Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age
Background and aims: Low density lipoprotein (LDL-C) and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). The correlation between LDL-C and apoB is usually thight, but in some cases LDL-C underestimates apoB levels and residual cardiovascular risk. We aimed to assess if a dis...
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| Veröffentlicht in: | European stroke journal 2024-06, Vol.9 (2), p.494-500 |
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| creator | Kriemler, Lilian Rudin, Salome Gawinecka, Joanna Gross, Felix Arnold, Markus Schweizer, Juliane Westphal, Laura Inauen, Corinne Pokorny, Thomas Dittrich, Tolga Toebak, Anna Arnold, Marcel Christ-Crain, Mirjam von Eckardstein, Arnold Rentsch, Katharina Katan, Mira De Marchis, Gian Marco |
| description | Background and aims:
Low density lipoprotein (LDL-C) and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). The correlation between LDL-C and apoB is usually thight, but in some cases LDL-C underestimates apoB levels and residual cardiovascular risk. We aimed to assess if a discordance of LDL-C-levels with apoB levels is associated with LAA stroke.
Methods:
We included patients with an acute ischemic stroke from two prospective studies enrolled at the University Hospital Bern, Basel and Zurich, Switzerland. LDL-C and apoB were measured within 24 h of symptom onset. By linear regression, for each LDL-C, we computed the expected apoB level assuming a perfect correlation. Higher-than-expected apoB was defined as apoB level being in the upper residual tertile.
Results:
Overall, we included 1783 patients, of which 260 had a LAA stroke (15%). In the overall cohort, higher-than-expected apoB values were not associated with LAA. However, a significant interaction with age was present. Among the 738 patients ⩽70 years of age, a higher-than-expected apoB was more frequent in patients with LAA- versus non LAA-stroke (48% vs 36%, p = 0.02). In multivariate analysis, a higher-than-expected apoB was associated with LAA stroke (aOR = aOR 2.48, 95%CI 1.14–5.38). Among those aged ⩽70 years and with LAA, 11.7% had higher than guideline-recommended apoB despite LDL-C ⩽ 1.8 mmol/L ( |
| doi_str_mv | 10.1177/23969873231221619 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11318434</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_23969873231221619</sage_id><sourcerecordid>2929066863</sourcerecordid><originalsourceid>FETCH-LOGICAL-c391t-7b7103c8fe5134f71411b624b8ac52cbbc60d5667049f2bf6cb0d876e61f30673</originalsourceid><addsrcrecordid>eNp9kc1uEzEUhUeIilalD8AGeclmiq898c8KQUoBKRKbsrY8njuJy2Q82A5VdmxZ9Tl4CF6mT4KjlAhUqRvbss_97vU5VfUC6DmAlK8Z10IryRkHxkCAflKd7O5qrRQ8PZwlP67OUrqmlIIGwRU8q465YlLPmDypbi98ciF2dnRIWsw3iCNZXCzqObFjR-wUBj-FKYaMfiTviE_EphSctxk7cuPzigw2LrG2MWPc1javMIbkht1axIW-wrV3JOUYviIpkMlmj2NO5O7Xb0nvfvzcoo2JhJ7YJT6vjno7JDy730-rL5fvr-Yf68XnD5_mbxe14xpyLVsJlDvV4wx400toAFrBmlZZN2OubZ2g3UwISRvds7YXrqWdkgIF9JwKyU-rN3vutGnX2LkyULSDmaJf27g1wXrz_8voV2YZvhsADqrhTSG8uifE8G2DKZt1-SwOgx0xbJJhmmkqhBK8SGEvdcWUFLE_9AFqdmGaB2GWmpf_Dnio-BtdEZzvBanYZq7DJo7FsEeIfwAfKqvE</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2929066863</pqid></control><display><type>article</type><title>Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Kriemler, Lilian ; Rudin, Salome ; Gawinecka, Joanna ; Gross, Felix ; Arnold, Markus ; Schweizer, Juliane ; Westphal, Laura ; Inauen, Corinne ; Pokorny, Thomas ; Dittrich, Tolga ; Toebak, Anna ; Arnold, Marcel ; Christ-Crain, Mirjam ; von Eckardstein, Arnold ; Rentsch, Katharina ; Katan, Mira ; De Marchis, Gian Marco</creator><creatorcontrib>Kriemler, Lilian ; Rudin, Salome ; Gawinecka, Joanna ; Gross, Felix ; Arnold, Markus ; Schweizer, Juliane ; Westphal, Laura ; Inauen, Corinne ; Pokorny, Thomas ; Dittrich, Tolga ; Toebak, Anna ; Arnold, Marcel ; Christ-Crain, Mirjam ; von Eckardstein, Arnold ; Rentsch, Katharina ; Katan, Mira ; De Marchis, Gian Marco</creatorcontrib><description>Background and aims:
Low density lipoprotein (LDL-C) and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). The correlation between LDL-C and apoB is usually thight, but in some cases LDL-C underestimates apoB levels and residual cardiovascular risk. We aimed to assess if a discordance of LDL-C-levels with apoB levels is associated with LAA stroke.
Methods:
We included patients with an acute ischemic stroke from two prospective studies enrolled at the University Hospital Bern, Basel and Zurich, Switzerland. LDL-C and apoB were measured within 24 h of symptom onset. By linear regression, for each LDL-C, we computed the expected apoB level assuming a perfect correlation. Higher-than-expected apoB was defined as apoB level being in the upper residual tertile.
Results:
Overall, we included 1783 patients, of which 260 had a LAA stroke (15%). In the overall cohort, higher-than-expected apoB values were not associated with LAA. However, a significant interaction with age was present. Among the 738 patients ⩽70 years of age, a higher-than-expected apoB was more frequent in patients with LAA- versus non LAA-stroke (48% vs 36%, p = 0.02). In multivariate analysis, a higher-than-expected apoB was associated with LAA stroke (aOR = aOR 2.48, 95%CI 1.14–5.38). Among those aged ⩽70 years and with LAA, 11.7% had higher than guideline-recommended apoB despite LDL-C ⩽ 1.8 mmol/L (<70 mg/dl), compared to 5.9% among patients with other stroke etiologies (p = 0.04). A triglyceride cut-off of ⩾0.95 mmol/L had, in external validation, a sensitivity of 71% and specificity of 52% for apoB ⩾ 0.65 g/L among patients with LDL-C <1.8 mmol/L.
Conclusions:
Among patients aged ⩽70 years, a higher-than-expected apoB was independently associated with LAA stroke. Measuring apoB may help identify younger stroke patients potentially benefiting from intensified lipid-lowering therapy.
Graphical abstract</description><identifier>ISSN: 2396-9873</identifier><identifier>ISSN: 2396-9881</identifier><identifier>EISSN: 2396-9881</identifier><identifier>DOI: 10.1177/23969873231221619</identifier><identifier>PMID: 38279527</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Age Factors ; Aged ; Apolipoprotein B-100 - blood ; Apolipoproteins B - blood ; Atherosclerosis - blood ; Atherosclerosis - diagnosis ; Cholesterol, LDL - blood ; Female ; Humans ; Ischemic Stroke - blood ; Ischemic Stroke - diagnosis ; Ischemic Stroke - epidemiology ; Male ; Middle Aged ; Original s ; Prospective Studies ; Risk Factors ; Stroke - blood ; Stroke - diagnosis ; Stroke - epidemiology</subject><ispartof>European stroke journal, 2024-06, Vol.9 (2), p.494-500</ispartof><rights>European Stroke Organisation 2024</rights><rights>European Stroke Organisation 2024 2024 European Stroke Organisation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c391t-7b7103c8fe5134f71411b624b8ac52cbbc60d5667049f2bf6cb0d876e61f30673</cites><orcidid>0000-0001-6031-1159 ; 0000-0002-5524-2301 ; 0009-0004-1006-9113 ; 0000-0002-0093-110X ; 0000-0002-9987-3631</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318434/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318434/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,21817,27922,27923,43619,43620,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38279527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kriemler, Lilian</creatorcontrib><creatorcontrib>Rudin, Salome</creatorcontrib><creatorcontrib>Gawinecka, Joanna</creatorcontrib><creatorcontrib>Gross, Felix</creatorcontrib><creatorcontrib>Arnold, Markus</creatorcontrib><creatorcontrib>Schweizer, Juliane</creatorcontrib><creatorcontrib>Westphal, Laura</creatorcontrib><creatorcontrib>Inauen, Corinne</creatorcontrib><creatorcontrib>Pokorny, Thomas</creatorcontrib><creatorcontrib>Dittrich, Tolga</creatorcontrib><creatorcontrib>Toebak, Anna</creatorcontrib><creatorcontrib>Arnold, Marcel</creatorcontrib><creatorcontrib>Christ-Crain, Mirjam</creatorcontrib><creatorcontrib>von Eckardstein, Arnold</creatorcontrib><creatorcontrib>Rentsch, Katharina</creatorcontrib><creatorcontrib>Katan, Mira</creatorcontrib><creatorcontrib>De Marchis, Gian Marco</creatorcontrib><title>Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age</title><title>European stroke journal</title><addtitle>Eur Stroke J</addtitle><description>Background and aims:
Low density lipoprotein (LDL-C) and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). The correlation between LDL-C and apoB is usually thight, but in some cases LDL-C underestimates apoB levels and residual cardiovascular risk. We aimed to assess if a discordance of LDL-C-levels with apoB levels is associated with LAA stroke.
Methods:
We included patients with an acute ischemic stroke from two prospective studies enrolled at the University Hospital Bern, Basel and Zurich, Switzerland. LDL-C and apoB were measured within 24 h of symptom onset. By linear regression, for each LDL-C, we computed the expected apoB level assuming a perfect correlation. Higher-than-expected apoB was defined as apoB level being in the upper residual tertile.
Results:
Overall, we included 1783 patients, of which 260 had a LAA stroke (15%). In the overall cohort, higher-than-expected apoB values were not associated with LAA. However, a significant interaction with age was present. Among the 738 patients ⩽70 years of age, a higher-than-expected apoB was more frequent in patients with LAA- versus non LAA-stroke (48% vs 36%, p = 0.02). In multivariate analysis, a higher-than-expected apoB was associated with LAA stroke (aOR = aOR 2.48, 95%CI 1.14–5.38). Among those aged ⩽70 years and with LAA, 11.7% had higher than guideline-recommended apoB despite LDL-C ⩽ 1.8 mmol/L (<70 mg/dl), compared to 5.9% among patients with other stroke etiologies (p = 0.04). A triglyceride cut-off of ⩾0.95 mmol/L had, in external validation, a sensitivity of 71% and specificity of 52% for apoB ⩾ 0.65 g/L among patients with LDL-C <1.8 mmol/L.
Conclusions:
Among patients aged ⩽70 years, a higher-than-expected apoB was independently associated with LAA stroke. Measuring apoB may help identify younger stroke patients potentially benefiting from intensified lipid-lowering therapy.
Graphical abstract</description><subject>Age Factors</subject><subject>Aged</subject><subject>Apolipoprotein B-100 - blood</subject><subject>Apolipoproteins B - blood</subject><subject>Atherosclerosis - blood</subject><subject>Atherosclerosis - diagnosis</subject><subject>Cholesterol, LDL - blood</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemic Stroke - blood</subject><subject>Ischemic Stroke - diagnosis</subject><subject>Ischemic Stroke - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original s</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Stroke - blood</subject><subject>Stroke - diagnosis</subject><subject>Stroke - epidemiology</subject><issn>2396-9873</issn><issn>2396-9881</issn><issn>2396-9881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1uEzEUhUeIilalD8AGeclmiq898c8KQUoBKRKbsrY8njuJy2Q82A5VdmxZ9Tl4CF6mT4KjlAhUqRvbss_97vU5VfUC6DmAlK8Z10IryRkHxkCAflKd7O5qrRQ8PZwlP67OUrqmlIIGwRU8q465YlLPmDypbi98ciF2dnRIWsw3iCNZXCzqObFjR-wUBj-FKYaMfiTviE_EphSctxk7cuPzigw2LrG2MWPc1javMIbkht1axIW-wrV3JOUYviIpkMlmj2NO5O7Xb0nvfvzcoo2JhJ7YJT6vjno7JDy730-rL5fvr-Yf68XnD5_mbxe14xpyLVsJlDvV4wx400toAFrBmlZZN2OubZ2g3UwISRvds7YXrqWdkgIF9JwKyU-rN3vutGnX2LkyULSDmaJf27g1wXrz_8voV2YZvhsADqrhTSG8uifE8G2DKZt1-SwOgx0xbJJhmmkqhBK8SGEvdcWUFLE_9AFqdmGaB2GWmpf_Dnio-BtdEZzvBanYZq7DJo7FsEeIfwAfKqvE</recordid><startdate>20240601</startdate><enddate>20240601</enddate><creator>Kriemler, Lilian</creator><creator>Rudin, Salome</creator><creator>Gawinecka, Joanna</creator><creator>Gross, Felix</creator><creator>Arnold, Markus</creator><creator>Schweizer, Juliane</creator><creator>Westphal, Laura</creator><creator>Inauen, Corinne</creator><creator>Pokorny, Thomas</creator><creator>Dittrich, Tolga</creator><creator>Toebak, Anna</creator><creator>Arnold, Marcel</creator><creator>Christ-Crain, Mirjam</creator><creator>von Eckardstein, Arnold</creator><creator>Rentsch, Katharina</creator><creator>Katan, Mira</creator><creator>De Marchis, Gian Marco</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6031-1159</orcidid><orcidid>https://orcid.org/0000-0002-5524-2301</orcidid><orcidid>https://orcid.org/0009-0004-1006-9113</orcidid><orcidid>https://orcid.org/0000-0002-0093-110X</orcidid><orcidid>https://orcid.org/0000-0002-9987-3631</orcidid></search><sort><creationdate>20240601</creationdate><title>Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age</title><author>Kriemler, Lilian ; Rudin, Salome ; Gawinecka, Joanna ; Gross, Felix ; Arnold, Markus ; Schweizer, Juliane ; Westphal, Laura ; Inauen, Corinne ; Pokorny, Thomas ; Dittrich, Tolga ; Toebak, Anna ; Arnold, Marcel ; Christ-Crain, Mirjam ; von Eckardstein, Arnold ; Rentsch, Katharina ; Katan, Mira ; De Marchis, Gian Marco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-7b7103c8fe5134f71411b624b8ac52cbbc60d5667049f2bf6cb0d876e61f30673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Apolipoprotein B-100 - blood</topic><topic>Apolipoproteins B - blood</topic><topic>Atherosclerosis - blood</topic><topic>Atherosclerosis - diagnosis</topic><topic>Cholesterol, LDL - blood</topic><topic>Female</topic><topic>Humans</topic><topic>Ischemic Stroke - blood</topic><topic>Ischemic Stroke - diagnosis</topic><topic>Ischemic Stroke - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original s</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Stroke - blood</topic><topic>Stroke - diagnosis</topic><topic>Stroke - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kriemler, Lilian</creatorcontrib><creatorcontrib>Rudin, Salome</creatorcontrib><creatorcontrib>Gawinecka, Joanna</creatorcontrib><creatorcontrib>Gross, Felix</creatorcontrib><creatorcontrib>Arnold, Markus</creatorcontrib><creatorcontrib>Schweizer, Juliane</creatorcontrib><creatorcontrib>Westphal, Laura</creatorcontrib><creatorcontrib>Inauen, Corinne</creatorcontrib><creatorcontrib>Pokorny, Thomas</creatorcontrib><creatorcontrib>Dittrich, Tolga</creatorcontrib><creatorcontrib>Toebak, Anna</creatorcontrib><creatorcontrib>Arnold, Marcel</creatorcontrib><creatorcontrib>Christ-Crain, Mirjam</creatorcontrib><creatorcontrib>von Eckardstein, Arnold</creatorcontrib><creatorcontrib>Rentsch, Katharina</creatorcontrib><creatorcontrib>Katan, Mira</creatorcontrib><creatorcontrib>De Marchis, Gian Marco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European stroke journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kriemler, Lilian</au><au>Rudin, Salome</au><au>Gawinecka, Joanna</au><au>Gross, Felix</au><au>Arnold, Markus</au><au>Schweizer, Juliane</au><au>Westphal, Laura</au><au>Inauen, Corinne</au><au>Pokorny, Thomas</au><au>Dittrich, Tolga</au><au>Toebak, Anna</au><au>Arnold, Marcel</au><au>Christ-Crain, Mirjam</au><au>von Eckardstein, Arnold</au><au>Rentsch, Katharina</au><au>Katan, Mira</au><au>De Marchis, Gian Marco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age</atitle><jtitle>European stroke journal</jtitle><addtitle>Eur Stroke J</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>9</volume><issue>2</issue><spage>494</spage><epage>500</epage><pages>494-500</pages><issn>2396-9873</issn><issn>2396-9881</issn><eissn>2396-9881</eissn><abstract>Background and aims:
Low density lipoprotein (LDL-C) and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). The correlation between LDL-C and apoB is usually thight, but in some cases LDL-C underestimates apoB levels and residual cardiovascular risk. We aimed to assess if a discordance of LDL-C-levels with apoB levels is associated with LAA stroke.
Methods:
We included patients with an acute ischemic stroke from two prospective studies enrolled at the University Hospital Bern, Basel and Zurich, Switzerland. LDL-C and apoB were measured within 24 h of symptom onset. By linear regression, for each LDL-C, we computed the expected apoB level assuming a perfect correlation. Higher-than-expected apoB was defined as apoB level being in the upper residual tertile.
Results:
Overall, we included 1783 patients, of which 260 had a LAA stroke (15%). In the overall cohort, higher-than-expected apoB values were not associated with LAA. However, a significant interaction with age was present. Among the 738 patients ⩽70 years of age, a higher-than-expected apoB was more frequent in patients with LAA- versus non LAA-stroke (48% vs 36%, p = 0.02). In multivariate analysis, a higher-than-expected apoB was associated with LAA stroke (aOR = aOR 2.48, 95%CI 1.14–5.38). Among those aged ⩽70 years and with LAA, 11.7% had higher than guideline-recommended apoB despite LDL-C ⩽ 1.8 mmol/L (<70 mg/dl), compared to 5.9% among patients with other stroke etiologies (p = 0.04). A triglyceride cut-off of ⩾0.95 mmol/L had, in external validation, a sensitivity of 71% and specificity of 52% for apoB ⩾ 0.65 g/L among patients with LDL-C <1.8 mmol/L.
Conclusions:
Among patients aged ⩽70 years, a higher-than-expected apoB was independently associated with LAA stroke. Measuring apoB may help identify younger stroke patients potentially benefiting from intensified lipid-lowering therapy.
Graphical abstract</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>38279527</pmid><doi>10.1177/23969873231221619</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-6031-1159</orcidid><orcidid>https://orcid.org/0000-0002-5524-2301</orcidid><orcidid>https://orcid.org/0009-0004-1006-9113</orcidid><orcidid>https://orcid.org/0000-0002-0093-110X</orcidid><orcidid>https://orcid.org/0000-0002-9987-3631</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 2396-9873 |
| ispartof | European stroke journal, 2024-06, Vol.9 (2), p.494-500 |
| issn | 2396-9873 2396-9881 2396-9881 |
| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Age Factors Aged Apolipoprotein B-100 - blood Apolipoproteins B - blood Atherosclerosis - blood Atherosclerosis - diagnosis Cholesterol, LDL - blood Female Humans Ischemic Stroke - blood Ischemic Stroke - diagnosis Ischemic Stroke - epidemiology Male Middle Aged Original s Prospective Studies Risk Factors Stroke - blood Stroke - diagnosis Stroke - epidemiology |
| title | Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age |
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