Résumé
Background@#and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. @*Methods@#Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). @*Results@#Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). @*Conclusions@#The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.
Résumé
Risk factors for cardiovascular disease [CVD] are multifactorial. Previous research has reported a high prevalence of CVD risk factors in teagarden workers. This study was conducted to assess prevalence and level of modifiable cardiovascular risk factors among tea-garden and general population in Dibrugarh, Assam. A community-based cross-sectional study using the World Health Organization's [WHO] Stepwise methodology was conducted in Dibrugarh District of Assam. A multistep random sampling was done to include adults aged 35 years and above, with an intended equal sampling from tea-garden and general population. INTERHEART modifiable non-laboratory based risk score was estimated. Salt consumption was estimated using questionnaire-based methods in both subgroups. A total of 2826 individuals participated in the study [1231 [43.6%] teagarden workers; 1595 [56.4%] general population]. Tobacco consumption was higher in tea-garden workers as compared with general population [85.2% vs. 41.7% [p < 0.0001]. Mean daily per-capita salt consumption was also significantly higher among tea-garden workers [29.60 vs. 22.89g, p = 0.0001]. Overall prevalence of hypertension was similar [44.4% vs. 45.2%], but among those who had hypertension, prevalence of undiagnosed hypertension was higher in tea-garden workers [82.8% vs. 74.4%, p< 0.0001]. Tea-garden workers had lower BMI, were more physically active, and had a lower prevalence of diabetes mellitus and metabolic syndrome. Their INTERHEART modifiable risk score was also lower [1.44 [2.5] vs. 1.79 [2.8], p = 0.001]. High prevalence of modifiable risk factors like tobacco consumption, high salt intake and high prevalence of hypertension indicates the need for early implementation of preventive actions in this population