Oxidized low-density lipoprotein predicts recurrent stroke in patients with minor stroke or TIA

Anxin Wang; Jie Xu; Guojuan Chen; David Wang; S Claiborne Johnston; Xia Meng; Jinxi Lin; Hao Li; Yibin Cao; Nan Zhang; Caiyun Ma; Liye Dai; Xingquan Zhao; Liping Liu; Yongjun Wang; Yilong Wang

doi:10.1212/WNL.0000000000006118

Oxidized low-density lipoprotein predicts recurrent stroke in patients with minor stroke or TIA

Neurology. 2018 Sep 4;91(10):e947-e955. doi: 10.1212/WNL.0000000000006118. Epub 2018 Aug 8.

Authors

Anxin Wang¹, Jie Xu¹, Guojuan Chen¹, David Wang¹, S Claiborne Johnston¹, Xia Meng¹, Jinxi Lin¹, Hao Li¹, Yibin Cao¹, Nan Zhang¹, Caiyun Ma¹, Liye Dai¹, Xingquan Zhao¹, Liping Liu¹, Yongjun Wang¹, Yilong Wang²

Affiliations

¹ From the Department of Neurology (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.), Beijing Tiantan Hospital, and Department of Epidemiology and Health Statistics (A.W.), School of Public Health, Capital Medical University; China National Clinical Research Center for Neurological Diseases (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.); Department of Neurology (G.C., Y.C.), Tangshan Gongren Hospital, North China University of Science and Technology, Tangshan, China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas, Austin.
² From the Department of Neurology (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.), Beijing Tiantan Hospital, and Department of Epidemiology and Health Statistics (A.W.), School of Public Health, Capital Medical University; China National Clinical Research Center for Neurological Diseases (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (A.W., J.X., X.M., J.L., H.L., N.Z., C.M., L.D., X.Z., L.L., Y.W., Y.W.); Department of Neurology (G.C., Y.C.), Tangshan Gongren Hospital, North China University of Science and Technology, Tangshan, China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas, Austin. yilong528@gmail.com.

PMID: 30089614
DOI: 10.1212/WNL.0000000000006118

Abstract

Objective: To investigate the association between oxidized low-density lipoprotein (oxLDL) and recurrent stroke in patients with minor stroke or TIA.

Methods: In the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial, baseline oxLDL levels were blindly measured in plasma with the 4E6 antibody in the core laboratory. The primary outcome was any stroke within 90 days. The secondary outcomes included any stroke within 1 year and ischemic stroke and combined vascular events within 90 days and 1 year. The associations of oxLDL with recurrent stroke were analyzed by Cox proportional hazards.

Results: Among 3,019 patients included in this study, the median (interquartile range) of oxLDL was 13.96 (6.65-28.81) μg/dL. After adjustment for conventional confounding factors, patients in the highest oxLDL quartile (≥28.81 μg/dL) had a higher risk of recurrent stroke within 90 days (hazard ratio 1.43, 95% confidence interval 1.03-1.98) compared to those in the lowest oxLDL quartile (<6.65 μg/dL). Similar results were found for secondary outcomes. We also found a J-shaped association between oxLDL and risk of each outcome. There were no significant interactions between oxLDL and low-density lipoprotein and use of dual antiplatelet, antihypertensive, antidiabetic, and statins agents.

Conclusions: Elevated oxLDL levels can independently predict recurrent stroke in patients with minor stroke or TIA.

Clinicaltrialsgov identifier: NCT00979589.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aspirin / therapeutic use
Blood Pressure / physiology
Body Mass Index
Clopidogrel / therapeutic use
Double-Blind Method
Female
Follow-Up Studies
Humans
Ischemic Attack, Transient / blood*
Ischemic Attack, Transient / drug therapy
Lipoproteins, LDL / blood*
Male
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use
Predictive Value of Tests
Recurrence
Severity of Illness Index
Stroke / blood*
Stroke / drug therapy

Substances

Lipoproteins, LDL
Platelet Aggregation Inhibitors
Clopidogrel
Aspirin

Associated data

ClinicalTrials.gov/NCT00979589