High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis.
BACKGROUND
Lipoprotein (a) (Lp[a]) has important atherothrombogenic properties, but its role in intracranial atherosclerosis remains unclear.


OBJECTIVE
To investigate the relationship between Lp(a) level and the extent of intracranial large-artery occlusive disease.


METHODS
Between June 2001 and August 2003, 166 consecutive first-ever TIA or stroke patients had intracranial stenoses on transcranial Doppler, of which 100 fulfilled all inclusion criteria. The extent of intracranial large-artery occlusive disease was assessed by the number of angiographically confirmed intracranial stenoses. Serum Lp(a) was determined a minimum of 3 months after stroke onset.


RESULTS
Two hundred eighty-one intracranial stenoses were documented. Fifty-one (51%) patients had three or more stenoses (greater-extent group). Patients in the highest Lp(a) quartile had a higher adjusted odds ratio (OR) for a greater extent than those in the lowest quartile (OR 3.43, 95% CI 1.04 to 11.33, p = 0.04). A positive correlation was found between Lp(a) concentration and the number of stenoses (r = 0.310, p = 0.002). Moreover, Lp(a) level increased gradually with the number of stenoses (p = 0.02). A multiple logistic regression model identified diabetes (OR 2.4, 95% CI 1.04 to 5.57, p = 0.04) and high Lp(a) (OR 2.52, 95% CI 1.03 to 6.18, p = 0.043) as independent markers of a greater extent of intracranial large-artery occlusive disease.


CONCLUSIONS
High Lp(a) level and diabetes mellitus are independent markers of a greater extent of intracranial large-artery occlusive disease. These findings support a role for Lp(a) in intracranial stenotic atherogenesis and might be useful for the selection of high-risk patients.
Arenillas
J F
JF
Neurovascular Unit, Department of Neuroradiology, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain. juanfarenillas@terra.es
Molina
C A
CA
Chacón
P
P
Rovira
A
A
Montaner
J
J
Coscojuela
P
P
Sánchez
E
E
Quintana
M
M
Alvarez-Sabín
J
J
D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000097:blood / Q000453:epidemiology; D017270:Lipoprotein(a) / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000097:blood / Q000453:epidemiology
D015415:Biomarkers; D017270:Lipoprotein(a)