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.
Jimenez-Conde
Jordi
J
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.
Biffi
Alessandro
A
Rahman
Rosanna
R
Kanakis
Allison
A
Butler
Christi
C
Sonni
Shruti
S
Massasa
Efi
E
Cloonan
Lisa
L
Gilson
Aaron
A
Capozzo
Karen
K
Cortellini
Lynelle
L
Ois
Angel
A
Cuadrado-Godia
Elisa
E
Rodriguez-Campello
Ana
A
Furie
Karen L
KL
Roquer
Jaume
J
Rosand
Jonathan
J
Rost
Natalia S
NS
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*