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DOI 10.11603/ijmmr.2413-6077.2021.1.12109

A CROSS SECTIONAL STUDY OF LIPID PROFILE IN NON-DIABETICS 
WITH STROKE IN URBAN CHITRADURGA

S.B. Vijeth, *V. Mangasuli, A.M. Amrutha,  
N. Bhoovanchandra, B. Sidenur

BASAVESHWARA MEDICAL COLLEGE AND HOSPITAL, CHITRADURGA, INDIA

Background. The amount of evidence regarding the relation between serum lipids, lipoproteins and 
cerebrovascular accident is not adequate. The atherogenecity of diabetics and non-diabetics are different. 
Therefore, non-diabetic patients were included in the study.

Objective. To study lipid abnormalities in non-diabetic stroke patients in our setup.
Methods. The study was carried out at the Department of General Medicine, BMCH, Chitradurga, during 

the period from June 2020 to December 2020. The lipid profile and the fasting blood sugar rates of 50 stroke 
patients without diabetes were studied. Their serum samples were assessed for fasting blood glucose (FBG), total 
cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol 
(HDL) by using standard biochemical methods.

Results. The age distribution of the subjects was from 19 to 72 years with a mean age of patients 54.8±15.75 
years. Among patients 31 (62%) were males and 19 (38%) were females. Among the study subjects 58% were 
hypertensive, 76% were smokers, 32% were alcoholics and 34% had family history of cerebrovascular accident. 
Among ischemic stroke group, the most common deranged value in the ischemic group was decreased HDL 
deranged in 54.1% of patients; the second most common deranged value – increased VLDL deranged in 40.5%. 
Among the hemorrhagic group the most common deranged value was also decreased HDL, which was deranged 
in 46.1% of patients and the second most common deranged value – increased total cholesterol, which was 
deranged in 53.8% patients.

Conclusion. Lipid profile should be considered while predicting the risk of stroke. 
KEYWORDS: lipid profile; dyslipidemia; non-diabetic stroke; serum cholesterol.

International Journal of Medicine and Medical Research 
2021, Volume 7, Issue 1, p. 68-73
copyright © 2021, TNMU, All Rights Reserved

S.B. Vijeth et al.

*Corresponding author: Vijayalaxmi Mangasuli, Assistant 
Professor, Basaveshwara Medical College and Hospital, Chi-
tradurga, Karnataka, 577501, India. E-mail: dr.vijugokak@
gmail.com

Introduction
As per World Health Organization, stroke is 

defined as a clinical syndrome consisting of 
rapidly developing clinical signs of focal (at 
times global) disturbance of cerebral function, 
with duration lasting more than 24 hours or 
leading to death with no apparent cause other 
than that of vascular origin [1].

Stroke is the second leading cause of death 
worldwide causing 6.2 million deaths in 2011 
[2]. Stroke is a medical emergency which is an 
acute neurological injury that occurs due to 
vascular pathology and presents as a brain 
infarction or haemorrhage. The modification of 
risk factors in stroke has brought down both 
mortality and morbidity of stroke remarkably 
in the last 30 years. Dyslipidemia is a major risk 
factor for stroke. It has been established that 
reduction of total cholesterol, LDL cholesterol, 
trigycerides, VLDL cholesterol and increasing 

HDL cholesterol by drugs decreases the inci-
dence of stroke.

In our study, lipid profile was studied in 
non-diabetic patients with stroke. Diabetes 
itself is associated with hyperlipidemia and 
increased atherosclerosis which makes it an 
undisputed risk factor for stroke. The athero-
genecity of diabetics and non-diabetics are 
different. With this background, we conducted 
the study of lipid profile in the non-diabetics 
with stroke in our setup.

Methods
Patients with stroke and non-diabetic atten-

ding OPD and IPD of the Department of General 
Medicine of Basaveshwara Medical College and 
Hospital, Chitradurga, were enrolled in the 
study. Patients with haemorrhagic strokes, 
embolic strokes, past/present H/O diabetes 
mellitus or history of head injury or usage of 
anti-coagulant drugs were excluded from the 
study. 

The study took place over the period of 6 
months from June 2020 to December 2020. 



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Sample size estimation was performed using 
open epi software version 2.3.1 at 95% con-
fidence level, 80% power of the study, proportion 
of cases with stroke with raised lipid parameters 
as 70% [3]. Sample size estimated was 37 
inflated to 50.

A brief personal history and medical history, 
including brief histories about co-existing 
disease states, family history of diabetes 
mellitus, and history of hypertension, past and 
present illnesses, dietary pattern, addiction and 
medication were recorded in self prepared 
questionnaire. Detailed general physical exa-
mination, systemic examination and neuro-
logical examination were performed to all the 
patients and were recorded.

The investigations done for the patients at 
presentation included fasting lipid profile 
(serum total cholesterol, serum triglycerides, 
serum high density lipoproteins, serum very 
low density lipoproteins, serum low density 
lipoproteins) and HbA1c levels [4].

Data was entered in excel sheet and analy-
sed using the Statistical Package for the Social 
Sciences 20 (SPSS Inc. Chicago). Results were 
presented in tabular and graphical forms. 
Mean, median, standard deviation and ranges 
were calculated for quantitative data. The Chi 
square analysis was used in testing for signi-
ficant differences between proportions and 
frequencies. The T-test was used in testing for 
significant differences between two means. The 
confidence interval was set at 95% limit, with 
level of significance, p≤0.05.

Results
50 patients were enrolled in the study. The 

age distribution of the subjects was between 

19 to 72 years with mean age of patients 
54.8±15.75 years. 31 (62%) were males and 19 
(38%) were females. It was established that 58% 
of our study subjects were hypertensive, 76% 
were smokers, 32% were alcoholics and 34% 
had family history of CVA (Table 1).

Analysis of lipid profile among both the 
groups of stroke, i.e., hemorrhagic and ischemic 
stroke, revealed that the most common rate 
deranged in the ischemic group was decreased 
HDL, which is deranged in 54.1% of patients and 
the second most common rate deranged was 
increased VLDL, which was deranged in 40.5%. 
Among the hemorrhagic group the most com-
mon deranged rate was also decreased HDL, 
which was deranged in 46.1% of patients, and 
the second most common deranged rate was 
increased total cholesterol, which was deranged 
in 53.8% of patients (Table 2).

Our study concluded a significant asso-
ciation between serum total cholesterol, trigly-
ceride, LDL level, VLDL level and risk of stroke. 
High levels of total cholesterol, trigly cerides, 
LDL cholesterol were associated with higher 
risk of stroke. Lowered HDL cholesterol levels 
were not significantly associated with stroke. 
The ratio of HDL/LDL cholesterol, TC/HDL cho-
lesterol for males and females was eva luated. 
However, the association with risk of stroke was 
not found (Table 3).

Discussion
Association of Total Cholesterol to the 

Non-Diabetics with Stroke
Our study involved 50 subjects and total 

cholesterol was elevated in the non-diabetics 
with stroke. The serum total cholesterol levels 
in cases of either ischaemic or haemorrhagic 

Table 1. Risk factors of stroke among study participants

Variables Hemorrhagic Stroke(n=13)
Ischemic Stroke 

(n=37) Chi-square test

Gender Male 9 (69.2) 22 (59.5) 0.4
p=0.5Female 4 (13.8) 15 (40.5)

Age in years <30 1 (7.6) 2 (5.4) 1.4
p=0.530-60 6 (46.2) 24 (64.9)

>60 6 (46.2) 11 (29.7)
Hypertension Present 9 (69.2) 20 (54.1) 0.9

p=0.3Absent 4 (30.8) 17 (45.9)
Smoking Yes 8 (61.5) 30 (81.1) 2.01

p=0.2No 5 (38.5) 7 (18.9)
Alcoholic Yes 5 (38.5) 11 (29.7) 0.34

p=0.6No 8 (61.5) 26 (70.3)
Family h/o CVA Present 5 (38.5) 12 (32.4) 0.16

p=0.7Absent 8 (61.5) 25 (67.6)

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stroke were high (10%) (total cholesterol >240 
mg% according to the Adult Treatment Panel 
(ATP) – the 3rd guidelines of National Cholesterol 
Education Program (NCEP)). 

Similar studies by Sreedhar K et al. [5] Ben-
fante et al. [6], Di Mascio et al. [7] showed both 
ischemic and hemorrhagic stroke were asso-
ciated with increased cholesterol levels. 

Contrary to our study, Iso et al. [8] em-
phasized an inverse association between serum 
cholesterol level and hemorrhagic stroke. There 
was no correlation between serum cholesterol 
and risk of stroke in a study by Harmsen et al. 
[9] Rastenyte et al. [10] and Hart CL et al. [11]

Association of Triglycerides to the Non-
Diabetics with Stroke

It was established that serum triglycerides 
were high in 23.1% of hemorrhagic stroke 
patients and 13.5% of ischemic stroke patients 
(>200 mg% according to ATP – 3rd guidelines). 
Sreedhar K et al. [5] in his study showed 80% of 
non-diabetic stroke patients with S.triglyceride 
>200mg/dl had ischemic stroke and the other 
20% had hemorrhagic stroke. Tilvis R.S et al. 
[12] in his study showed serum triglyceride was 

higher in ischemic stroke. Farid et al. [13] also 
had similar results in his study in 1972. Ha-
chinski et al. [14] showed a positive association 
of triglycerides in patients with atherothrombotic 
stroke and transient ischemic attacks compare 
to the control subjects. Albucher J.K et al. [15] 
2000 showed serum triglycerides in normal 
range in the study on stroke.

Association of Serum HDL Cholesterol to 
the Non-Diabetics with Stroke

In the study of HDL cholesterol in stroke 
patients, it was found out that the ischemic 
group (54.1%) patients had greater abnormal 
levels (<40mg% according to ATP – 3rd guidelines) 
than the haemorrhagic group (46.1%). Simons 
et al. [16] study revealed that HDL cholesterol 
had protective effect on ischemic stroke. Alok 
Mohankar et al. [17] in 1993 showed that 
increased LDL levels and low HDL levels were 
associated with atherosclerosis. Albucher et al. 
[15] study clearly indicated HDL – cholesterol 
as the only lipid associated with stroke risk. It 
emphasised the need for management of low 
HDL cholesterol in young patients regardless 
of atherosclerosis.

Table 2. Lipid profile among cases and controls

Variables Hemorrhagic Stroke(n=13)
Ischemic Stroke 

(n=37) Chi-square test

Total Cholesterol <200 7 (53.8) 24 (64.8) 0.6
p=0.5*200-240 5 (38.5) 9 (24.3)

>240 1 (7.7) 4 (10.9)
Serum Triglyceride <150 6 (46.1) 21 (56.8) 0.7

p=0.5*150-199 4 (30.8) 11 (29.7)
200-499 3 (23.1) 5 (13.5)

LDL cholesterol <100 7 (53.8) 17 (45.9) 0.5
p=0.5*100-130 1 (7.7) 9 (24.4)

131-160 3 (23.1) 5 (13.5)
>160 2 (15.4) 6 (16.2)

HDL cholesterol <40 6 (46.1) 20 (54.1) 0.24
p=0.6≥40 7 (53.8) 17 (45.9)

VLDL cholesterol ≤30 6 (46.1) 22 (59.5) 0.7
p=0.4>30 7 (53.8) 15 (40.5)

Note. * – Fisher’s Exact Test.

Table 3. Comparison of lipid profile between types of stroke

Lipid Component Mean Value in Ischemic Stroke
Mean Value in Hemorrhagic 

Stroke P Value

TC 171.5 214.7 0.001
Serum TG 138.2 163.7 0.018
HDL 43.4 45.8 0.822
LDL 100.5 136.1 0.004
VLDL 27.6 32.7 0.174

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Association of Serum LDL Cholesterol to 
the Non-Diabetics with Stroke

Among ischemic stroke cases, 16.2% had 
high LDL cholesterol and this was 15.4% among 
haemorrhagic stroke cases. Sreedhar K et al. 
[5] showed that high levels of serum LDL 
cholesterol had significant risk of ischemic 
stroke in the non-diabetics. Botet et al. [18] and 
Hachinski et al. [14] showed positive correlation 
between LDL cholesterol levels and risk of 
stroke. Kurth T et al. [19] 2007 showed remar-
kable increase in serum LDL levels in ischemic 
stroke patients. 

Association of Serum VLDL Cholesterol 
to the Non-Diabetics with Stroke

In our study, among ischemic stroke cases 
40.5% had increased VLDL cholesterol and this 
was 53.8% among haemorrhagic stroke cases. 
Bidyadhar et al. [20] 1984 showed that VLDL was 
increased in their study on stroke. Sreedhar K 
et al. [5] in the study showed that high VLDL 
was not associated with risk of stroke in non-
diabetic patients. 

Conclusions
According to our study the conclusion can 

be drawn that the most common type of lipid 
abnormality were abnormal triglycerides, 
abnormal VLDL, abnormal LDL. So, these 
parameters should be considered while pre-
dicting the risk of stroke in a dyslipidemic 
patient. Stroke patients with dyslipidemia need 
a comprehensive health care approach involving 
dietician, physician and good bio chemistry 
back up. In Indian scenario, where majority of 
the patients belong to the low socio-economic 
status, life style modification plays a more 
important role in prevention and management 
of stroke and dyslipidemia in contrast to high 
cost of lipid lowering agents.

Conflict of Interests
Authors declare no conflict of interest.
Author’s Contributions
Dr. Vijeth S.B., Dr. Vijayalaxmi Mangasuli, 

Dr. Am rutha A.M., Dr. Bhoovanchandra N., Dr. Bha-
gyalaxmi Sidenur – conceptualization, metho-
dology, formal analysis, writing – original draft, 
writing – reviewing and editing; Dr. Vijeth S.B., 
Dr. Vijayalaxmi Mangasuli, Dr. Amrutha A.M. – 
investigation, formal analysis.

ПОПЕРЕЧНЕ ДОСІЛДЖЕННЯ ПОКАЗНИКІВ ЛІПІДНОГО ПРОфІЛю 
У ПАЦІєНТІВ-НЕДІАБЕТИКІВ, КОТРІ ПЕРЕНЕСЛИ ІНСУЛЬТ, МІСТА 
ЧИТРАДУРГА

S.B. Vijeth, *V. Mangasuli, A.M. Amrutha, N. Bhoovanchandra, B. Sidenur
BASAVESHWARA MEDICAL COLLEGE AND HOSPITAL, CHITRADURGA, INDIA

Вступ. Зв’язок між рівнем сироваткових ліпідів, ліпопротеїнів та частотою розвитку порушень  
мозкового кровообігу не є достатньо доведеним. Оскільки рівень атерогеності діабетиків та 
недіабетиків є різним, тому в дослідження були включені пацієнти без діабету.

Мета. Вивчення порушень ліпідного обміну у пацієнтів з недіабетичним інсультом у місцевій лікарні.
Методи. Дослідження проводилося у General Medicine Department, BMCH, Chitradurga протягом 

періоду з червня 2020 року по грудень 2020 року. Вивчався ліпідний профіль та показники глікемії натще 
у 50 пацієнтів з інсультом без діабету. Визначалися вміст глюкози крові натще (FBG), загального 
холестерину (TC), тригліцеридів (TG), ліпопротеїдів низької щільності (LDL) та ліпопротеїдів високої 
щільності (HDL) за допомогою стандартних біохімічних методів.

Результати. Віковий розподіл пацієнтів складав від 19 до 72 років із середнім віком 54,8±15,75 років. 
Чоловіки становили 62% (31), жінки – 38% (19). Серед досліджуваних 58% мали гіпертонічну хворобу, 
76% були курцями, 32% – алкоголіки, а 34% мали сімейний анамнез із порушенням мозкового кровообігу. 
Серед групи ішемічного інсульту найчастіше спостерігалося зниження ліпопротеїдів високої щільності 
(54,1%), другим найпоширенішим відхиленням було збільшення ліпопротеїдів дуже низької щільності – 
у 40,5%. Серед групи з геморагічним інсультом найчастіше спостерігалося також зниження ліпопротеїдів 
високої щільності, яке виявлялося у 46,1% пацієнтів, другим найпоширенішим відхиленням було 
збільшення загального холестерину, яке спостерігалося у 53,8% пацієнтів.

Висновки. Під час прогнозування ризику інсульту слід враховувати ліпідний профіль. 
КЛЮЧОВІ СЛОВА: ліпідний профіль; дисліпідемія; недіабетичний інсульт; сироватковий 

холестерин. 

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Information about the authors
Dr. Vijeth S.B., Associate Professor, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, 

India
ORCID: 0000-0002-6882-2604, e-mail: vijethsb71@gmail.com
Dr. Vijayalaxmi Mangasuli, Assistant Professor, Basaveshwara Medical College and Hospital, 

Chitradurga, Karnataka, India
ORCID: 0000-0002-2861-2012, e-mail: dr.vijugokak@gmail.com
Dr. Amrutha A.M., Assistant Professor, Basaveshwara Medical College and Hospital, Chitradurga, 

Karnataka, India
ORCID: 0000-0003-4958-031x, e-mail: amrutha.angadi89@gmail.com
Dr Bhoovanchandra N., Postgraduate, Basaveshwara Medical College and Hospital, Chitradurga, 

Karnataka, India
ORCID: 0000-0008-2112-3265, e-mail:bhoovan2@gmail.com
Dr Bhagyalaxmi Sidenur, Assistant Professor, Basaveshwara Medical College and Hospital, Chitradurga, 

Karnataka, India
ORCID: 0000-0001-6012-3166, e-mail: bhagyasidenur@gmail.com

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Received 19 May 2021; revised 12 Jun 2021; 
accepted 13 Jun 2021.

This is open access article distributed under the Creative Com-
mons Attribution License, which permits unrestricted use, 
distribution, and reproduction in any medium, provided the 
original work is properly cited.

S.B. Vijeth et al.