Higher lipoprotein (a) levels in atherothrombotic than lacunar ischemic cerebrovascular disease

Cerrato, Paolo; Imperiale, Daniele; Fornengo, Paolo; Bruno, Graziella; Cassader, Maurizio; Maffeis, P.; Perin, Paolo Cavallo; Pagano, Gianfranco; Bergamasco, B.

doi:10.1212/wnl.58.4.653

Cited by 26 publications

(33 citation statements)

References 9 publications

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“…612,613 One found that Lp(a) levels were higher in patients with stroke related to large-vessel atherothrombotic disease than in patients with lacunar stroke. 614 A meta-analysis of 31 studies comprising 56 010 subjects found that Lp(a) was higher in stroke patients and that incident stroke was 22% (RR, 1.22; 95% CI, 1.04 to 1.43) more frequent in patients in the highest compared with the lowest tertile of Lp(a). 615 …”

Section: Elevated Lipoprotein(a)mentioning

confidence: 99%

Guidelines for the Primary Prevention of Stroke

Goldstein¹,

Bushnell²,

Adams³

et al. 2011

Stroke

1,261

572

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Background and Purpose-This guideline provides an overview of the evidence on established and emerging risk factors for stroke to provide evidence-based recommendations for the reduction of risk of a first stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council Scientific Statement Oversight Committee and the AHA Manuscript Oversight Committee. The writing group used systematic literature reviews (covering the time since the last review was published in 2006 up to April 2009), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations using standard AHA criteria (Tables 1 and 2). All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. The guideline underwent extensive peer review by the Stroke Council leadership and the AHA scientific statements oversight committees before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Schemes for assessing a person's risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic predisposition. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat

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Section: Elevated Lipoprotein(a)mentioning

confidence: 99%

Guidelines for the Primary Prevention of Stroke

Goldstein¹,

Bushnell²,

Adams³

et al. 2011

Stroke

1,261

572

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“…The study base for this report were 352 consecutive Caucasian patients admitted to our neurological ward from December 1995 to November 1999 for ICVD (stroke or TIA), as previously described [20]. Patients were admitted to the Emergency Department of the S. Giovanni Battista Hospital (the University hospital in Turin) and then to the Neurology ward, since they were aged less than 65 years or had a complex neurological picture.…”

Section: Methodsmentioning

confidence: 99%

Apolipoprotein E Polymorphism and Stroke Subtypes in an Italian Cohort

et al. 2005

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Background: Studies have indicated that apolipoprotein E (ApoE)-ε4 is a risk factor for ischemic cerebrovascular diseases (ICVD), but the existence of this association is still controversial. The aims of this study were: (1) to compare ApoE genotype and allele frequencies in Italian cases with ICVD and in healthy control subjects and (2) to compare ApoE allele frequencies among ischemic stroke subtypes. Methods: A hospital-based cohort of 302 Italian subjects with ICVD and 228 healthy subjects have been recruited to investigate the role of ApoE polymorphisms as risk factors for ICVD. TOAST criteria were employed to stratify ICVD cases by subtypes. Results: No significant differences in ApoE genotype and allele frequencies were found between cases and control subjects. The frequency of ApoE-ε4 was lower in cases than in control subjects (6% vs. 10.1%), although not significantly. No differences in ApoE genotype and allele frequencies were evident among ICVD subtypes. However, out of 36 ApoE-ε4 alleles 23 (3.7%) were found in subjects with ICVD related to primary degenerative arterial disease related to large vessel disease and small vessel disease, and 13 (2.1%) in remaining subjects. Using logistic regression analysis we assessed whether ApoE-ε4 allele was independently associated with risk of ICVD related to a primary degenerative arterial disease compared to other ICVD subtypes. While classical risk factors were significantly associated with higher risk for ICVD due to large vessel disease and small vessel disease than other ICVD subtypes, the role of ApoE-ε4 allele was not significant (OR 1.25, 95% CI 0.57–2.74). Conclusion: Our study shows similar ApoE-ε4 genotype and allele frequencies in patients with ICVD and in control subjects. No differences were found among different ICVD subtypes either.

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“…While high Lp(a) levels have clearly been shown to be associated with the genesis of coronary artery disease [9] and the combined end point of stroke, vascular death and death from all causes in the elderly [10], its role in the genesis of stroke and transient ischemic attack remains debated [10,11,12,13,14,15,16,17,18,19,20,21]. Whereas coronary artery disease is caused almost exclusively by atherosclerosis, stroke is a heterogeneous condition of different etiologic origins, i.e.…”

Section: Introductionmentioning

confidence: 99%

Lp(a) Lipoprotein and Plasminogen Activity in Patients with Different Etiology of Ischemic Stroke

Petersen

Schmied²,

Zeller³

et al. 2006

Cerebrovasc Dis

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Background and Purpose: Lp(a) lipoprotein plays an important part in atherothrombogenesis and is considered an independent risk factor for coronary heart disease. However, its role in cerebrovascular disease remains unclear, in particular because of the heterogeneous nature of strokes. We investigated whether elevated Lp(a) is more frequent in ischemic stroke related to atherothrombosis than in other etiologies of stroke. Because of the close structural homology between Lp(a) and plasminogen, we also studied the role of plasminogen in different stroke subtypes and whether there is a dependency on Lp(a) plasma levels. Methods: Lp(a) levels and plasminogen activity were measured in 253 consecutive patients with acute ischemic stroke and in 63 controls (CS). Subtypes of stroke were established according to the TOAST criteria. Results: Median Lp(a) levels were found to be higher in the total cerebral infarction group and in patients with large artery atherosclerosis (LAA) when compared with CS (20.9 and 22.0 mg/dl, respectively, vs. 16.0 mg/dl; p < 0.05). In addition, elevated Lp(a) levels >30 mg/dl were more frequent among the LAA subgroup than among CS (39.4 vs. 11.1%; p < 0.001). Mean plasminogen activity was lower in the total cerebral infarction group (110.8 vs. 120.3%; p < 0.001) and in patients with cardioembolic stroke (109.8 vs. 120.3%; p < 0.05) when compared with CS. There was no correlation between Lp(a) levels and plasminogen activity. Conclusions: Our results support the hypothesis that elevated Lp(a) is a risk factor for ischemic stroke and especially for strokes caused by LAA. Low plasminogen activity may play a role in the pathogenesis of cerebrovascular disease, especially for the development of cardioembolic stroke.

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Higher lipoprotein (a) levels in atherothrombotic than lacunar ischemic cerebrovascular disease

Cited by 26 publications

References 9 publications

Guidelines for the Primary Prevention of Stroke

Guidelines for the Primary Prevention of Stroke

Apolipoprotein E Polymorphism and Stroke Subtypes in an Italian Cohort

Lp(a) Lipoprotein and Plasminogen Activity in Patients with Different Etiology of Ischemic Stroke

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