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High-density lipoprotein cholesterol is associated with lowered cognitive recovery among acute ischemic stroke patients with mild cognitive impairment

First author：Rui Wang,Zhuomin Jiao

Corresponding author： Jie Xu,Xia Meng

HDL Acute ischemic stroke Mild cognitive impairment Cognitive decline PSCI

essential_information

2023-09-26

Published articles

Journal：Acta Neurol Belg

Publication type: Clinical Trial

IF(IF): 2.7

PMID: 37752321 Link To Pubmed Full text Download

Background And Purpose

缺血性卒中后常伴发认知功能障碍，严重降低了患者日常活动的能力，并增加残疾和死亡风险。研究卒中后认知功能障碍好转的危险因素，对预防和治疗卒中后认知功能障碍有重要临床意义。队列研究显示[1]，中年时期血脂包括总胆固醇、低密度脂蛋白胆固醇(LDL-c)和甘油三酯水平升高，与之后老年期的认知能力下降显著相关。而卒中后降脂治疗与认知障碍风险降低也显著相关[2]。血脂异常与卒中后患者认知功能障碍的关系，目前未见报道。因此，我们推测急性缺血性卒中患者基线血脂相关指标异常对卒中后认知功能障碍改善有不利影响，同时探讨降脂治疗后血脂相关指标下降幅度对认知功能障碍改善的作用。明确血脂相关指标与卒中后认知功能障碍改善的风险关系。

Method

Five hundred fifty-eight AIS and MCI patients from the NICE study were enrolled, and divided into four groups, according to their baseline HDL quartiles; median HDL was 1.12 mmol/L (interquartile range 0.96-1.34 mmol/L). The primary outcome examined was the extent of cognitive improvement, defined as ΔMoCA (Montreal Cognitive Assessment) ≥ 2, while the secondary outcome was cognitive deterioration, defined as ΔADAS-cog (Alzheimer's Disease Assessment Scale-Cognitive Subscale) ≥ 4 or ΔMMSE (Mini-Mental State Examination) ≤ - 3, at 6-months post-AIS.

Conclusion

All these findings suggested that low plasma HDL was positively associated with improved cognitive functioning among AIS patients with MCI after 6 months.

Main results

We found that 314 (56.27%), 49 (8.78%), and 31 (5.56%) patients had ΔMoCA ≥ 2, ΔADAS-cog ≥ 4, and ΔMMSE ≤ - 3, respectively. Furthermore, cognitive improvement negatively correlated to HDL levels, with the lowest being present among patients in quartiles 4 (Q4; adjusted OR = 0.44, 95% CI 0.25-0.78, P = 0.0050) and Q3 (OR = 0.38, CI 0.23-0.65, P = 0.0004), compared to Q2 (OR = 0.57, CI 0.34-0.96, P = 0.0331). Q2 patients also had positive correlations with ΔADAS-cog ≥ 4 (OR = 5.18, CI 1.55-17.29, P = 0.0074). However, no association between HDL and ΔMMSE ≤ - 3 was observed, nor with LDL and any cognitive changes. Additionally, restricted cubic spline analysis found a nonlinear relationship between HDL and cognitive improvements.