Hyperlipidemia and reduced white matter hyperintensity volume in patients with ischemic stroke.
OBJECTIVE
White matter hyperintensity (WMH), or leukoaraiosis, is a radiologic finding generally assumed to reflect diseased small cerebral vasculature. WMH has significant functional impact through its relation to cognitive decline and risk of ischemic and hemorrhagic stroke. Accumulating evidence suggests that some manifestations of small-vessel disease such as intracerebral hemorrhage are associated with low levels of cholesterol. We sought to determine the relation between hyperlipidemia and WMH severity in patients with acute ischemic stroke (AIS).


METHODS
We analyzed 2 independent, hospital-based AIS cohorts. Demographic and clinical data were collected prospectively. WMH was measured using semiautomated volumetric image analysis and a semiquantitative visual grading scale. Univariate and multivariable regression analyses were used to assess the relation between WMH severity and study variables.


RESULTS
A total of 631 and 504 subjects in the first and second cohorts, respectively, were included. In univariate analyses, advancing age and hypertension were associated with severity of WMH (P<0.001) in both cohorts. In the multivariable analysis, after controlling for age, sex, and significant risk factors in the univariate and age-adjusted analyses, patients with a history of hyperlipidemia had less severe WMH in both cohorts (P<0.01).


CONCLUSIONS
Results from 2 independent cohorts demonstrate that AIS patients with a history of hyperlipidemia have less severe WMH at the time of stroke. These data support the hypothesis that hyperlipidemia may play a relatively protective role in cerebral small-vessel disease.
Stroke Service, Department of Neurology and Center for Human Genetics Research, Massachusetts General Hospital, and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard University, Boston, Mass 02114, USA.
Jordi
J
Jimenez-Conde
Alessandro
A
Biffi
Rosanna
R
Rahman
Allison
A
Kanakis
Christi
C
Butler
Shruti
S
Sonni
Efi
E
Massasa
Lisa
L
Cloonan
Aaron
A
Gilson
Karen
K
Capozzo
Lynelle
L
Cortellini
Angel
A
Ois
Elisa
E
Cuadrado-Godia
Ana
A
Rodriguez-Campello
Karen L
KL
Furie
Jaume
J
Roquer
Jonathan
J
Rosand
Natalia S
NS
Rost
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000097:blood / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011446:Prospective Studies; D020521:Stroke / Q000097:blood / Q000473:pathology*