Serum lipid profiles and post-stroke depression in acute ischemic stroke patients

Abstract

Purpose: Post-stroke depression (PSD) is a psychiatric complication after stroke that leads to poorer stroke outcomes. Recent observational studies have indicated that lipid profiles were associated with a higher risk of stroke and depression. This study aims to further explore the possible relationship between serum lipid profiles and the development of PSD.

Methods: A total of 373 acute ischemic stroke patients were examined. Serum lipid profiles including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), apolipoprotein A1 (Apo A1) and apolipoprotein B (Apo B) were measured within 24 hrs of admission. Depression symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17) at the one-month follow-up, and HAMD scores ≥7 indicated a diagnosis of PSD.

Results: A total of 114 patients were diagnosed with PSD at the one-month follow-up, for a percentage of 30.6%. There were significant differences in HDL-C levels (P<0.001), LDL-C levels (P=0.002) and the LDL/HDL ratio (P<0.001) between the PSD and non-PSD groups, but no differences were observed in TGs, TC, Apo A1 or Apo B. Low serum HDL-C levels (r = −0.157, P<0.001) and elevated LDL-C levels (r =0.139, P=0.002) and the LDL/HDL ratio (r =0.227, P<0.001) were associated with HAMD scores. After adjusting for the NIHSS score, BI score, mRS score and alcohol consumption in the logistic analysis, low HDL-C levels and the highest quartile (≥3.07) of the LDL/HDL ratio were independently associated with the development of PSD (OR =0.250, 95% CI, 0.077–0.813, P=0.021 and OR =1.874, 95% CI, 1.050–3.347, P=0.034, respectively).

Conclusion: Decreased levels of HDL-C and elevated levels of LDL/HDL ratio are associated with PSD. HDL-C and the LDL/HDL ratio are independent predictors of PSD.

Keywords:

• lipid profiles
• high-density lipoprotein cholesterol
• LDL/HDL ratio
• post-stroke depression

Abbreviation list

PSD, post-stroke depression; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglycerides; TC, total cholesterol; Apo A1, apolipoproteins A1; Apo B, apolipoproteins B; BMI, body mass index; CAD, coronary artery disease; MDD, major depressive disorder; HAMD, Hamilton Depression Scale; NIHSS, National Institutes of Health Stroke Scale; BI, Barthel Index; mRS, modified Rankin Scale; IQR, interquartile range; SD, standard deviation; OR, odds ratio; CI, confidence intervals.

Supplementary material

Table S1 Clinical and demographic characteristics of the excluded and included samples

Acknowledgments

This study was supported by Wenzhou Municipal Sci-Tech Bureau Program (Y20160002), National Key Technology Research and Development Program of the Ministry of Science and Technology of China (grant number: 2015BAI13B01) as well as the Projects of National Science Foundation of China (No. 81873799). We are greatly indebted to the staff and to the patients for their contributions to this study.

Author contributions

Huiping Shen, Jincai He and Wenjie Tang designed the study and wrote the protocol. Authors Huiping Shen, Xinjie Tu, Xiaoqian Luan, Yaying Zeng collected data of study. Author Huiping Shen conducted literature searches and provided summaries of previous research studies. Author Huiping Shen conducted the statistical analysis. Authors Huiping Shen and Xinjie Tu wrote the first draft of the manuscript. All authors contributed toward data analysis, drafting and critically revising the article, gave final approval of the vesion to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.