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Rapidly progressive stroke in a young adult with very low high-density lipoprotein cholesterol
S A Zivkovic1, O L Lopez, M Zaretsky
1Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Insights
Extremely low high-density lipoprotein (HDL) cholesterol levels may contribute to advanced cerebrovascular atherosclerosis and fatal ischemic strokes in young adults. This case highlights the importance of considering very low HDL as a risk factor in this population.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Genetics
Background:
- Ischemic strokes affect young adults, often due to cardioembolic events, small vessel disease, or drug use.
- Large vessel cerebral atherosclerosis, typically linked to high LDL cholesterol, can also cause stroke.
- Low high-density lipoprotein (HDL) cholesterol is a known risk factor, but its impact with extremely low levels is unclear.
Observation:
- A patient presented with advanced atherosclerosis and an extremely low HDL level of 3 mg/dL.
- The condition led to a rapidly progressive, fatal stroke primarily affecting the posterior circulation.
- This case involves a young adult, an age group where such severe atherosclerosis is less common.
Findings:
- Very low HDL cholesterol levels can be associated with severe cerebrovascular atherosclerosis.
- Extremely low HDL may significantly increase the risk of fatal ischemic stroke, even in young individuals.
- The case demonstrates a link between genetic disorders causing very low HDL and advanced atherosclerosis.
Implications:
- Clinicians should consider very low HDL cholesterol levels as a potential risk factor for stroke in young adults.
- Further research is needed to understand the relationship between genetic disorders causing extremely low HDL and cerebrovascular disease.
- Early identification and management of lipid disorders, including very low HDL, may be crucial for stroke prevention in younger populations.
Abstract:
Ischemic strokes can affect young adults (15-45 years old). Most such strokes are caused by cardioembolic events, small vessel disease, or illicit drug use, and less frequently by large vessel atherosclerosis. Large vessel cerebral atherosclerosis is usually associated with high levels of low-density lipoprotein (LDL) cholesterol, but a low level of high-density lipoprotein (HDL) is also a risk factor for ischemic strokes. The magnitude of increased risk is unclear, particularly with extremely low HDL levels found only in various genetic and inherited disorders. Advanced atherosclerosis developed in the patient in this study, with HDL of 3 mg/dL, leading to rapidly progressive stroke with a fatal outcome. The disease primarily affected the posterior circulation. The course of this case illustrates that very low HDL may be associated with advanced cerebrovascular atherosclerosis and fatal stroke, and as such should be considered in young individuals with stroke.