Association of Plasma Lipids with White Matter Hyperintensities in Patients with Acute Ischemic Stroke

Figures & data

Figure 1 Flowchart showing the patient selection.

Figure 2 (A–H) Sample images of WMH grade. A 53 years male patient with DWMH grade 0 and PVWMH grade 1 (A and B); A 60 years male patient with DWMH grade 1 and PVWMH grade 1 (C and D); A 55 years male patient with DWMH grade 2 and PVWMH grade 2 (E and F); A 86 years female patient with DWMH grade 3 and PVWMH grade 3 (G and H). A, C, E, G are axial T2WI images; B, D, F, H are coronal FLAIR images.

Table 1 Characteristics of AIS Patients without Previous Stroke

	DWMH Low-Burden N=519	DWMH High-Burden N=382	P	PVWMH Low-Burden N=399	PVWMH High-Burden N=502	P	Fazekas Score Low-Burden N=330	Fazekas Score High-Burden N=571	P
Age, yr	64.3±10.9	72.2±10.9	<0.001	61.8±10.2	72.3±10.4	<0.001	61.0±10.2	71.5±10.6	<0.001
Male (%)	360(69.4%)	224(58.6%)	0.001	281(70.4%)	303(60.4%)	0.002	238(72.1%)	346(60.6%)	<0.001
History of smoking (Y,%)	200(38.5%)	102(26.7%)	<0.001	162(40.6%)	140(27.9%)	<0.001	139(42.1%)	163(28.5%)	<0.001
History of drinking (Y,%)	128(24.7%)	84(22.0%)	0.350	100(25.1%)	112(22.3%)	0.333	82(24.8%)	130(22.8%)	0.478
Diabetes (Y,%)	206(39.7%)	145(38.0%)	0.598	153(38.3%)	198(39.4%)	0.737	123(37.3%)	228(39.9%)	0.431
History of heart disease (Y,%)	93(17.9%)	98(25.7%)	0.005	57(14.3%)	134(26.7%)	<0.001	49(14.8%)	142(24.9%)	0.001
Hypertension (Y,%)	363(69.9%)	321(84.0%)	<0.001	282(70.7%)	402(80.1%)	0.001	219(66.4%)	465(81.4%)	<0.001
HDL, mmol/L	1.24±0.28	1.29±0.29	0.013	1.24±0.28	1.28±0.29	0.031	1.23±0.28	1.28±0.29	0.009
TC, mmol/L	4.57±1.05	4.50±1.07	0.328	4.57±1.07	4.52±1.05	0.465	4.55±1.06	4.54±1.06	0.885
TG, mmol/L	1.74±1.10	1.57±1.07	0.022	1.77±1.10	1.59±1.08	0.020	1.79±1.14	1.60±1.06	0.014
LDL, mmol/L	3.12±0.93	3.03±0.94	0.169	3.12±0.94	3.04±0.94	0.189	3.11±0.94	3.06±0.93	0.386

Abbreviations: AIS, Acute ischemic stroke; DWMH, Deep white matter hyperintensities; PVWMH, Periventricular white matter hyperintensities; HDL, High density lipoprotein; TC, Total cholesterol; TG, Triglycerides; LDL, Low density lipoprotein.

Table 2 Associated Factors of DWMH Burden

	Unadjusted OR (95% CI)	P	Model 1 OR (95% CI)	P	Model 2 OR (95% CI)	P	Model 3 OR (95% CI)	P	Model 4 OR (95% CI)	P
HDL, mmol/L	1.809 (1.133–2.887)	0.013	1.229 (0.742–2.036)	0.424	1.230 (0.722–2.094)	0.446	1.240 (0.728–2.112)	0.428	1.487 (0.732–3.021)	0.273
TC, mmol/L	0.939 (0.828–1.065)	0.328	0.975 (0.850–1.118)	0.715	0.961 (0.836–1.106)	0.579	0.955 (0.830–1.099)	0.522	0.852 (0.575–1.261)	0.423
TG, mmol/L	0.859 (0.752–0.981)	0.025	0.983 (0.859–1.125)	0.804	0.966 (0.842–1.109)	0.628	0.968 (0.843–1.111)	0.642	1.026 (0.868–1.213)	0.760
LDL, mmol/L	0.905 (0.785–1.043)	0.170	0.970 (0.831–1.131)	0.693	0.962 (0.822–1.125)	0.626	0.954 (0.815–1.117)	0.560	1.102 (0.737–1.648)	0.637

Notes: Confounding factors: Model 1: age+sex; Model 2: age+sex+previous history (smoking, alcohol drinking, diabetes, cardiopathy, hypertension); Model 3: age+sex+previous history+admission NIHSS. Model 4: age+sex+previous history+admission NIHSS+other lipid fractions.

Abbreviations: NIHSS, The National Institutes of Health Stroke Scale; DWMH, Deep white matter hyperintensities; HDL, High density lipoprotein; TC, Total cholesterol; TG, Triglycerides; LDL, Low density lipoprotein.

Table 3 Associated Factors of PVWMH Burden

	Unadjusted OR (95% CI)	P	Model 1 OR (95% CI)	P	Model 2 OR (95% CI)	P	Model 3 OR (95% CI)	P	Model 4 OR (95% CI)	P
HDL, mmol/L	1.673 (1.047–2.674)	0.031	1.010 (0.591–1.725)	0.971	0.998 (0.571–1.742)	0.994	1.004 (0.575–1.752)	0.990	1.020 (0.486–2.140)	0.959
TC, mmol/L	0.955 (0.843–1.081)	0.465	1.034 (0.895–1.196)	0.649	1.022 (0.882–1.185)	0.769	1.017 (0.877–1.179)	0.828	1.026 (0.678–1.555)	0.902
TG, mmol/L	0.866 (0.765–0.980)	0.022	1.042 (0.905–1.199)	0.568	1.026 (0.889–1.184)	0.726	1.027 (0.890–1.185)	0.716	1.027 (0.863–1.221)	0.766
LDL, mmol/L	0.910 (0.791–1.047)	0.189	1.020 (0.866–1.200)	0.814	1.019 (0.864–1.201)	0.825	1.011 (0.857–1.194)	0.896	0.977 (0.638–1.497)	0.916

Notes: Confounding factors: Model 1: age+sex; Model 2: age+sex+previous history (smoking, alcohol drinking, diabetes, cardiopathy, hypertension); Model 3: age+sex+previous history+admission NIHSS. Model 4: age+sex+previous history+admission NIHSS+other lipid fractions.

Abbreviations: NIHSS:The National Institutes of Health Stroke Scale; PVWMH, Periventricular white matter hyperintensities; HDL, High density lipoprotein; TC, Total cholesterol; TG, Triglycerides; LDL, Low density lipoprotein.

Table 4 Associated Factors of Total WMH Burden (Fazekas Score)

	Unadjusted OR (95% CI)	P	Model 1 OR (95% CI)	P	Model 2 OR (95% CI)	P	Model 3 OR (95% CI)	P	Model 4 OR (95% CI)	P
HDL, mmol/L	1.922 (1.178–3.135)	0.009	1.165 (0.669–2.028)	0.589	1.192 (0.667–2.132)	0.554	1.197 (0.669–2.141)	0.544	1.080 (0.499–2.337)	0.845
TC, mmol/L	0.991 (0.872–1.126)	0.885	1.079 (0.930–1.252)	0.314	1.064 (0.914–1.239)	0.421	1.061 (0.911–1.236)	0.447	1.091 (0.707–1.682)	0.694
TG, mmol/L	0.860 (0.760–0.973)	0.016	1.022 (0.886–1.178)	0.770	0.993 (0.857–1.151)	0.928	0.994 (0.857–1.152)	0.932	0.986 (0.825–1.178)	0.876
LDL, mmol/L	0.938 (0.812–1.084)	0.385	1.055 (0.893–1.247)	0.562	1.055 (0.890–1.251)	0.537	1.051 (0.885–1.247)	0.572	0.964 (0.618–1.503)	0.871

Notes: Confounding factors: Model 1: age+sex; Model 2: age+sex+previous history (smoking, alcohol drinking, diabetes, cardiopathy, hypertension); Model 3: age+sex+previous history+admission NIHSS. Model 4: age+sex+previous history+admission NIHSS+other lipid fractions.

Abbreviations: NIHSS:The National Institutes of Health Stroke Scale; WMH, White matter hyperintensities; HDL, High density lipoprotein; TC, Total cholesterol; TG, Triglycerides; LDL, Low density lipoprotein.

Table 5 Multivariate Logistic Regression Analysis in Male AIS Patients

	DWMH		PVWMH		Total WMH Burden (Fazekas Score)
	Multivariate OR (95% CI)	P	Multivariate OR (95% CI)	P	Multivariate OR (95% CI)	P
HDL, mmol/L	2.342 (0.903–6.078)	0.080	1.259 (0.478–3.315)	0.642	0.949 (0.352–2.555)	0.917
TC, mmol/L	0.781 (0.451–1.354)	0.379	0.803 (0.460–1.403)	0.441	1.200 (0.682–2.110)	0.527
TG, mmol/L	1.013 (0.802–1.281)	0.911	1.077 (0.857–1.354)	0.525	0.973 (0.773–1.225)	0.816
LDL, mmol/L	1.140 (0.650–1.999)	0.648	1.215 (0.684–2.158)	0.506	0.833 (0.466–1.489)	0.538

Notes: Confounding factors: age+previous history (smoking, alcohol drinking, diabetes, cardiopathy, hypertension)+admission NIHSS+other lipid fractions.

Abbreviations: WMH, White matter hyperintensities; HDL, High density lipoprotein; TC, Total cholesterol; TG, Triglycerides; LDL, Low density lipoprotein.

Table 6 Multivariate Logistic Regression Analysis in Female AIS Patients

	DWMH		PVWMH		Total WMH Burden (Fazekas Score)
	Multivariate OR (95% CI)	P	Multivariate OR (95% CI)	P	Multivariate OR (95% CI)	P
HDL, mmol/L	0.716 (0.242–2.118)	0.546	0.817 (0.259–2.579)	0.731	1.314 (0.375–4.603)	0.670
TC, mmol/L	0.990 (0.557–1.759)	0.973	1.407 (0.765–2.589)	0.273	0.986 (0.485–2.008)	0.970
TG, mmol/L	1.046 (0.810–1.350)	0.732	0.992 (0.758–1.299)	0.956	1.012 (0.754–1.358)	0.937
LDL, mmol/L	1.016 (0.566–1.824)	0.957	0.747 (0.403–1.386)	0.355	1.146 (0.557–2.357)	0.711

Notes: Confounding factors: age+previous history (smoking, alcohol drinking, diabetes, cardiopathy, hypertension)+admission NIHSS+other lipid fractions.

Abbreviations: WMH, White matter hyperintensities; HDL, High density lipoprotein; TC, Total cholesterol; TG, Triglycerides; LDL, Low density lipoprotein.