Elsevier

Atherosclerosis

Volume 212, Issue 2, October 2010, Pages 682-688
Atherosclerosis

Elevated serum lipoprotein(a) as a potential predictor for combined intracranial and extracranial artery stenosis in patients with ischemic stroke

https://doi.org/10.1016/j.atherosclerosis.2010.07.007Get rights and content

Abstract

Objectives

Despite compelling evidence of lipoprotein(a) [Lp(a)] as a risk factor for ischemic stroke, its underlying mechanism remains unclear. Our aim is to investigate whether serum Lp(a) level is associated with the extent and location of cerebral steno-occlusive lesions, and with large artery atherosclerotic (LAA) stroke in Korean patients.

Methods

We analyzed data prospectively collected over a 3-year period on consecutive patients with stroke or TIA. Based on an angiographic study, a total of 1012 patients were classified into four subtypes: non-cerebral stenosis (n = 654), intracranial stenosis (n = 198), extracranial carotid stenosis (n = 86), and combined intracranial and extracranial carotid stenosis (n = 74). Independent associations of Lp(a) levels with the extent and location of cerebral stenosis were evaluated, and Lp(a) levels of subtypes by the TOAST criteria were compared.

Results

Lp(a) levels of LAA stroke were significantly higher than those of the other four stroke mechanisms. Patients with more advanced intracranial (p = 0.001) and extracranial carotid stenoses (p = 0.001) tended to have higher Lp(a) levels. In multiple regression analysis, the third Lp(a) quartile was the strongest risk factor for isolated intracranial (OR 3.36, 95% CI 1.77–6.37) or extracranial stenosis (OR 4.82, 95% CI 1.96–11.88), whereas the fourth Lp(a) quartile was the most powerful predictor for combined intracranial and extracranial carotid stenosis (OR 4.98, 95% CI 1.92–12.91).

Conclusions

Our results indicate that greatly elevated Lp(a) levels are associated with LAA stroke and extensive burden of cervicocerebral steno-occlusive lesions, which might offer indirect evidence of proatherothrombogenic role of Lp(a) in 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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