neurology. 2008; 70(11):841–847. PMID: 18160673.

10. Kim BJ, Han MK, Park TH, Park SS, Lee KB, Lee BC, et al. Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry. Int J Stroke. 2014; 9(4):514–518. PMID: 24256115.

11. Kim BJ, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, et al. Case characteristics, hyperacute treatment, and outcome information from the clinical research center for stroke-fifth division registry in South Korea. J Stroke. 2015; 17(1):38–53. PMID: 25692106.

12. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007; 115(20):e478–e534. PMID: 17515473.

13. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001; 285(19):2486–2497. PMID: 11368702.

14. Gauvreau K, Pagano M. The analysis of correlated binary outcomes using multivariate logistic regression. Biom J. 1997; 39(3):309–325.

15. Ko Y, Lee S, Chung JW, Han MK, Park JM, Kang K, et al. MRI-based algorithm for acute ischemic stroke subtype classification. J Stroke. 2014; 16(3):161–172. PMID: 25328874.

16. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019; 139(25):e1082–e1143. PMID: 30586774.

17. Ginsberg HN. New perspectives on atherogenesis: role of abnormal triglyceride-rich lipoprotein metabolism. Circulation. 2002; 106(16):2137–2142. PMID: 12379586.

18. Boquist S, Ruotolo G, Tang R, Björkegren J, Bond MG, de Faire U, et al. Alimentary lipemia, postprandial triglyceride-rich lipoproteins, and common carotid intima-media thickness in healthy, middle-aged men. Circulation. 1999; 100(7):723–728. PMID: 10449694.

19. Hwang JH, Kam S, Shin JY, Kim JY, Lee KE, Kwon GH, et al. Incidence of metabolic syndrome and relative importance of five components as a predictor of metabolic syndrome: 5-year follow-up study in Korea. J Korean Med Sci. 2013; 28(12):1768–1773. PMID: 24339707.

20. Moon S, Park JS, Ahn Y. The cut-off values of triglycerides and glucose index for metabolic syndrome in American and Korean adolescents. J Korean Med Sci. 2017; 32(3):427–433. PMID: 28145645.

21. Coughlan BJ, Sorrentino MJ. Does hypertriglyceridemia increase risk for CAD? Growing evidence suggests it plays a role. Postgrad Med. 2000; 108(7):77–84. PMID: 11126144.

22. Kreisberg RA. Diabetic dyslipidemia. Am J Cardiol. 1998; 82(12A):67U–73U.

23. van de Woestijne AP, Wassink AM, Monajemi H, Liem AH, Nathoe HM, van der Graaf Y, et al. Plasma triglyceride levels increase the risk for recurrent vascular events independent of LDL-cholesterol or nonHDL-cholesterol. Int J Cardiol. 2013; 167(2):403–408. PMID: 22265582.

24. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019; 380(1):11–22. PMID: 30415628.

25. Pikija S, Milevcić D, Trkulja V, Kidemet-Piskac S, Pavlicek I, Sokol N. Higher serum triglyceride level in patients with acute ischemic stroke is associated with lower infarct volume on CT brain scans. Eur Neurol. 2006; 55(2):89–92. PMID: 16636555.

26. Weir CJ, Sattar N, Walters MR, Lees KR. Low triglyceride, not low cholesterol concentration, independently predicts poor outcome following acute stroke. Cerebrovasc Dis. 2003; 16(1):76–82. PMID: 12766366.

27. Dziedzic T, Slowik A, Gryz EA, Szczudlik A. Lower serum triglyceride level is associated with increased stroke severity. Stroke. 2004; 35(6):e151–e152. PMID: 15131316.

28. Eun MY, Seo WK, Lee J, Kim M, Kim J, Kim JH, et al. Age-dependent predictors for recurrent stroke: the paradoxical role of triglycerides. Eur Neurol. 2013; 69(3):171–178. PMID: 23296152.

29. Listenberger LL, Han X, Lewis SE, Cases S, Farese RV Jr, Ory DS, et al. Triglyceride accumulation protects against fatty acid-induced lipotoxicity. Proc Natl Acad Sci U S A. 2003; 100(6):3077–3082. PMID: 12629214.

30. Zhao L, Wang R, Song B, Tan S, Gao Y, Fang H, et al. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke. Int J Stroke. 2015; 10(5):752–758. PMID: 25924059.