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Association of Dyslipidemia and Ischemic Stroke

Urooj Taheed Baluch et al

Original Article

Association of Dyslipidemia and


Ischemic Stroke
Background: Stroke is leading cause of death world wide. Dyslipidemia is one of the
important risk factor in patients with coronary heart disease.
Objective: To see the association of dyslipidemia in patients who have presented with
ischemic stroke in Pakistan Institute of Medical Sciences
Subjects and Methods: This retrospective study was conducted at neurology
department of Pakistan institute of medical sciences from January 1st 2008 to March 1st
2008. A total of 53 patients having ischemic stroke which was confirmed on CT scan were
included and there lipid profiles were studied.
Results: In a total of 53 patients, 32 were male and 21 female. 28% of patient were in age
group of 61-70 years.19% patient had dyslipidemia; of them, 18% had low HDL, while high
LDL, cholesterol and triglycerides were observed in 26%, 24% and 32% patients,
respectively. 42% of patients were hypertensive and 35% were diabetics. This data was
similar to that of the western and Asian studies
Conclusion: Like HTN and diabetes, dyslipedemia is another important and modifiable
risk factor controlling which might reduce the incidence of ischemic stroke reducing the
financial and emotional burden of the nation.
Key Words: Ischemic Stroke, Dyslipedemia, HDL, LDL, Cholesterol, Triglycerides

Introduction
Stroke, after heart diseases and cancer is the
third leading cause of death world wide.1 Stroke is also
a leading cause of functional impairments, with 20% of
survivors requiring institutional care after 3 months and
15-30% gets permanently disabled.2 Of all strokes, 88%
are classified as ischemic, and the remainders are
hemorrhagic, either subarachnoid (9%) or intracerebral
(3%).3 Ischemic
stroke
is
mostly
due
to
thromboembolism secondary to atherosclerosis in the
major arteries. Other causes include infarction due to
embolism from heart and intrinsic disease of the small
perforating vessels. Nikolai first proposed a link between
cholesterol and atherosclerosis in 1912.4 Kunitomo M. et
al worked on mice in Japan and found that
atherosclerotic lesions are formed in the aorta of mice
fed a high-cholesterol and high-linoleic diet, in parallel
with elevated serum lipid peroxide levels.5 Abnormalities
of serum lipids are major risk factors for coronary heart
disease and most recently established as risk factor in
cerebrovascular disease.6 Studies have shown that
lowering cholesterol may decrease carotid atheroma
thus resulting in a decline in carotid territory infarcts.6
Two prospective studies in men subsequently
Ann. Pak. Inst. Med. Sci. 2008;4(3): 165-167

Urooj Taheed Baluch*


Ismaa Kiani*
Zaib-un-nisa*
Mazhar Badshah**
* Post graduate resident
** Assistant professor department of
neurology
Department of Medicine and
Department of Neurology
Pakistan Institute of Medical Sciences
Islamabad

Address for Correspondence:


Dr Urooj Taheed Baluch
Department of Medicine
Pakistan Institute of Medical Sciences,
Islamabad.
Email: drbaloch79@yahoo.com

showed increases in ischemic stroke rates at higher


levels of total cholesterol.7,8 The Asia Pacific Cohort
Studies Collaboration found a 25% increase in ischemic
stroke rates for every 1 mmol/L increase in total
cholesterol.9 The US Womens Pooling Project (24,343
women at risk) found a 25% increased risk of fatal
ischemic stroke for each 1 mmol/L increase in total
cholesterol in women 30 to 54 years of age.10 Only a few
studies have analyzed the relationship between LDL
cholesterol (the major component of total cholesterol)
and ischemic stroke.
No consistent association has been found,
although the total number of subjects at risk in these
studies are limited.11 An inverse relationship between
HDL and stroke risk was demonstrated in both the
Oxford Shire Community Study and the Northern
Manhattan Stroke Study.12
In a study of subjects with CAD, ischemic
cerebrovascular events were significantly associated
with high triglyceride and low HDL cholesterol levels.13
Thus, there does appear to be a clear relationship
between dyslipidemia and the risk of ischemic stroke in
both men and women.14
This study was carried out to see the
association of dyslipidemia in patients who have
presented with ischemic stroke in our setup.

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Association of Dyslipidemia and Ischemic Stroke

Urooj Taheed Baluch et al

Materials and Methods


Inclusion Criteria: All patients between 30 to 90 years
who were admitted in department of Neurology of PIMS
with first ever stroke verified by CT scan brain during the
2 months period from Jan 1st 2008 to Feb 29th 2008
were included in the study
Exclusion Criteria: We excluded the patients who had
a recent myocardial infarction with left ventricular failure,
history of previous stroke, syncopal attack, presumptive
diagnosis of ischemic stroke with no evidence on the CT
scan, neurological deficit secondary to epilepsy,
infective or metastatic disorder, or pre-existing severe
physical and cognitive disorder.
A detailed history was recorded and physical
examination was undertaken. Blood samples of all the
patients were taken on the next morning or the second
day of stroke, as recommended15 and were sent for lipid
profile at laboratory of PIMS.
ATP III classification was followed for
dyslipidemia:
Low HDL
< 40 mg/dl
High LDL
> 190 mg/dl
High Cholesterol
>200 mg/dl
High Triglycerides
>200 mg/dl

were present. Only 5 % of the patients had none of the


risk factors.
When all the dyslipedemia were considered
individually it was seen that 18% of patients had low
HDL levels, 26%, 24% and 32% patient had high LDL,
triglycerides, and cholesterol levels respectively (Figure
3).

Figure 1: Age distribution of patients


suffering from stroke

Results
A total of 60 patients were admitted during the
period of study; seven of them were excluded, as 2 had
myocardial infarction with left ventricular failure, 1
patient had SLE, 1 patient was a case of brain
metastasis, 2 patients had infective endocarditis and 1
patient had an episode of stroke a year back. Amongst a
total of 53 patients selected, 21(40%) were females and
32(60 %) males (Table1).

Figure 2: Percentages of All Three Risk


Factors in Patients of Stroke

Table 1: Demographic data of patients


Total no of patients
No of patients excluded
No of patients included
No of female patients
No of male patients
No of patients with hypertension
No of patients with diabetes
No of patients with dyslipidemia

60
7
53
21
32
22
19
9

The no of patients increased as the age group


increased and it was 28% in the age group of 61-70
years (Figure 1). The classical risk factors like
hypertension, diabetes along with dyslipedemia were
studied. Data (Figure 2) showed that 42% were
hypertensive, 35% were diabetic, 19% were
dyslipidemic, and in 34% of patients all the risk factors

Ann. Pak. Inst. Med. Sci. 2008;4(3): 165-167

Figure 3: Percentages of Different Types of


Dyslipidemias in Patients with Stroke

Discussion
Stroke continues to have a great impact on
public health. Stroke is frequent, recurring, and is more
often disabling than fatal. Although some determinants

166

Association of Dyslipidemia and Ischemic Stroke

of stroke, such as age, gender, race, ethnicity and


heredity cannot be modified, they are risk markers.
However more important are the modifiable factors
controlling them can and will reduce the incidence of the
disease 16. Hypercholesterolemia and various
lipoproteins fractions have been associated with the
severity of carotid atherosclerosis. Associations of
stroke and dyslipidemia have become quantified in
recent studies.
Figure 4 compares our results with previous
studies. In our study dyslipidemia including high
cholesterol, triglycerides and LDL along with low HDL
was 19%.while a Study done in Denmark it was 26% 17,
205 in a Yugoslavia study17, and in Iran study.17The
result of other risk factors were also similar to the
western and Asian studies. Hypertension was present in
42% of our patients similar to 30%, 47.9% and 54% in
Denmark 17, Yugoslavia 17 and Iran 17.However
association of diabetes was found to be higher 35% as
compare to 10-30% seen in western countries 18. Like in
a Yugoslavian study 17 it was 5.5%. While is similar
when compared to Asian studies, 45 % in an Iranian
study.17

Urooj Taheed Baluch et al

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Figure 4: Comparison of All the Three Risk


Factor between Our Study and Study from
Different Countries

14.

Conclusion
Our study although had a small no of sample
size and was over a short period of 60 days has results
similar to that of the western studies revealing
association of 15.4% to 30% of dyslipedemia to the
ischemic stroke. It also shows that not only high levels
of LDL,TG and cholesterol but low levels of good
cholesterol, HDL, is also associated with atherosclerosis
and in turn stroke. There is need of educating people
regarding there dietary habits and life style to reduce the
incidence of this disabling disease as prevention is
better than cure.

Ann. Pak. Inst. Med. Sci. 2008;4(3): 165-167

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