Background and Purpose:Notwithstanding the current guideline-based management, patients with stroke retain a substantial risk of further vascular events. We aimed to assess the contribution of atherogenic dyslipidemia (AD) to this residual risk.Methods:This was a prospective observational study, in which 792 patients (mean age, 70.1 years; male, 60.2%) with acute ischemic stroke (n=710) or transient ischemic attack (n=82) within 1 week of onset were consecutively enrolled and followed for 1 year. AD was defined as having both elevated levels of triglycerides ≥150 mg/dL and low HDL-C (high-density lipoprotein cholesterol) <40 mg/dL in men or <50 mg/dL in women, under fasting conditions. The primary outcome was a composite of major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death.Results:The prevalence of AD was 12.2%. Patients with AD more often had intracranial artery stenosis than those without (42.3% versus 24.1%; P=0.004), whereas no differences were observed in the prevalence of extracranial artery stenosis (17.7% versus 12.9%; P=0.62) or aortic plaques (33.3% versus 27.0%; P=0.87). At 1 year, patients with AD were at a greater risk of major adverse cardiovascular events (annual rate, 24.5% versus 10.6%; hazard ratio [95% CI], 2.33 [1.44–3.80]) and ischemic stroke (annual rate, 16.8% versus 8.6%; hazard ratio [95% CI], 1.84 [1.04–3.26]) than those without AD. When patients were stratified according to baseline LDL-C (low-density lipoprotein cholesterol) level, AD was predictive of major adverse cardiovascular events among those with LDL-C ≥100 mg/dL (n=509; annual rate, 20.5% versus 9.6%; P=0.036) as well as those with LDL-C <100 mg/dL (n=283; annual rate, 38.6% versus 12.4%; P<0.001).Conclusions:AD is associated with intracranial artery atherosclerosis and a high residual vascular risk after a stroke or transient ischemic attack. AD should be a promising modifiable target for secondary stroke prevention.Registration:URL: https://upload.umin.ac.jp; Unique identifier: UMIN000031913.

中文翻译：

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中风或短暂性脑缺血发作后的动脉粥样硬化血脂异常和残余血管风险

背景和目的：尽管目前有基于指南的管理，但卒中患者仍存在发生进一步血管事件的重大风险。我们旨在评估致动脉粥样硬化性血脂异常 (AD) 对这种残留风险的影响。方法：这是一项前瞻性观察性研究，其中 792 名急性缺血性卒中患者（平均年龄 70.1 岁；男性，60.2%）（n=710 ) 或在发病 1 周内发生短暂性脑缺血发作 (n=82) 连续入组并随访 1 年。AD 被定义为在禁食条件下，甘油三酯水平升高≥150 mg/dL 和低 HDL-C（高密度脂蛋白胆固醇）<40 mg/dL（男性）或<50 mg/dL（女性）。主要结局是主要不良心血管事件的复合，包括非致死性卒中、非致死性急性冠脉综合征和血管性死亡。结果：AD患病率为12.2%。AD 患者比非 AD 患者更常发生颅内动脉狭窄（42.3% 对 24.1%；P = 0.004），而颅外动脉狭窄（17.7% 对 12.9%； P = 0.62）或主动脉斑块（33.3% 对 27.0%；P = 0.87）的患病率没有观察到差异。1 年时，AD 患者发生主要不良心血管事件（年发生率，24.5% 对 10.6%；风险比 [95% CI]，2.33 [1.44–3.80]）和缺血性卒中（年发生率，16.8 % 对 8.6%；风险比 [95% CI], 1.84 [1.04–3.26]) 比没有 AD 的人。当根据基线 LDL-C（低密度脂蛋白胆固醇）水平对患者进行分层时，AD 可预测 LDL-C ≥100 mg/dL 患者的主要不良心血管事件（n=509；年发生率，20.5% vs 9.6%） %; P=0.036) 以及 LDL-C <100 mg/dL (n=283; 年发生率, 38.6% vs 12.4%; P <0.001)。结论：AD 与颅内动脉粥样硬化和高残余血管风险相关中风或短暂性脑缺血发作后。AD 应该是中风二级预防的有希望的可修改目标。注册：URL：https://upload.umin.ac.jp；唯一标识符：UMIN000031913。