Study of correlation between dyslipidemia and cerebrovascular accidents in non-diabetic patients at tertiary health care center

 

Raju Talawar¹, Darshna Makwana^2*

 

¹Assistant Professor, Department of General Medicine, J.N.M.C. Nehru Nagar, Belagavi, Karnataka-590010, INDIA.

²Assistant Professor, Department of General Medicine, B.J.M.C. Asarwa, Ahmedabad, Gujarat, INDIA.

Email: drrajutalawar@gmail.com

 

RESULT

 

Table 1: CT Scan Of Brain (Territory Infarct Distribution)

 

Severity of ischemic stroke at onset was measured using NIHS Scale. Mild (0-6)- 32 pts, Moderate (7-14)- 13 pts, Severe (<14)- 5 pts. Among the whole population mid mNIHSS scale (0-6) was found in 32 patients, moderate NIHSS scale (7-14) was observed in 13 patients and severe mNIHSS scale (>14) was found in 5 patients. The mild mNIHSS scale contributes 64% of whole population, moderate and severe mNIHSS scale contributes 26% and 10% of study population

 

Table 1: Co-relation between mNIHSS score and Lipid profile:

The study showed significant correlation between NIHSS measured by Pearson correlation value and p value of lipid abnormalities at onset of stroke. The study showed significant p value for LDL (0.00) and also high r value for LDL (0.49). The p value of other lipids is also significant but r value is not significantly high.

 

Table 3: Co-relation between MRS and Lipid profile

MRS score showed a good clinical outcome with reduction in LDL levels and the corresponding P value is 0.26 and r value of 0.15 which is significant.

 

DISCUSSION

Epidemiological studies suggest that patients with elevated lipid levels are at higher risk for CVA. Although serum lipids have been incriminated in the pathogenesis of atherosclerosis, very little is known concerning the possible inter-relationship between abnormal levels of serum lipids and development of vascular complications. Belief in the possibility of such interrelationship arouse in part from the observation that lipid composition of the intima of the arteries resembles that of serum. Hence Dyslipidemia has emerged clearly as a major risk factor associated with increased risk of atherosclerosis. The relationship between atherosclerosis and elevated serum lipids is well established and aggressive treatment of dyslipidemia decreases the risk of stroke.¹ Recent studies have shown that distribution of triglycerides and cholesterol within major lipoprotein classes are of importance for the development of atherosclerosis, which is the precursor to stroke.² Hypercholesterolemia is a moderate risk factor for stroke.² Elevated plasma concentration of low density lipoproteins (LDL) and low high density lipoprotein concentration (HDL) are associated with an increased risk of atherosclerosis.2 While there is an overwhelming amount of evidence relating high levels of serum total and LDL cholesterol and low levels of HDL cholesterol with coronary atherosclerosis, the relation between serum lipids, lipoproteins and cerebrovascular atherosclerosis is less clear.³ Studies of cholesterol levels in stroke patients have revealed results varying from insignificant changes to a moderate elevation. The mild mNIHSS scale contributes 64% of whole population, moderate and severem NIHSS scale contributes 26% and 10% of study population. Severity of ischemic stroke at onset was measured using NIHS Scale. Mild (0-6)- 32 pts, Moderate (7-14)- 13 pts, Severe (<14)- 5 pts.Among the whole population mid mNIHSS scale (0-6) was found in 32 patients, moderate NIHSS scale (7-14) was observed in 13 patients and severe mNIHSS scale (>14) was found in 5 patients. The mild mNIHSS scale contributes 64% of whole population, moderate and severe mNIHSS scale contributes 26% and 10% of study population. In our study there was significant p value for LDL (0.00) and also high r value for LDL (0.49). The p value of other lipids is also significant but r value is not significantly high.MRS score showed a good clinical outcome with reduction in LDL levels and the corresponding P value is 0.26 and r value of 0.15 which is significant.MRS score showed a good clinical outcome with reduction in LDL levels and the corresponding P value is 0.26 and r value of 0.15 which is significant. K Sreedhar found in 32 patients had elevated serum total cholesterol levels, of which 81.3% had ischaemic stroke and the rest haemorrhagic stroke. 10 patients had elevated serum triglyceride levels, of which 80% had ischaemic stroke and the rest haemorrhagic stroke. 33 patients had elevated serum low density lipoprotein levels of which 75.8% had ischaemic stroke whereas the remaining had haemorrhagic stroke

 

CONCLUSION

It can be concluded from our study that there good co-relation is found with LDL i.e. good clinical outcome was with reduced level of it so the intervention should be directed specifically to reduce the level it.

 

REFERENCES

1. Central Bureau of Health Intelligence. National Health Profile. New Delhi: Directorate General of Health Sciences, 2008:102
2. World Health Organization. Workshop Report on Stroke Surveillance in India. (last checked 28 June 2012)
3. Gotto AM. Some reflections on arteriosclerosis: past, present, and future. Circulation 1985; 72:8-17.
4. American Heart Association. Heart disease and stroke statistics-2006 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Committee. Circulation 2006 e85-e151.
5. Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G et al. Primary Prevention of Ischemic Stroke: A Statement for Healthcare Professionals from the Stroke Council of the American Heart Association. Circulation. 2001; 103:163.
6. Ballantyne CM, Herd JA, Ferlic LL, et al. Influence of low HDL on progression of coronary artery disease and response to fluvastatin therapy. Circulation. 1999; 99(6):736-743.
7. Gordon DJ, Probstfield JL, Garrison RJ, et al. High-density lipoprotein cholesterol and cardiovascular disease: four prospective American studies. Circulation.1989; 79(1):8-15.
8. Miller GJ, Miller NE. Plasma-high-density-lipoprotein concentration and development of ischaemic heart-disease. Lancet. 1975;1(7897):16-19.
9. Stampfer MJ, Sacks FM, Salvini S, Willett WC, Hennekens CH. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med. 1991; 325(6):373-381.
10. Kasnel SE, Cccchian BL, Chalela JA (2005). Modified NIHS scale can be estimated from stroke records.Stroke 34 (2): 568- 70.
11. Wilson JL, Harendran, Grant M et al. (2002). Improving the assessment of outcome in the stroke: use of a structural interview to assign grades on the MRS. Stroke 33 (9): 2243- 48.
12. Harrison’s principles of internal medicine, 19^th edition, vol2, cerobrovascular diseases, page no 2559-61.
13. Park’s textbook of preventive and social medicine, 23^rd edition, epidemiology of chronic non communicable diseases, page no 368-71.
14. K Sreedhar, BanumathySrikant,  Laxmikant Joshi. Lipid Profile in Non-Diabetic Stroke – A Study of 100 Cases. JAPI. september2010; 547-551.