Highlights
- •LDL-C and ApoB are associated with atherosclerotic stenosis in stroke patients.
- •ApoB was consistently associated with intracranial stenosis regardless of statin use.
- •LDL-C was associated with atherosclerosis only in statin-naïve patients.
- •This differential effect may partially explain the residual risk in statin use.
- •Lipid-lowering therapy targeting not only LDL-C, but also ApoB, is needed.
Abstract
Background and aims
To reduce cardiovascular risk, low-density lipoprotein cholesterol (LDL-C) is the
primary target of statin treatment, while apolipoprotein B (ApoB) is secondary. We
investigated the association between atherosclerotic stenosis and LDL-C or ApoB levels
and whether a difference in association exists according to pre-admission statin use
in ischemic stroke patients.
Methods
This retrospective cross-sectional study included consecutive patients with acute
ischemic stroke or transient ischemic attack who underwent lipid profile and angiographic
testing. Patients were categorized into four groups according to stenosis location:
normal, extracranial atherosclerotic stenosis (ECAS), intracranial atherosclerotic
stenosis (ICAS), or ECAS + ICAS. Subgroup analyses were performed by pre-admission
statin use.
Results
Of the 6338 patients included, 1980 (31.2%) were in the normal group, 718 (11.3%)
in the ECAS group, 1845 (29.1%) in the ICAS group, and 1795 (28.3%) in the ECAS + ICAS
group. Both LDL-C and ApoB levels were associated with every location of stenosis.
A significant interaction was found between pre-admission statin use and LDL-C level
(p for interaction <0.05). LDL-C was associated with stenosis only in statin-naïve patients,
whereas ApoB was associated with ICAS, with or without ECAS, in both statin-naïve
and statin-treated patients. ApoB also showed a consistent association with symptomatic
ICAS in both statin-treated and statin-naïve patients, whereas LDL-C did not.
Conclusions
ApoB was consistently associated with ICAS, particularly symptomatic stenosis, in
both statin-naïve and statin-treated patients. The close association between ApoB
levels and residual risk in statin-treated patients could be partially explained by
these results.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: March 19, 2023
Accepted:
March 17,
2023
Received in revised form:
February 14,
2023
Received:
November 21,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
