title: Predictors of cholesterol and lipoprotein(a) testing in children with arterial ischemic stroke.
abstract: BACKGROUND
  Professional societies recommend screening lipids in healthy children. Dyslipidemia and elevated lipoprotein(a) are risk factors for adult cardiovascular disease and stroke. Their role in childhood arterial ischemic stroke is unexplored. Inconsistencies in testing limit analysis of existing lipid data. The objective of this study is to identify predictors and modifiable barriers to lipid testing in pediatric stroke.
  
  
  METHODS
  In this cross-sectional analysis, children (28 days-18 years) with arterial ischemic stroke were identified from the International Pediatric Stroke Study registry (January 2003-April 2012). Analyzed predictors of recorded lipid or lipoprotein a (Lp(a)) testing were age, sex, race, ethnicity, body mass index (BMI) category, other stroke risk factors, country, US region, and recurrent thrombosis.
  
  
  RESULTS
  Among 1652 participants (median, 6 years [interquartile range, 1.7-12.7]; 59.0% male; 40.8% white; 7.0% black), at least 1 lipid parameter or Lp (a) was available for 461 (27.9%). Compared with infants, testing was incrementally higher for older age categories. Compared with whites, testing was lower in blacks (adjusted odds ratio [OR], .5; 95% confidence interval [CI], .4-.5; P < .0001). Hispanic ethnicity only predicted testing within the United States (OR, 2.2; 95% CI, 1.4-3.4; P = .001]. Testing was lower in the United States and Australia and higher in Chile. Any thrombotic recurrence and recurrent symptomatic arterial ischemic stroke were associated with testing, unlike male sex, BMI, other stroke risk factors, and region in the United States.
  
  
  CONCLUSIONS
  Only a quarter of children with stroke had recorded lipid testing. Older age, white race, and recurrence predicted testing. In future study adjusting for these predictors may be necessary. Standardized lipid testing in children with arterial ischemic stroke may further our understanding of this potential risk factor.
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York. Electronic address: sms92@columbia.edu.
authors.forename: Sally
authors.initials: S
authors.lastname: Sultan
authors.affiliation: Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, New York; Gertrude H Sergievsky Center, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Nicole
authors.initials: N
authors.lastname: Schupf
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Dowling
authors.affiliation: Division of Neurology and Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: DeVeber
authors.affiliation: Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York; Gertrude H Sergievsky Center, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D002545:Brain Ischemia / Q000097:blood*; D002539:Cerebral Arterial Diseases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood*; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006403:Hematologic Tests / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020767:Intracranial Thrombosis / Q000097:blood; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D012959:Socioeconomic Factors; D020521:Stroke / Q000097:blood*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D017270:Lipoprotein(a); D002784:Cholesterol
keywords: Pediatric stroke; cholesterol; lipids; lipoprotein(a); prevention; risk factors