Frontiers in Neurology (Oct 2010)
The role of fasting versus nonfasting triglycerides in ischemicstroke: a systematic review
Abstract
Objective: To synthesize results from pertinent studies and determine if fasting and/or nonfasting triglycerides are a risk factor for ischemic stroke. Method: We performed two independent systematic literature searches using the PubMed and ScienceDirect databases to identify studies examining the relationship between fasting and nonfasting triglyceride concentrations and ischemic stroke risk. A meta-analysis was performed using ischemic stroke as a primary endpoint. Results: Twenty-five reports were identified, including 13 prospective cohort and 12 case-control studies. Baseline characteristics, study samples, methods, and primary outcomes varied. Of 13 prospective cohort studies, 9 assessed triglyceride concentrations in the fasting state. Seven of these identified triglycerides as an independent risk factor for ischemic stroke risk (n=1624 ischemic cases). Three prospective cohort studies identified a positive association between elevated nonfasting triglyceride concentrations and ischemic stroke risk (n=2050 ischemic cases). One prospective cohort study that compared fasting and nonfasting triglycerides identified only nonfasting triglycerides as an independent risk factor for ischemic stroke. Of 12 case-control studies identified, 5 identified a positive relationship between ischemic stroke risk and elevated fasting triglycerides (n=838 cases). Seven case-control studies were included in the metaanalysis (n=1996 ischemic stroke cases), revealing an odds ratio of 1.15 (95% CI, 1.08 to 1.21). Conclusions: The available data are inconsistent. The relationship between triglyceride levels and ischemic stroke needs further investigation under standardized conditions. We recommend a standardized triglyceride tolerance test to further investigate the associations between fasting versus nonfasting triglyceride levels and ischemic stroke.
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