Background: The relationship between lipoprotein(a) (Lp(a)) and ischemic stroke is still controversial in the elderly. The purpose of the present paper was to evaluate the significance of Lp(a) in the development of extracranial carotid lesions and ischemic stroke.
Methods: A total of 371 elderly subjects, studied with carotid ultrasonography (US) and brain computed tomography (CT), was stratified into two groups according to serum Lp(a) levels: the normal Lp(a) and high Lp(a) (>40 mg/dL) groups. Carotid plaques were divided into three types based on the US echogenicity: hypoechoic, hyperechoic, and heterogeneous plaques. Low‐density areas (LDA) on brain CT images were classified into three groups depending on their distribution: basal ganglionic, cortical and only leuko‐araiosis types.
Results: The incidence of bilateral carotid lesions and the ratios of hypoechoic and heterogeneous plaques were significantly higher in the high Lp(a) group than in the normal Lp(a) group. Both the mean height and length of plaque were also greater in the high Lp(a) group. Mean Lp(a) levels were significantly elevated in cases with hypoechoic and heterogeneous types, compared to the cases without lesions. Higher mean Lp(a) levels were seen in cases with any kind of LDA than in normal subjects on CT, but there was no significant difference in the incidence of each LDA between the two groups.
Conclusions These findings indicate that serum Lp(a) is strongly related to carotid lesions, especially hypoechoic and heterogeneous plaque types, in Japanese elderly patients. This suggests that Lp(a) could promote the formation of lipid‐rich atheromatous plaque with intraplaque hemorrhage or superimposed thrombi. Serum Lp(a) also seemed to be a risk for all types of LDA.
To clarify current changes in the patterns of carotid atherosclerosis in Japan, carotid ultrasonographic findings in Japanese male patients with aortic aneurysm were compared between two groups examined in different periods. The first group was recruited from 42 consecutively examined patients in 1997, while the second group consisted of 40 consecutive patients from September, 2001 to January, 2002. Carotid lesions were analyzed by computer, and classified into three types based on the texture: echolucent, hyperechoic, and heterogeneous types. The mean age of the first group was 72 years, similar to that of the second group. In the first group, cigarette smoking was frequently noted, while the mean BMI was greater and IHD and CVD were frequent in the second group. Fifty carotid lesions were seen in each group. Severe stenosis and hypoechoic type lesions were more frequent in the second group than in the first group. These findings indicated that hypoechoic-type lesions, which are considered to be lipid deposition, hemorrhage, or loose fibrous tissue, and severe stenosis, were increased in the more recent group. This predicted that circulatory disturbance due to unstable atherosclerotic lesions may increase in the future among the elderly because carotid lesions reflect vascular change in other organs. J Atheroscler Thromb, 2003; 10: 13-18.
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