Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the Prevalence of Asymptomatic Intracranial Atherosclerotic Stenosis

Kaijiang Kang; Yu Wang; Jianwei Wu; Anxin Wang; Jia Zhang; Jie Xu; Yi Ju; Xingquan Zhao

doi:10.3389/fneur.2020.555274

Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the Prevalence of Asymptomatic Intracranial Atherosclerotic Stenosis

Front Neurol. 2020 Nov 26:11:555274. doi: 10.3389/fneur.2020.555274. eCollection 2020.

Authors

Kaijiang Kang^{1

2

3

4}, Yu Wang^{1

2

3

4}, Jianwei Wu^{1

2

3

4}, Anxin Wang^{1

5

6}, Jia Zhang^{1

2

3

4}, Jie Xu^{1

2

3

4}, Yi Ju^{1

2

3

4}, Xingquan Zhao^{1

2

3

4}

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
⁴ Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
⁵ Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
⁶ Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.

Abstract

Background and Purpose: Intracranial atherosclerosis has gained increasing attention due to the high risk of recurrent clinical or subclinical ischemic events, while the relationship between low-density lipoprotein cholesterol (LDL-C) measured at a single time point and intracranial atherosclerotic stenosis (ICAS) is inconsistent. This study aims to assess the association between cumulative exposure to increased LDL-C and the prevalence of asymptomatic ICAS. Methods: The Asymptomatic Polyvascular Abnormalities Community study was investigated on the epidemiology of asymptomatic polyvascular abnormalities in Chinese adults. In this study, we included 4,523 participants with LDL-C measured at 3 examinations in 2006, 2008, and 2010. Cumulative exposure to increased LDL-C was calculated as following: LDL-C burden_2006-2008 = [(LDL-C₂₀₀₆-1.8) + (LDL-C₂₀₀₈-1.8)]/2 ^* time_2006-2008; LDL-C burden = LDL-C burden_2006-2008 + LDL-C burden_2008-2010. Transcranial doppler ultrasonography was performed in 2010 to detecting the ICAS. Results: Of the 4,347 patients, 13.3% (580/4,347) were diagnosed with ICAS. In univariate analysis, the association between LDL-C burden and ICAS prevalence was significant, the odds ratios (95% confidence interval) from the lowest to the highest quartile were 1 (reference), 1.30 (0.99-1.70), 1.32 (1.01-1.73), and 2.14 (1.66-2.75), respectively (P < 0.05). After adjustment for potential confounding factors, the same result was reached. Conclusions: Cumulative exposure to increased LDL-C is concentration-dependently associated with increased prevalence of asymptomatic ICAS, especially in those under the age of 65 y or free of hypertension, diabetes mellitus, and hyperlipidemia.

Keywords: LDL-C; TCD; epidemiology; intracranial atherosclerotic stenosis; risk factor.