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Research Article| Volume 371, P14-20, April 2023

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Differential association between apolipoprotein B and LDL cholesterol and cerebral atherosclerosis according to pre-stroke statin use

  • Minyoul Baik
    Affiliations
    Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea

    Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, South Korea
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  • Hyo Suk Nam
    Affiliations
    Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea

    Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, South Korea
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  • Ji Hoe Heo
    Affiliations
    Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea

    Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, South Korea
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  • Hye Sun Lee
    Affiliations
    Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
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  • Young Dae Kim
    Correspondence
    Corresponding author. Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
    Affiliations
    Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea

    Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, South Korea
    Search for articles by this author

      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

      Keywords

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