Patients who have suffered an atherothrombotic stroke and also have high triglyceride levels are at a higher risk of suffering another stroke within one year, even when they were taking statins, compared to stroke patients who do not have high triglycerides. These findings from a new study have been published in the journal Neurology.¹

This study enrolled 870 patients with acute ischemic stroke or transient ischemic attack (TIA) within one week of onset from the Tokyo Women’s Medical University Stroke Registry, which is an ongoing prospective, observational registry. The mean age of the participants was 70 years and males constituted nearly 61% of the study population. The objective of the study was to find any association between hypertriglyceridemia and continuing vascular risk in patients with atherothrombotic stroke manifesting as another nonfatal stroke or nonfatal acute coronary syndrome at one year. One-quarter of the patients (n=217) had hypertriglyceridemia with fasting triglycerides levels ≥150 mg/dL.

Patients with hypertriglyceridemia had significant intracranial artery stenosis (≥50%). The stenosis was more prominent in the anterior circulation, rather than extracranial artery stenosis.

Compared to patients without high triglycerides, the risk of stroke, heart attack or death was 21% higher in patients with hypertriglyceridemia compared to nearly 10% greater risk for those who did not have increased triglycerides. This risk was evident even after adjusting for variables like low-density lipoprotein (LDL) cholesterol and statin use.

Hypertriglyceridemia patients with atherothrombotic strokes were at a greater risk of recurrent vascular events with an annual rate of 35.1% versus 14.2% in non-hypertriglyceridemia patients. A similar elevated risk of vascular events was observed in hypertriglyceridemia patients with significant intracranial artery stenosis (annual rate 29.9% vs 14.7%, respectively) and extracranial carotid artery stenosis (annual rate 23.0% vs. 9.4%, respectively).

Fourteen out of the 114 patients (12%) with normal triglycerides had another stroke compared to 33 out of the 217 patients with high triglycerides. Less than one percent of patients (one out of 114) with normal triglyceride levels developed acute coronary syndrome one year after atherothrombotic stroke, whereas five out of the 60 patients (8%) with high triglyceride levels suffered an acute coronary syndrome after one year.

However, no such association was noted in patients with cardioembolic stroke in whom the annual rate of future vascular events was 19% vis a vis 10.5% in patients without hypertriglyceridemia.

This study has shown that atherothrombotic stroke patients with high triglycerides were still at risk of future vascular events despite the use of statins suggesting the role of hypertriglyceridemia as a risk factor for another stroke or cardiac events. Not just statins, a multipronged action to lower triglycerides is required. A note of caution here, this study only documents an association between raised triglycerides and risk of atherothrombotic strokes and does not establish a cause-and-effect relationship.

Reference

1. Hoshino T, et al. Prognostic role of hypertriglyceridemia in patients with stroke of atherothrombotic origin. Neurology Mar 2022, 10.1212/WNL.0000000000200112; DOI: 10.1212/WNL.0000000000200112.