The lipid profiles for asymptomatic intracranial arterial stenosis (aICAS) among rural residents in China were found to be characterized by high atherogenic cholesterol, low antiatherogenic cholesterol, and high ratios of atherogenic-to-antiatherogenic cholesterol or lipoproteins, according to a study published in the Journal of Clinical Lipidology.  

In the Asian population, ICAS is a common cause of ischemic stroke, and aICAS is associated with an overall 3-fold higher risk for ischemic stroke. Thus, the identification of clinically manageable risk factors for aICAS remains critical. The lipid profiles for aICAS may provide a unique fingerprint of lipid metabolism compared with those for cardiovascular and peripheral vascular atherosclerosis. Investigators sought to characterize the lipid profiles associated with aICAS in rural-dwelling adults in China.

In this population-based study, 2027 individuals (aged ≥40 years), free of stroke, were enrolled from 46 villages in the Shandong Province of China between October 2017 and October 2018. Data were collected via structured questionnaire survey, blood tests, and transcranial color Doppler (TCD) examinations. aICAS was diagnosed by integrating TCD with magnetic resonance angiography (MRA). Binary logistic and multinomial logistic regression models were used to determine the odds ratio (OR) for the presence and severity of aICAS associated with lipid parameters.

Of the 2027 individuals in this cohort, 154 (7.6%) were diagnosed with aICAS, of whom 33.8%, 24% and 42.2% were diagnosed with mild, moderate, and severe aICAS, respectively. Adults with vs without aICAS had increased levels of low density lipoprotein cholesterol (LDL-C), small dense low-density lipoprotein cholesterol (sdLDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), triglyceride (TG), apolipoprotein B (ApoB), ApoB/ApoA-1 ratio, LDL-C/HDL-C ratio, and total cholesterol (TC)/HDL-C ratio, as well as lower levels of HDL-C and ApoA-1 (P <.01).

The multi-adjusted OR of aICAS was 1.41 (95 %CI, 0.997-2.00) for high sdLDL-C, 1.44 (95 %CI, 1.02-2.04) for high lipoprotein(a), 1.71 (95 %CI, 1.21-2.44) for low ApoA-1, 1.43 (95 %CI, 1.00-2.04) for low HDL-C, 1.61 (95 %CI, 1.14-2.27) for a high apolipoprotein B (ApoB)/ApoA-1 ratio, 1.95 (95 %CI, 1.38-2.76) for high (LDL-C)/HDL-C ratio, and 1.51 (95 %CI, 1.06-2.14) for high total cholesterol (TC)/HDL-C ratio. Furthermore, low HDL-C, but not high LDL-C, was correlated with the presence of aICAS in this middle-aged and elderly population.

High levels of lipoprotein(a), sdLDL-C, and lipid ratios were significantly associated with an increased likelihood of moderate to severe aICAS when severity of aICAS was analyzed (P <.05). Lastly, a high number of abnormal lipid measurements was associated with an increased likelihood of aICAS (Ptrend <.001).

Limitations of the study include the inability to establish a causal relationship between lipid profiles and aICAS and a limited generalizability due to area homogenous population.

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“These findings may have potential implications for therapeutic interventions to slow aICAS progression and prevent clinical stroke,” concluded the study authors.

Reference

Wang S, Wang X, Zhao Y, Ji X, Sang S, Shao S, et al. Characterizing lipid profiles associated with asymptomatic intracranial arterial stenosis in rural-dwelling adults: A population-based study (published online April 19, 2020). Journal of Clinical Lipidology. doi.org/10.1016/j.jacl.2020.04.005