European Journal of Cardiovascular Medicine

Cerebrovascular accidents (CVAs), also called as strokes, considered as second leading cause of death and disability globally1. World Stroke Organization (WSO) reported that over 13.7 million new strokes occur every year and annually about 5.5 million people dying because of stroke globally2. A CVA is defined as a rapidly developing sequence of clinical events leading to a focal or global loss of cerebral function lasting for a minimum of 24 hours or leading to death, with no apparent cause other than that of vascular origin3.

The pathological mechanism of stroke may be either ischemic and hemorrhagic disturbances of the cerebral blood circulation. Ischemic stroke occurs as a result of occlusion of any cerebral artery by a thrombus (thrombotic cerebral infarction) or embolus (embolic cerebral infarction), with ischemia in part or all of the territory supplied by the occluded artery. Populations with hypertension have a higher incidence of ischemic stroke. Furthermore, ischemic strokes affect a wide age group, particularly 7th to 9th decades of life4.

The association between dyslipidemia and atherosclerosis is well established and treating dyslipidemia can reduce the risk of stroke. Dyslipidemia, refers to presence of abnormal lipid levels in the blood, including increased low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC) and decreased levels of high-density lipoproteincholesterol (HDL-C)5. Although vascular disease is a main contributor in the pathogenesis of stroke6.

Hypercholesterolemia is also a known risk factor for stroke, with elevated levels of plasma low-density lipoprotein cholesterol (LDLC) and decreased levels of high-density lipoprotein cholesterol (HDLC) being associated with an increased risk of atherosclerosis. While there is strong evidence connecting high total cholesterol and LDL cholesterol levels, as well as low HDL cholesterol levels, with coronary artery sclerosis, the relationship between serum lipids, liver proteins, and cerebral vascular atherosclerosis remains less clearly understood4,7.

The correlation of dyslipidemia with coronary artery disease (CAD) has been extensively studied, along with various other risk factors. However, the association of dyslipidemia with stroke remains limited in India. Additionally, Indian patients have distinct social, lifestyle, and dietary habits compared to Western populations, which may influence the risk factors and outcomes related to stroke8. Therefore, it is important to investigate the differences in serum lipid levels across various stroke subtypes in Devanahalli, Bengaluru.

AIM

This study aimed to assess the lipid profile of stroke patients and to compare the lipid profile of hemorrhagic stroke and ischemic stroke in patients admitted to Akash hospital, Devanahalli, Bengaluru rural, Karnataka, India

This cross-sectional observational study was conducted in Department of General Medicine, Akash Institute of Medical Sciences and Research Centre (AIMSRC), Devanahalli, Bengaluru, Karnataka, India. In this study, a total of 112 patients with new onset ischemic and hemorrhagic stroke, confirmed by CT/MRI and presented within 24 hours of onset of stroke admitted in Akash hospital and fulfilled the inclusion and exclusion criteria were enrolled in this study.

Inclusion Criteria

Patients who were willing to participate in the study, patients with new onset stroke confirmed by CT and presented within 24 hours of onset of stroke were taken into study.

Exclusion Criteria

Patients who are not willing to participate in the study, patients aged under 18 years.

Sample size calculation

Sample size was calculated by using the formula n= Z2pq/d2 with a power of 80% and Type I error of 5%. Simple random sampling method was followed for recruiting the study subjects4.

Estimation of biochemical parameters

Under aseptic conditions, venous blood samples were collected, centrifuged to obtain serum sample. The obtained serum was used for biochemical analysis of total cholesterol (cholesterol oxidase/peroxidase), triglycerides (glycerol phosphate oxidase/peroxidase), HDL-C (HDL-C- Direct) were estimated by using Cobas C111 Biochemistry fully auto analyzer. LDL-C and VLDL-C were calculated by Frieldwald’s formula. Detailed history, physical and clinical examination was done for all the study subjects.

Statistical Analysis

The results were represented in mean±SD. Categorical variables expressed in number and percentages. Mann Whitney U test was applied. P-value <0.05 was considered as significant. Analysis of data is done using Statistical package for social science 22.00 (SPSS 22.00 for windows; SPSS inc, Chicago, USA).

This study is aimed to assess and compare the lipid profile hemorrhagic and ischemic stroke by involving 112 patients. Among them, males were 63 (56.2%) and females were 49 (43.8%).

In this study, 68 (60.7%) cases were above 60 years of age, 28 (25%) were 51-60 years of age, 10 (8.9%) were 41-50 years of age and 6 (5.3%) were in 31-40 years of age group. Among the comorbidities, hypertension 42 (37.5%) emerges as the most prevalent. Diabetes mellitus was in 30 (26.7%) cases, coronary heart disease in 22 (19.6%) and 18 (16.0%) cases were without comorbidities as shown in table 1. In this study, 88 (78.6%) cases were with infarcts and 24 (21.4%) cases were hemorrhagic. Majority of subjects were non-smokers 58 (51.8%) and smokers were 54 (48.2%) as shown in table 1.

Table 1: Prevalence of comorbidities, type of stroke and smoking status among study subjects

In this study, lipid profile parameters were compared between study subjects with hemorrhage and infarcts.Serum cholesterol (196.88±21.40) levels were significantly increased in haemorrhagic stroke compared with infarcts. There are no statistically significant differences were observed in HDL, LDL, VLDL and triglycerides levels between hemorrhagic and ischemic stroke as shown in table 2.

      Table 2: Comparison of lipid profile in hemorrhagic stroke and ischemic stroke among patients in the study

      * Statistically significant

In a comparison of lipid profiles between smokers and non-smokers, significant differences were observed in LDL (smokers 94.4±20.3 mg/dL vsnon-smoker 104.96±22.9 mg/dL). However, no statistically significant differences were observed in total cholesterol, HDL, VLDL and triglycerides levels between smokers and non-smokers as indicated in table 3.

        Table 3: Comparison of lipid profile in smokers and non-smokers among the patients in the study

         * Statistically significant

In a comparison of lipid profiles between patients with diabetic and non-diabetic subjects, significant differences were observed in total cholesterol levels (diabetic 192.8±31.4 mg/dL vsnon-diabetic 178.8±30.0 mg/dL), increased Triglycerides (diabetics 132.6±18.6 mg/dL vsnon-diabetic 121.9±36.0 mg/dL). However, no statistically significant differences were observed in HDL, LDL and VLDL levels between diabetic and non-diabetic subjects as shown in table 4.

      Table 4: Comparison of lipid profile in Diabetic and Non-Diabetic among patients in the study

      * Statistically significant

This study is aimed to assess and compare the lipid profile hemorrhagic and ischemic stroke by involving 112 patients. Among them, males were 63 (56.2%) and females were 49 (43.8%).

In accordance of our study findings, a study by Murphy SJ et al., reported that the incidence of stroke is higher in males compared with females until menopause, which is when females lose the anti-thrombotic benefits of endogenous estrogen9. In a study conducted by SB. Vijeth et al., reported more prevalence of stroke in males than females7.

In this study, 68 (60.7%) cases were above 60 years of age, 28 (25%) were 51-60 years of age, 10 (8.9%) were 41-50 years of age and 6 (5.3%) were in 31-40 years of age group. This suggests a significant proportion of the population falls into the elderly age group. In support of our findings Singh JP et al., reported that most common age groups were 61-85 years10.

In terms of type of stroke in our study, ischemic stroke emerges as most prevalent accounting for 88 (78.6%) patients, while haemorrhagic in 24 (21.4%) patients. In support of our findings Nirmala AC et al., study reported that 145 (82%) patients had ischemic stroke and 32 (18%) patients had haemorrhagic stroke4.Hypertension was the

most predominant comorbidity.  Unsurprisingly,

hypertension has been identified as the single most predominant risk factor for stroke11. Similarly, Siddeswari R et al., study also reported that out of 100 patients, 82 had ischemic stroke and 18 had haemorrhagic stroke8.

In the comparison of lipid profiles between patients with haemorrhagic stroke and ischemic stroke, total cholesterol levels were significantly increased in hemorrhagic stroke (p < 0.001). In a study conducted by Mi T et al., reported that increased serum cholesterol is a risk factor for stroke12.

Decreased HDL was seen in all the stroke patients. Similarly, in SB. Vijeth et al., raised total cholesterol levels were seen in 53.8% patients. HDL levels were most common rate deranged in both ischemic and haemorrhagic stroke 7.Also, Singh V et al., reported decreased HDL levels was most common pattern of dsylipidemia observed in stroke followed by raised total cholesterol10.

In a comparison of lipid profiles between patients with smoker and non-smoker statistically significant differences were observed as raised LDL among non-smokers. Similarly, Nirmala AC et al., reported that most common parameter deranged in non-smokerswas increased LDL4.

In comparison of lipid profiles between diabetic stroke and non-diabetic stroke, statistically significant differences were observed in increased total cholesterol levels and increased triglyceride levels among the diabetic stroke group. In accordance with our findings, Gupta R et al., reported that mean levels of lipids were significantly higher in diabetic strokes compared to non-diabetic strokes13. Similarly, Hakim Mohammad Shafi et al., in their study observed that prevalence of dyslipidemia was higher in diabetic stroke as compared to non-diabetic stroke14.DM causes endothelial cell damage, inflammation and premature arterial stiffness, which contribute to plaque deposition; hence, DM has been recognized as a modifiable risk factor for CVA15. Another study describes a higher risk and prevalence of DM type II in patients with hyperlipidemia than in the control population 16.

LIMITATIONS

This has a small sample size, this study is not a follow-up study and thus does not shed light on the progression of the patients thus necessitating follow-up.

In a comparison of lipid profiles between patients with hemorrhagic stroke and ischemic stroke, statistically significant differences were observed as raised total cholesterol levels. In comparison of lipid profiles between smokers and non-smoker significant differences were observed in increased LDL among non-smokers. Decreased HDL was seen in all the stroke patients. Inthe comparison of lipid profiles between Diabetic and non-diabetic stroke patients, increased total cholesterol and triglyceride levels among the diabetic group. Overall, these findings emphasize the importance of holistic approaches encompassing lifestyle modifications, risk factor control, and personalized pharmacotherapy with hypolipidemic drugs may help in reducing the mortality and morbidity of stroke.

Funding: Nil

Conflict of interest: Nil

Acknowledgements: We would like to thank the authorities of Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bengaluru, Karnataka, India.

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