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This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 70, Number 11, March 11, 2008 Data Supplement All Versions of this Article: 01.wnl.0000294323.48661.a9v1 70/11/841    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bang, O. Y. Articles by Ovbiagele, B. Search for Related Content PubMed PubMed Citation Articles by Bang, O. Y. Articles by Ovbiagele, B. Related Collections Diagnostic test assessment Stroke prevention Other cerebrovascular disease/ Stroke All Cerebrovascular disease/Stroke All epidemiology Screening in epidemiology Risk factors in epidemiology

Association of serum lipid indices with large artery atherosclerotic stroke

From the Department of Neurology, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Suwon, Korea (O.Y.B.); and Department of Neurology, UCLA Medical Center, Los Angeles, CA (O.Y.B., J.L.S., D.S.L., S.P., B.O.).

Address correspondence and reprint requests to Dr. Bruce Ovbiagele, Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095 ovibes{at}mednet.ucla.edu

Background: Low-density lipoprotein cholesterol (LDL) is the primary lipid target for vascular risk reduction in stroke patients, but emerging data suggest that other lipid indices may better predict vascular hazard. We evaluated the relationship between several measures of the classically obtained serum lipid panel and the occurrence of large artery atherosclerotic stroke.

Methods: Data prospectively collected over a 4-year period on subjects admitted with ischemic stroke or TIA to a university medical center were analyzed. Independent associations of fasting serum lipid indices with large artery atherosclerotic (LAA) stroke mechanism were evaluated.

Results: Of 1,049 patients, 247 (23.5%) were classified with LAA, 224 (21.4%) were classified with small vessel disease (SVD), and 578 (55%) were non-LAA, non-SVD subtype. Lipid levels were similar between LAA and SVD patients. Total cholesterol, triglycerides, LDL, non–high-density lipoprotein cholesterol (HDL), and triglyceride:HDL ratio were significantly higher in LAA vs non-LAA, non-SVD patients. After adjustment for age, hypertension, diabetes, smoking, body mass index, and premorbid statin use, significant odds ratios (ORs) for LAA compared with all other ischemic stroke subtypes for patients in the uppermost lipid quartiles (vs lowest) were triglycerides (OR 2.69, 95% CI 1.44 to 5.02) and non-HDL (OR 2.39, 95% CI 1.40 to 4.11). LDL was not associated with LAA.

Conclusions: Compared with all other ischemic stroke subtypes, elevated levels of serum triglycerides and non–high-density lipoprotein, but not low-density lipoprotein (LDL), are associated with large artery atherosclerotic stroke. These non-LDL lipid measures may have utility in delineating atherosclerotic stroke risk.

GLOSSARY: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; ATP = Adult Treatment Panel; BMI = body mass index; HDL = high-density lipoprotein cholesterol; IQR = interquartile range; LAA = large artery atherosclerosis; LDL = low-density lipoprotein cholesterol; MAC = middle cerebral artery; NIHSS = NIH Stroke Scale; OR = odds ratio; SVD = small vessel disease; TC = total cholesterol; TG = triglyceride; WBC = white blood cell.

Supplemental data at www.neurology.org

e-Pub ahead of print on December 26, 2007, at www.neurology.org.

Disclosure: The authors report no conflicts of interest.

Received June 20, 2007. Accepted in final form September 13, 2007.

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