Evidence map›Paper›PMID 35677977›Full record

ArticleJournal of stroke2022

Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE).

Martin J O'Donnell, Matthew McQueen, Allan Sniderman, Guillaume Pare, Xingyu Wang, Graeme J Hankey, Sumathy Rangarajan, Siu Lim Chin, Purnima Rao-Melacini, John Ferguson and 35 more

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of stroke, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
6.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

45 authors at 20 institutions in 28 countries.

Martin J O'DonnellPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Matthew McQueenPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Allan SnidermanDivision of Cardiology, McGill University Health Center, Montreal, QC, Canada.
Guillaume ParePopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Xingyu WangNational Center of Cardiovascular Disease, Beijing, China.
Graeme J HankeySchool of Medicine and Pharmacology, The University of Western Australia, Perth, Australia.
Sumathy RangarajanPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Siu Lim ChinPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Purnima Rao-MelaciniPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
John FergusonDepartment of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland.
Denis XavierSt John's Medical College and Research Institute, Bangalore, India.
Liu LishengNational Center of Cardiovascular Disease, Beijing, China.
Hongye ZhangBeijing Hypertension League Institute, Beijing, China.
Prem PaisSt John's Medical College and Research Institute, Bangalore, India.
Patricio Lopez-JaramilloFundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia.
Albertino DamascenoFaculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
Peter LanghorneDepartment of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK.
Annika RosengrenDepartment of Molecular and Clinical Medicine, Sahlgrenska Academy and University Hospital, University of Gothenburg, Gothenburg, Sweden.
Antonio L DansCollege of Medicine, University of Philippines, Manila, Philippines.
Ahmed ElsayedDepartment of Surgery, Al Shaab Teaching Hospital, Khartoum, Sudan.
Alvaro AvezumInternational Research Center, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil.
Charles MondoDepartment of Cardiology, Kiruddu National Referral Hospital, Kampala, Uganda.
Conor JudgeDepartment of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland.
Hans-Christoph DienerInstitute for Medical Informatics, Department of Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Danuta RyglewiczInstitute of Psychiatry and Neurology, Warsaw, Poland.
Anna CzlonkowskaDepartment of Neurology, Military Institute of Aviation Medicine, Warsaw, Poland.
Nana PogosovaNational Research Center for Preventive Medicine, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
Christian WeimarInstitute for Medical Informatics, Department of Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Romana IqbalDepartment of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Rafael DiazEstudios Clínicos Latino America (ECLA), Instituto Cardiovascular de Rosario (ICR), Rosario, Argentina.
Khalid YusoffUniversity College Sedaya International (UCSI) University, Kuala Lumpur, Malaysia.
Afzalhussein YusufaliDepartment of Medicine, Hatta Hospital, Dubai Health Authority, Dubai Medical College, Dubai, United Arab Emirates.
Aytekin OguzDepartment of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
Ernesto PenaherreraDepartment of Cardiology, Hospital Luis Vernaza, Guayaquil, Ecuador.
Fernando LanasFaculty of Medicine, University of La Frontera, Temuco, Chile.
Okechukwu S OgahDivision of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria.
Adesola OgunniyiDepartment of Medicine, University College Hospital, Ibadan, Nigeria.
Helle K IversenRigshospitalet, University of Copenhagen, Copenhagen, Denmark.
German MalagaCayetano Heredia University, Lima, Peru.
Zvonko RumboldtDepartment of Medicine, University of Split, Split, Croatia.
Shahram OveisgharanDepartment of Neurology, Rush Alzheimer's Disease Center, Chicago, IL, USA.
Fawaz Al HussainKing Saud University, Riyadh, Saudi Arabia.
Yongchai NilanontNeurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Salim YusufPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
INTERSTROKE Investigators
Population Health Research Institute · CANational Clinical Research Center for Digestive Diseases · CNOllscoil na Gaillimhe – University of Galway · IESt.John's Medical College Hospital · INUniversity College Hospital, Ibadan · NGUniversity of Duisburg-Essen · DEAga Khan University Hospital · PKDubai Health Authority · AEEduardo Mondlane University · MZFoscal Hospital · COGlasgow Royal Infirmary · GBHospital Alemão Oswaldo Cruz · BRHospital Luis Vernaza · ECInstitute of Psychiatry and Neurology · PLInstituto Cardiovascular de Rosario · ARIstanbul Medeniyet University · TRKing Saud University · SAMcGill University Health Centre · CANational Research Center for Preventive Medicine · RURush University · US

Funding

AstraZenecaBoehringer IngelheimCanadian Stroke NetworkChest, Heart and Stroke ScotlandCIHRHeart and Stroke Foundation of CanadaMSDPfizer CanadaRegion Vastra GotalandSwedish Heart and Lung FoundationSwedish Research CouncilThe Health & Medical Care Committee of the Regional Executive BoardThe Stroke AssociationThe UK-Stroke Research Network
6 · The paper itself

Abstract

background and purposeThe 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.

methodsStandardized 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).

resultsOur 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).

conclusionsThe 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.

Indexed as

ApolipoproteinsCase-controlDyslipidemiaLipoproteinsRisk factorStroke

Identifiers

PMID35677977
PMCPMC9194539
OpenAlexW4282023851

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.