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

Figures & data

Table 1 Clinical and demographic characteristics of the patients

	PSD (114)	Non-PSD (259)	P-value
Sex; M/F	66/48	172/87	0.116
Age (years), mean ± SD	62.07±11.40	63.23±9.80	0.320
BMI (kg/m^2), mean ± SD	24.19±4.40	24.51±8.14	0.709
Years of education, median (IQR)	4.5 (0–6)	4 (0–7)	0.610
Marital status, married, n (%)	101 (88.6)	231 (89.2)	0.809
Lesion location, n (%)
Frontal lobe	14 (12.3)	35 (13.5)	0.745
Parietal lobe	11 (9.6)	20 (7.7)	0.535
Temporal lobe	6 (5.3)	10 (3.9)	0.538
Occipital lobe	7 (6.1)	16 (6.2)	0.989
Basal ganglia	56 (49.1)	116 (44.8)	0.439
Brainstem	5 (4.4)	13 (5.0)	0.793
Cerebellum	3 (2.6)	8 (3.1)	0.810
Other	12 (10.5)	21 (8.1)	0.449
Vascular risk factors, n (%)
Hypertension	81 (71.1)	185 (71.4)	0.941
Diabetes mellitus	28 (24.6)	55 (21.2)	0.477
CAD	5 (4.40)	21 (8. 10)	0.193
Current smoking	31 (27.2)	77 (29.7)	0.619
Current alcohol consumption	32 (28.1)	105 (40.5)	0.021
Neuropsychological function
NIHSS score at baseline, median (IQR)	3 (2–6)	2 (1–3)	<0.001
BI at discharge, median (IQR)	95 (75–100)	100 (100–100)	<0.001
mRS at 1 month, median (IQR)	2 (1–3)	1 (1–2)	<0.001
Laboratory findings
HDL-C (mmol/L), mean ± SD	1.04±0.24	1.15±0.27	<0.001
LDL-C (mmol/L), mean ± SD	2.94±0.88	2.64±0.87	0.002
LDL/HDL ratio, median (IQR)	2.77 (2.26–3.56)	2.32 (1.75–2.87)	<0.001
TC (mmol/L), mean ± SD	4.81±1.08	4.60±1.05	0.081
TGs (mmol/L), mean ± SD	1.77±1.05	1.72±1.07	0.639
Apo A1 (g/L), median (IQR)	1.10 (1.00–1.38)	1.20 (1.00–1.40)	0.449
Apo B (g/L), median (IQR)  Apo B/Apo A1, median (IQR)	0.90 (0.70–1.10) 0.72 (0.61–0.96)	0.90 (0.70–1.10) 0.72 (0.57–0.85)	0.965 0.566

Notes: Values are shown as number (percentage) or as medians (IQR) and mean (SD). Values of P<0.05 were considered to be statistically significant.

Abbreviations: PSD, post-stroke depression; BMI, body mass index; CAD, coronary artery disease; NIHSS, National Institutes of Health Stroke Scale; BI, Barthel Index; mRS, modified Rankin Scale; 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; SD, standard deviation; IQR, interquartile range.

Figure 1 Study recruitment profile.

Abbreviation: PSD, post-stroke depression.

Figure 2 Comparisons of HDL-C, LDL-C and LDL/HDL ratios in patients with and without PSD. (A) HDL-C levels, (B) LDL-C levels, (C) LDL/HDL ratio. In the box-and-whisker plots, the horizontal line in the middle of each box indicates the median value; the lower and upper ends of the box represent the 25th and 75th percentiles, and the peripheral lines extending to the outer fences represent minimum to maximum, respectively. (A), (B) used two-tailed unpaired t-test; (C) used Mann–Whitney U-test. **P<0.01, ***P<0.001.

Abbreviations: PSD, post-stroke depression; HDL-C, high-density lipoprotein cholesterol, LDL-C, low-density lipoprotein cholesterol.

Table 2 Correlation coefficients evaluating the relationship of Hamilton Depression Scale scores and lipid profiles and other potential confounding variables

HAMD scores	r	P-value
Age	0.010	0.842
BMI	0.030	0.570
Education	−0.043	0.412
Neuropsychological function
NIHSS score	0.225	<0.001
BI score	−0.335	<0.001
mRS	0.247	<0.001
Laboratory findings
HDL-C	−0.157	<0.001
LDL-C	0.139	0.002
LDL/HDL	0.227	<0.001
TC	0.083	0.110
TGs  Apo A1  Apo B  Apo B/Apo A1	0.030 –0.221 0.060 0.151	0.558 0.096 0.657 0.258

Note: Values of P<0.05 were considered to be statistically significant.

Abbreviations: PSD, post-stroke depression; HAMD, Hamilton Depression Rating Scale 17-item, BMI, body mass index; NIHSS, National Institutes of Health Stroke Scale; BI, Barthel Index; mRS, modified Rankin Scale; 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.

Table 3 LDL/HDL ratios across quartiles of patients

	PSD (n=114)	Non-PSD (n=259)	χ2	P-value
Quartile 1	15 (13.2)	77 (29.7)	11.699	0.001
Quartile 2	21 (18.4)	71 (27.4)	3.445	0.063
Quartile 3	33 (28.9)	63 (24.3)	0.347	0.347
Quartile 4	45 (39.5)	48 (18.6)	18.546	<0.001

Notes: Values are shown as number (percentage). Four quartiles (≤1.88, 1.88–2.47, 2.47–3.07 and ≥3.07). Values of P<0.05 were considered to be statistically significant.

Abbreviation: PSD, post-stroke depression.

Table 4 Clinical and demographic characteristics of patients in each quartile

	Quartile 1 (n=92)	Quartile 2 (n=92)	Quartile 3 (n=96)	Quartile 4 (n=93)	P-value
Sex; M/F	55/37	64/28	58/38	61/32	0.465
Age (years), mean ± SD	64.20±10.17	63.70±10.16	62.63±9.66	61.02±11.12	0.166
BMI (kg/m^2), mean ± SD	23.91±3.21	24.90±13.00	24.01±3.90	24.90±3.57	0.704
NIHSS score at baseline, median (IQR)	2 (1–3)	2 (1–3)	3 (1–4)	3 (1.5–5)	0.002
BI at discharge, median (IQR)	100 (100–100)	100 (100–100)	100 (90–100)	100 (90–100)	0.012
mRS at 1 month, median (IQR)	1 (1–2)	1 (1–2)	1 (1–2)	1 (1–3)	0.017
HAMD score at 1 month, median (IQR)	4 (1–6)	3 (2–6)	4 (2–8)	6 (3–10)	<0.001
HDL-C (mmol/L), mean ± SD	1.25±0.35	1.15±0.22	1.11±0.21	0.96±0.17	<0.001
LDL-C (mmol/L), mean ± SD	1.76±0.58	2.52±0.46	3.02±0.56	3.60±0.67	<0.001
TC (mmol/L), mean ± SD	1.40±1.02	1.68±0.93	1.95±1.38	1.90±0.72	0.001
TGs (mmol/L), mean ± SD	3.74±0.91	4.46±0.74	5.00±0.90	5.44±0.86	<0.001
Apo A1 (g/L), median (IQR)	1.30 (1.00–1.60)	0.80 (0.70–0.85)	0.96 (0.90–1.10)	1.10 (1.08–1.33)	<0.001
Apo B (g/L), median (IQR)	0.60 (0.50–0.80)	1.30 (1.05–1.05)	1.20 (1.00–1.30)	1.20 (1.00–1.30)	0.370
Apo B/Apo A1, median (IQR)	0.55 (0.45–0.57)	0.63 (0.57–0.66)	0.77 (0.69–0.85)	1.08 (0.83–1.20)	<0.001

Notes: Values are shown as number (percentage) or as medians (IQR) and mean (SD). Values of P<0.05 were considered to be statistically significant.

Abbreviations: BMI, body mass index; NIHSS, National Institutes of Health Stroke Scale; BI, Barthel Index; mRS, modified Rankin Scale; HAMD, Hamilton Depression Rating Scale 17-item, 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; SD, standard deviation; IQR, interquartile range.

Table 5 Multivariate logistic model of the clinical determinants of PSD

	Model1^a		Model 2^b
	OR (95% CI)	P-value	OR (95% CI)	P-value
NIHSS score	1.224 (1.126–1.331)	<0.001		0.072
BI score	0.980 (0.963–0.996)	<0.001	0.955 (0.937–0.973)	<0.001
mRS	1.841 (1.477–2.293)	<0.001		0.058
Current alcohol consumption	0.572 (0.355–0.923)	0.022	0.559 (0.329–0.950)	0.032
HDL-C	0.139 (0.049–0.392)	<0.001	0.250 (0.077–0.813)	0.021
LDL-C	1.490 (1.151–1.929)	0.002		0.207
LDL/HDL	1.952 (1.506–2.530)	<0.001		0.009
Quartile 1	0.483 (0.256–0.914)	0.025
Quartile 4	2.326 (1.390–2.893)	0.001	1.874 (1.050–3.347)	0.034

Notes: Values of P<0.05 were considered to be statistically significant. ^aModel 1: unadjusted; ^bModel 2: considering the incidence of PSD as the dependent variable and both quartile 2 and quartile 3 as the reference, adjusted for NIHSS score, BI score, mRS and current alcohol consumption.

Abbreviations: PSD, post-stroke depression; OR, odds ratio; CI, confidence interval; NIHSS, National Institutes of Health Stroke Scale; BI, modified Barthel Index; mRS, modified Rankin Scale; HDL-C, high-density lipoprotein cholesterol, LDL-C, low-density lipoprotein cholesterol.

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

	Included (373)	Excluded (265)	P-value
Age (years), mean ±SD	62.46±10.78	61.14±10.39	0.102
Sex; M/F	238/135	158/107	0.305
BMI (kg/m^2), mean ±SD	24.41±7.24	23.42±4.38	0.280
Education Years, median (IQR)	4 (0–6)	4 (0–6)	0.150
Marital states, married, n (%)	332 (89.0)	237 (89.4)	0.864
HDL-C (mmol/L), mean ±SD	1.14±0.27	1.02±0.34	0.467
LDL-C (mmol/L), mean ±SD	2.77±0.90	2.91±0.90	0.237
TC (mmol/L), mean ±SD	4.67±1.06	4.76±1.16	0.414
TG (mmol/L), mean ±SD	1.74±1.06	1.71±1.11	0.852
Apo A1 (g/L), median (IQR)	1.20 (1.00–1.40)	1.30 (1.20–1.30)	0.485
Apo B (g/L), median (IQR)	0.90 (0.70–1.10)	1.10 (0.80–1.30)	0.318
Apo B/Apo A1, median (IQR)	0.72 (0.57–0.85)	0.75 (0.62–1.00)	0.735
NIHSS score at baseline, median (IQR)	2 (1–4)	3 (1–4)	0.576
BI at discharge, median (IQR)	100 (95–100)	100 (95–100)	0.068
mRS at 1month, median (IQR)	1 (1–2)	1 (1–2)	0.533

Notes: Values are shown as number (percentage) or as medians (IQR) and mean (SD). Values of P<0.05 were considered to be statistically significant.

Abbreviations: BMI, body mass index; 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; NIHSS, National Institutes of Health Stroke Scale; BI, Barthel Index; mRS, modified Rankin Scale; SD, standard deviation; IQR, interquartile range.