Abstract
INTRODUCTION: Dyslipidemia is the most important causal risk factor for atherosclerotic cardiovascular diseases (ASCVD). Atherosclerosis affects multiple vascular beds, accounting for nearly majority of Coronary heart disease and some proportion of Ischemic strokes. Baseline lipid levels have an effect on the short-term mortality due to cerebrovascular accident (CVA). But in some studies, there was no dyslipidemia in patients who presented with acute ischemic stroke. It is important to evaluate the serum lipid levels in both the types of strokes to guide lipid lowering therapy, which can reduce incidence of stroke and related mortality. This study is undertaken to analyse and evaluate the role of serum lipids in patients of stroke in our centre. The recently updated guidelines for management of dyslipidemia from the European Society of Cardiology (ESC), European Atherosclerosis society (EAS) and Lipid association of India (LAI) presents a further challenge since they recommend aggressive goals for LDL lowering based on the risk profile. Literature shows that aggressive lipid management is initiated but not maintained in patients with ischemic stroke. OBJECTIVES: Analyse and evaluate the lipid values in Acute ischemic stroke to initiate aggressive lipid management. MATERIALS AND METHODS: It's a Prospective observational study for the period of six months, enrolled 63 patients of Acute Ischemic Stroke admitted at our center. Serum lipid profile was measured in all patients. Data was entered in Microsoft Excel and analysed by descriptive statistics. Patients between 40 – 80 years of age of either sex with clinical findings, brain CT-scan or MRI indicative of cerebral infarction were enrolled in this study. The patients with cardio-embolic stroke, hemorrhagic stroke, any underlying diseases especially liver disease, familial hypercholesterolemia, hypothyroidism and pregnancy were excluded. With Ethics committee's approval, patients parameters such as Age, Sex, Weight, Co-morbidities (hypertension, diabetes, ischemic heart disease, previous stroke, LDL value, HDL value, Total cholesterol, Triglycerides, non HDL, HbA1C, history of lipid lowering drugs, were entered on Excel sheet. RESULTS: In this study conducted on 63 patients, its been found that females accounts for 25%, Incidence of Young adult stroke was significant,(16%). Patients with co-morbidities were significant in number (71.4%.) Patients on antilipid treatment were few (9.6%), amongs all ischemic stroke patients Out of 63, diabetic patients (HbA1C > 6.5%) were 31, among those 48.5% of patients had LDL > 100 mg/dL, in 9.6% patients had LDL values between 71–100 mg/dL and in 41.90% of patients had LDL < 70 mg/dl. VLDL values were deranged more commonly in diabetic group than in non-diabetic group. The TG levels, however, did not influence the risk of ischemic stroke. DISCUSSIONS: An increase in low-density lipoprotein (LDL) cholesterol or a decrease in high-density lipoprotein (HDL) cholesterol may be additional risk factors for cerebrovascular diseases. In this study, we prospectively evaluated patients with ischemic stroke (except for cardioembolic) with lipid values such as serum cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, very low-density lipoprotein cholesterol, and apoprotein A and B. In the ischemic stroke patient, age and high levels of LDL are associated with greater risk of developing ischemic stroke. The TG levels, however, did not influence the risk. Findings of the present study indicating no role for TG values in the ischemic strokes. One meta-analysis found that in clinical trials reductions in LDL-C level were associated with a significant relative risk reduction in stroke for the atherosclerotic subtype. Also found that treatment with cholesterol-lowering medications modified the effect of an elevated LDL-C level, such that those not taking medications did not have an association with ischemic stroke risk. Stroke risk reduction strategies aimed at reducing all components of the plasma lipid profile will have significant benefits. CONCLUSIONS: Although serum lipids are well known risk factors for atherosclerosis, the relationship between serum lipid profile and ischemic stroke is not very strong. While the increased serum cholesterol level is directly related to the risk of coronary disease. But the relationship between cholesterol level and the risk of stroke remains undetermined because dyslipidemia alone may not be causative factor for development of stroke. Targetting high LDL levels should be the primary goal to reduce these events and eventually decrease the related morbidity and mortality rates. The present study was designed to evaluate the lipid profile levels in patients of acute ischemic stroke. Its been found that the incidence of young stroke was 16%. This small study gives very strong indication for complete evaluation to define risk factors for development of ischemic stroke.