Stéphanie Debette in Neurology

Plasma lipids and cerebral small-vessel disease

Plasma lipids and cerebral small vessel disease.
Schilling S, Tzourio C, Dufouil C, Zhu Y, Berr C, Alpérovitch A, Crivello F, Mazoyer B, Debette S. Neurology. 2014 Oct 15. pii: 10.1212/WNL.


Small-vessel disease is a major cause of both ischemic stroke and intracerebral hemorrhage. It is highly prevalent in the general population, even in the absence of clinical stroke, as revealed by brain MRI in large community based samples. MRI markers of small-vessel disease, such as white matter hyperintensity volume and lacunes, are associated with a faster cognitive decline, an increased risk of dementia and stroke, and increased mortality rates at the community level. In contrast with the strong undisputed association between high LDL-cholesterol and myocardial infarction, epidemiologic studies have failed to demonstrate a robust association of hypercholesterolemia with risk of stroke.

We examined the association between lipid fractions (triglycerides, LDL-cholesterol, HDL-cholesterol) and white matter hyperintensity volume and lacunes in a study sample comprising 2,608 participants from the 3C-Dijon Study and the Epidemiology of Vascular Aging Study (EVA), two large French population-based cohorts of elderly persons. Analyses were performed separately in each study and combined using meta-analysis. We found that increasing triglycerides were significantly associated with larger white matter hyperintensity volume and with higher frequency of lacunes. Associations were attenuated but maintained after adjusting for other vascular risk factors or for inflammatory markers.
Associations were present and in the same direction both in participants taking and those not taking lipid-lowering drugs. Increasing LDL-cholesterol tended to be associated with a decreased frequency and severity of all MRI markers of cerebral small-vessel disease in both studies. We conclude that increasing triglycerides but not other lipid fractions were associated with the presence and severity of MRI markers of cerebral small-vessel disease in older community persons.