The effect of high triglyceride on prognosis of stroke patients

This article is from the NEJM Journal Watch Prognostic Impact of High Triglycerides After Stroke or TIA Review of the Prognostic Impact of High Triglycerides After Stroke or Transient Ischemic Attack by Seemant Chaturvedi, MD High Triglycerides Levels was independently associated with an increased risk of recurrence
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For patients with stroke or transient ischemic attack (TIA), the focus of lipid management is mostly statin therapy for elevated low-density lipoprotein (LDL)
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A recent clinical trial determined that a goal of LDL <70 mg/dL is best to prevent future strokes (NEJM JW Neurol Jan 2020 and N Engl J Med 2020; 382:9)
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The importance of high triglycerides in stroke or TIA patients has received little attention
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The authors conducted a single-center registry study of patients hospitalized for stroke or TIA
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They assessed lipids and stroke mechanisms and followed patients for up to 1 year
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High triglyceride levels were defined as fasting values ​​≥150 mg/dL
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The primary outcome was the incidence of major adverse cardiovascular events (MACE), including nonfatal stroke, nonfatal myocardial infarction, and vascular death
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During the 5-year period, 870 patients (mean age, 70.
1 years; 61% men) were enrolled in the trial
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Regarding the mechanism of stroke, 20% were atherothrombotic, 21% were small vessel disease, 25% were embolism, and 28% had an unknown mechanism
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One-quarter of participants with high triglyceride levels had a higher incidence of MACE during follow-up (20.
9% vs.
9.
7%); adjusted for confounding variables such as diabetes, other lipid values, and statin use , the difference was still very significant (hazard ratio, 2.
46)
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In patients with intracranial atherosclerosis (29.
9% vs.
14.
7%) and patients with extracranial stenosis (23.
0% vs.
9.
4%), the incidence of MACE was significantly higher in participants with high triglycerides than those without high triglycerides participants
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Among patients with cardioembolic stroke, the incidence of MACE did not differ significantly by triglyceride level
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Commenting on these findings suggest that clinicians should not focus solely on LDL levels when analyzing lipids in patients with stroke or TIA
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Patients with high triglycerides may benefit from intensive diabetes control (if concomitant diabetes) and drug therapy targeting high triglyceride levels, especially in patients with atherosclerotic stroke (N Engl J Med 2019; 380:11)
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Reviewed article Hoshino T et al.
Prognostic role of hypertriglyceridemia in patients with stroke of atherothrombotic origin.
Neurology 2022 Mar 16; [e-pub].
(https://doi.
org/10.
1212/WNL.
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