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Lipids and stroke: a paradox resolved
V Hachinski1, C Graffagnino, M Beaudry
1Department of Clinical Neurological Sciences, London Health Sciences Centre-University Campus, Ontario, Canada.
Insights
High LDL cholesterol and triglycerides are key risks for atherothrombotic stroke. Serum ferritin levels, however, do not correlate with cerebrovascular disease risk.
Area of Science:
- Cardiovascular Science
- Neurology
- Clinical Biochemistry
Background:
- Dyslipidemia is a known risk factor for coronary artery disease.
- The link between dyslipidemia and ischemic cerebrovascular disease is less understood.
- Stroke heterogeneity may obscure the relationship between lipid profiles and cerebrovascular events.
Purpose of the Study:
- To investigate the association between lipid profiles and atherothrombotic cerebrovascular disease.
- To determine if serum ferritin levels correlate with atherothrombotic cerebrovascular disease.
Main Methods:
- A case-control study involving 90 patients with atherothrombotic stroke or transient ischemic attack (TIA) and 90 matched controls.
- Measurement of serum lipids (total cholesterol, LDL, HDL, triglycerides), lipoprotein(a), apolipoprotein E phenotype, and serum ferritin.
- Comparison of these markers between patients and controls.
Main Results:
- Significantly higher levels of total cholesterol, LDL cholesterol, and triglycerides in patients compared to controls.
- Significantly lower levels of HDL cholesterol in patients.
- No significant differences in lipoprotein(a), apolipoprotein E phenotype distribution, or serum ferritin levels between groups.
Conclusions:
- Elevated LDL cholesterol and triglyceride levels are independent risk factors for atherothrombotic cerebrovascular disease (stroke/TIA).
- Serum ferritin levels do not appear to be associated with atherothrombotic cerebrovascular or coronary disease.
Background:
Although dyslipidemia is a well established risk factor for coronary artery disease, its relationship to ischemic cerebrovascular disease has remained unclear, perhaps because of the heterogeneous nature of strokes.
Methods:
In a case-control study, we measured the serum concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, serum triglycerides, and lipoprotein(a) levels and determined the apolipoprotein E phenotype and serum ferritin level in 90 consecutive systematically investigated patients with stroke or transient ischemic attack of atherothrombotic origin. Ninety age-, sex-, and community-matched subjects served as controls.
Results:
Plasma total cholesterol (5.99 vs 5.45 mmol/L [232 vs 211 mg/dL], P=.003), low-density lipoprotein cholesterol (3.96 vs 3.45 mmol/L [153 vs 133 mg/dL], P=.004), and serum triglyceride (2.09 vs 1.82 mmol/L [8] vs 70 mg/dL], P=.03) levels were significantly higher among the patients with atherothrombotic strokes and transient ischemic attacks than among the control subjects. The inverse was true for high-density lipoprotein cholesterol (1.07 vs 1.18 mmol/L [41 vs 46 mg/dL], P=.02) levels. No significant differences were found in lipoprotein(a) levels or in the distribution of apolipoprotein E phenotypes or allele frequency. Serum ferritin levels did not differ significantly between patients and control subjects.
Conclusions:
Elevated low-density lipoprotein cholesterol and triglyceride levels are significant independent risk factors in patients with proven atherothrombotic cerebrovascular disease manifesting as stroke or transient ischemic attack. The level of stored serum iron, as reflected by serum ferritin levels, does not correlate with the presence of atherothrombotic cerebrovascular or coronary disease.