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Serum lipids and stroke
A M Kar1, R K Garg1, Sps Gaur1
1Department of Neurology, King George's Medical College, Lucknow, India.
Insights
Serum lipid levels, particularly low-density lipoprotein (LDL) and high-density lipoprotein (HDL), are linked to cerebrovascular atherosclerosis. Optimal timing for post-stroke lipid testing remains unclear, impacting risk assessment.
Area of Science:
- Cardiovascular Science
- Neurology
- Metabolic Disorders
Background:
- Serum lipids and lipoproteins are established risk factors for coronary atherosclerosis.
- Their association with cerebrovascular atherosclerosis, including carotid artery disease, is less consistent but increasingly recognized.
- Specific lipid profiles, such as elevated low-density lipoprotein (LDL) and reduced high-density lipoprotein (HDL), correlate with atherosclerosis.
Purpose of the Study:
- To explore the relationship between serum lipids and lipoproteins and cerebrovascular atherosclerosis.
- To evaluate the utility of various lipid markers in assessing cranial atherosclerosis.
- To discuss the implications of cholesterol levels on stroke pathology and the challenges in post-stroke lipid assessment.
Main Methods:
- Review of existing studies correlating lipid levels with angiographic or ultrasonographic evidence of carotid artery atherosclerosis.
- Analysis of the role of conventional lipids, advanced lipoprotein markers (e.g., Lipoprotein (a), Apo B, Apo AI), and HDL subfractions.
- Discussion of the impact of total serum cholesterol levels on different stroke types (hemorrhage vs. atherothrombosis).
Main Results:
- Increased LDL and decreased HDL show a correlation with carotid artery atherosclerosis.
- Lipoprotein (a), apolipoproteins, and HDL subfractions may be superior indicators of cranial atherosclerosis compared to standard lipid panels.
- Cholesterol levels influence stroke type: low levels (<160 mg/dL) are linked to intracerebral hemorrhage, while high levels predispose to large vessel atherothrombosis.
Conclusions:
- While lipid profiles are linked to cerebrovascular disease, precise risk prediction and the impact of lipid-lowering interventions on stroke incidence require further investigation.
- The optimal timing for serum lipid and lipoprotein analysis following a stroke is not definitively established, with differing opinions on immediate versus delayed testing.
- Management of hyperlipidemia is crucial for reducing the risk of coronary heart disease and potentially subsequent strokes.
Abstract:
Serum lipids and lipoproteins are strongly related to coronary atherosclerosis but their association with cerebrovascular atherosclerosis is far less clear and consistent, though lipid levels have been related to carotid artery atherosclerosis, in anumber of studies having angiographic or ultrasonographic evidences of atheromas of common carotid bifurcation and internal carotid artery. In these studies there appears to be an impressive correlation of increased low density lipoprotein (LDL) and reduced high density lipoprotein (HDL) to the atherosclerosis. Lipoprotein (a), Apoproteins (apo B and apo AI), and HDL sub fractions (HDL2 and HDL3) are emerging better indicators of cranial atherosclerosis than conventional serum lipid levels. Varying levels of serum cholesterol are responsible for deferring vascular pathologies of underlying stroke. With levels of total serum cholesterol below 160 mg/dL there is a greater proclivity for intracerebral hemorrhage, whereas elevated levels predispose to large vessel at herothrombosis. There is no definite proof that cholesterol reduction by diet or drug will reduce the incidence of stroke. Total cholesterol decreases after myocardial infarction and similarly, stroke is also accompanied by variable alterations in serum lipids levels, hence, post-stroke measurement of serum lipids may not be a true representative of the individual's risk. Anunanswered query is, the time when blood should be sampled for the lipid and lipoprotein estimation following stroke? This is difficult to state categorically. Some favor that it should be done immediately after the stroke but others argue that it should be performed after the patient's condition is stabilized (approximately 3 months after the stroke). Treatment with diet and or drugs may be required in a hyperlipidemic patient to lesson the risk of coronary heart disease (CHD) and possibly even subsequent stroke.
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