Elevated serum lipoprotein(a) as a potential predictor for combined intracranial and extracranial artery stenosis in patients with ischemic stroke
Section snippets
Background
Since the experimental discovery of proatherothrombogenic properties of lipoprotein(a) [Lp(a)], a LDL-particle composed of apolipoprotein B-100 to which apolipoprotein(a) is covalently bound, Lp(a) has been recognized as a potentially important treatable risk factor for atherosclerotic disease [1], [2]. As a result of numerous clinical studies, elevated Lp(a) level turned out to be an independent risk factor for ischemic stroke and coronary heart disease (CHD) [3], [4], [5]. In contrast to the
Patients and workups
We analyzed data in a prospectively maintained stroke registry of consecutive Korean patients admitted with acute (<7 days after onset) ischemic stroke or transient ischemic attack (TIA) from April 2006 through April 2009 to a tertiarry referral hospital, Seoul, South Korea. Exclusion criteria included being non-Korean, Lp(a) and fasting lipid panels not drawn within 24 h after hospital admission, presence of diverse medical illness or current medications that influence serum Lp(a) levels [17],
Results
All 1223 consecutive patients with acute ischemic stroke and TIA had admitted in our stroke center during the study period, and 1012 met full study inclusion criteria. Reasons for exclusion were as follows: incomplete work up for cerebrovascular status, 46; miss of Lp(a) measurement, 146; oral pill medication, 1; end stage renal disease, 8; and Caucacian patients, 10. The included patient group consisted of 635 (62.7%) male and 377 (37.3%) female, were all Korean, and the mean age was 63.8 ± 12.6
Discussion
The present study shows that serum Lp(a) levels were correlated with the burden of intracranial and extracranial carotid stenosis in the consecutive stroke or TIA patients. In addition, we found that moderately elevated serum Lp(a) level was strongly associated with isolated intracranial or extracranial carotid stenosis, whereas greatly elevated serum Lp(a) level independently predicts combined intracranial and extracranial carotid lesions. The reason for this is that patients with combined
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