CardioSmart | Risk Factors for Heart Disease: LDL
High Triglycerides Linked to Stroke Risk
Researchers in Denmark say that high concentrations of triglycerides in the blood increase the risk of stroke.
By Nancy Walsh, MedPage Today
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Wednesday, Feb. 23, 2011- Elevated nonfasting triglycerides — but not cholesterol levels — were associated with an increased risk of ischemic stroke, a large Danish study found.
Compared with women whose nonfasting triglyceride levels were below 89 mg/dL, women whose triglycerides were 443 mg/dL or higher were about four times more likely to have a stroke caused by a blood clot, according to Dr. Marianne Benn, of Copenhagen University Hospital, and colleagues.
And among men, high triglycerides doubled the risk of stroke compared with men who had the lowest levels of triglycerides, the researchers reported online in theAnnals of Neurology.
Do Strokes Affect Women Differently?
Triglycerides, which are a type of fat found in the blood, are considered normal if the concentration is less than 150 mg/dL. Elevated triglycerides have been linked to obesity and diabetes.
Current stroke prevention guidelines provide advice on target cholesterol, but not nonfasting triglycerides.
Yet, Benn and colleagues pointed out, "Elevated nonfasting triglycerides are markers of elevated levels of cholesterol in lipoprotein remnants thought to be atherogenic in the same way as low-density lipoprotein (LDL) cholesterol, by accumulation in the arterial wall."
To explore a possible association between nonfasting triglycerides and ischemic stroke, the researchers analyzed data from the Copenhagen City Heart Study, which included 7,579 women and 6,372 men who had measurements of cholesterol and triglycerides at baseline between 1976 and 1978.
Mean age was 54. Median level of nonfasting triglycerides at baseline was 115 mg/dL in women and 151 mg/dL men.
Corresponding levels of total cholesterol were 240 mg/dL in women and 220 mg/dL in men.
At baseline, none of the participants were using lipid-lowering therapy.
During a median follow-up of 26 years, 837 men and 837 women had ischemic strokes.
The investigators suggested that a likely reason for the risk associated with nonfasting triglycerides is that they "are a marker of elevated lipoprotein remnant cholesterol."
Remnants, they explained, are particles of lipoprotein that form during the metabolism of the large lipoprotein particles known as chylomicrons, and particles of very-low-density lipoprotein.
These particles are capable of penetrating arterial walls, where they can deposit cholesterol in the intima. Ultimately, this can lead to atherosclerosis.
The researchers acknowledged that it was "difficult to explain" why cholesterol did not appear to be associated with risk of ischemic stroke except in men with the highest levels, since increases in both cholesterol and triglycerides increase the risk of other disorders such as myocardial infarction.
The difference may relate to pathogenesis of the different conditions, they suggested.
How Will You Know You're Having a Stroke?
"Myocardial infarction is mainly a thrombotic disease and ischemic stroke is mainly an embolic disease, and this difference in etiology could be part of the explanation of the findings," they wrote.
There also may be other factors contributing to ischemic stroke, such as disease of the heart valves.
Limitations to the study included the homogeneity of the population studied and blood sampling being done at inconsistent times of day.
"Our findings suggest that levels of nonfasting triglycerides should be included in guidelines as a marker of elevated levels of remnant lipoprotein cholesterol," they advised.
The study was funded by the Danish Medical Research Council, the Danish Heart Foundation, and the Chief Physician Johan Boserup and Lise Boserup's Fund.
One co-author has received lecture and consultancy fees from AstraZeneca, Abbott, Merck, Pfizer, sanofi aventis, and Boehringer Ingelheim.
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