Stroke, Vol 24, 965-969, Copyright © 1993 by American Heart Association
S Shintani, S Kikuchi, H Hamaguchi and T Shiigai
BACKGROUND AND PURPOSE: This study was conducted to evaluate the role of
high serum lipoprotein(a) levels in a group of patients with a relatively
early onset of cerebral infarction as a whole and in a subgroup with the
perforating artery occlusion subtype of cerebral infarction. METHODS:
Fifty-four patients with cerebral infarction, the onset of which was before
age 65 years (37 men, 17 women; mean age, 61.9 +/- 7.7 years) were examined
in this study. When patients with atrial fibrillation were excluded to omit
cardiac embolic strokes from analysis, the group consisted of 45 patients.
The patients were classified into two subtype groups, the perforating
artery occlusion group and the cortical artery occlusion group, by using
magnetic resonance imaging. Lipoprotein(a) levels were measured by an
enzyme- linked immunosorbent assay. Four biochemical variables (serum
levels of lipoprotein(a), high-density lipoprotein cholesterol, low-density
lipoprotein cholesterol, and triglycerides) and other potential risk
factors such as hypertension, diabetes mellitus, smoking habits, alcohol
intake, and family history were analyzed by stepwise logistic regression to
determine the independent and significant risk factors for cerebral
infarction without atrial fibrillation. RESULTS: The incidence of subjects
with serum lipoprotein(a) levels > or = 42.6 mg/dL, which is the 95th
percentile level of the control subjects, was significantly increased in
the total cerebral infarction group (P < .025) and the perforating
artery occlusion group (P < .025) compared with the control group. In
addition, by using stepwise logistic regression analysis in the total and
perforating artery occlusion patient groups we identified three independent
and significant risk factors: hypertension, a low high-density lipoprotein
cholesterol level, and a high serum lipoprotein(a) level. In the cortical
artery occlusion group, the sample size was not large enough for the
statistical analysis. Diabetes mellitus is the only known factor that
correlates with serum lipoprotein(a) levels, but there were no significant
correlations between serum lipoprotein(a) levels and history of diabetes
mellitus or fasting blood sugar. CONCLUSIONS: These findings indicate that
high serum lipoprotein(a) levels are an independent risk factor in the
development of cerebral infarction when subjects with atrial fibrillation
were excluded from the total group and the perforating artery occlusion
subtype group.
ARTICLES
High serum lipoprotein(a) levels are an independent risk factor for cerebral infarction
Department of Neurology, Toride Kyodo General Hospital, Ibaraki, Japan.
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