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September 04, 2018; 91 (10) Article

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
First published August 8, 2018, DOI: https://doi.org/10.1212/WNL.0000000000006118
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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.

ClinicalTrials.gov identifier: NCT00979589.

Glossary

BMI=
body mass index;
BP=
blood pressure;
CHANCE=
Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events;
CI=
confidence interval;
CVD=
cardiovascular disease;
HR=
hazard ratio;
LDL=
low-density lipoprotein;
NIHSS=
NIH Stroke Scale;
oxLDL=
oxidized low-density lipoprotein

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Comment Page 443

  • Received October 23, 2017.
  • Accepted in final form May 10, 2018.
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