Triglycerides and carotid intima-media thickness in ischemic stroke patients.

BACKGROUND: Common carotid artery intima-media thickness (CCA-IMT) is an established marker for atherosclerosis. The role of triglycerides in CCA-IMT remains controversial. We sought to determine if elevated fasting and post-challenge triglycerides are associated with CCA-IMT. METHODS: All acute ischemic stroke patients who participated in the Berlin "Cream & Sugar" study in the Charité Virchow and Charité Mitte Campuses between January 2009 and January 2014 and underwent carotid artery ultrasound studies were eligible for inclusion. A combined oral glucose and triglyceride tolerance test was performed 3-7 days after first ever ischemic stroke. Patients were classified according to triglyceride metabolism-namely, (1) patients reaching a maximum triglyceride levels 3 h post-challenge ("fast metabolizers," n = 37), (2) patients with increasing triglycerides 4 (medium metabolizers, n = 64), and (3) 5 h post-challenge ("slow metabolizers," n = 44; 13 missing). RESULTS: We included 158 patients (34% female; mean age 63 years, SD 14). Absolute non-fasting triglyceride levels were positively associated with CCA-IMT. A final multiple regression model revealed that older age, more severe strokes, and higher levels of fasting triglycerides were significantly and independently associated with higher mean CCA-IMT. Older age, higher waist-to-hip ratio, and higher levels of thyroid-stimulating hormone were independently associated with higher maximum CCA-IMT. CONCLUSION: Fasting triglycerides but not post-challenge triglycerides associate with CCA-IMT. An oral fat challenge may not add information on atherosclerotic status in ischemic stroke patients. CLINICAL TRIAL REGISTRATION INFORMATION: The Berlin "Cream & Sugar" study is registered with EudraCT (2009-010356-97) and clinicaltrials.gov (NCT 01378468).

The role of fasting versus non-fasting triglycerides in ischemic stroke: a systematic review.

OBJECTIVE: To synthesize results from pertinent studies and determine if fasting and/or non-fasting triglycerides are a risk factor for ischemic stroke. METHOD: We performed two independent systematic literature searches using the PubMed and ScienceDirect databases to identify studies examining the relationship between fasting and non-fasting triglyceride concentrations and ischemic stroke risk. A meta-analysis was performed using ischemic stroke as a primary endpoint. RESULTS: Twenty-five reports were identified, including 13 prospective cohort and 12 case-control studies. Baseline characteristics, study samples, methods, and primary outcomes varied. Of 13 prospective cohort studies, nine assessed triglyceride concentrations in the fasting state. Seven of these identified triglycerides as an independent risk factor for ischemic stroke risk (n = 1624 ischemic cases). Three prospective cohort studies identified a positive association between elevated non-fasting triglyceride concentrations and ischemic stroke risk (n = 2050 ischemic cases). One prospective cohort study that compared fasting and non-fasting triglycerides identified only non-fasting triglycerides as an independent risk factor for ischemic stroke. Of 12 case-control studies identified, five identified a positive relationship between ischemic stroke risk and elevated fasting triglycerides (n = 838 cases). Seven case-control studies were included in the meta-analysis (n = 1996 ischemic stroke cases), revealing an odds ratio of 1.15 (95% CI, 1.08-1.21). CONCLUSIONS: The available data are inconsistent. The relationship between triglyceride levels and ischemic stroke needs further investigation under standardized conditions. We recommend a standardized triglyceride tolerance test to further investigate the associations between fasting versus non-fasting triglyceride levels and ischemic stroke.