Lipoprotein (a) and Apolipoprotein E ε4 as Independent Risk Factors for Ischemic Stroke

Background Controversies exist concerning the association between serum lipids and ischemic stroke. Objective To investigate the relationship between serum lipid, apolipoprotein E (apoE) genotype and risk of ischemic stroke. Methods We measured the concentrations of serum lipids, lipoprotein (a) [Lp(a)], and apoE genotype, as well as the distribution of other potential risk factors, in 90 pairs of age- and sex-matched ischemic stroke patients and stroke-free controls. Results The prevalence of hypertension, family history of stroke and hypertension, and smoking and drinking habits were significantly higher in cases than in controls. Total cholesterol, low-density lipoprotein cholesterol, and Lp(a) levels were higher in ischemic stroke patients than in controls (5.7 ± 1.2 versus 5.3 ± 1.2 mmol/l, P<0.05; 3.7 ± 1.0 versus 3.1 ± 1.0 mmol/l, P< 0.01; and 197.6 ± 30.6 versus 90.4 ± 11.2 mg/l, P< 0.01, respectively). The cases had lower high-density lipoprotein cholesterol and apolipoprotein A-l concentrations compared with the controls. The apoE ε3/ε4 genotype was more frequent in cases (21.1%) than in controls (8.9%, P<0.05). Conclusion The results of the study indicate that serum Lp(a) level and apoE ε4 are the prominent lipidic predictors for ischemic stroke in addition to the general risk factors such as history of hypertension, family history of stroke and cigarette smoking.

[1]  N. Yorioka,et al.  Apolipoprotein E polymorphism and renal disease. , 1999, Kidney international. Supplement.

[2]  A. Hofman,et al.  Atherosclerosis, apolipoprotein E, and prevalence of dementia and Alzheimer's disease in the Rotterdam Study , 1997, The Lancet.

[3]  K. Manton,et al.  Apolipoprotein E polymorphism and stroke in a population sample aged 75 years or more. , 1996, Stroke.

[4]  G. Franceschini,et al.  Plasma lipoprotein(a) is an independent factor associated with carotid wall thickening in severely but not moderately hypercholesterolemic patients. , 1996, Stroke.

[5]  F. Coria,et al.  Apolipoprotein E variants in ischemic stroke. , 1995, Stroke.

[6]  M. Laakso,et al.  Apolipoprotein E4 phenotype is not an important risk factor for coronary heart disease or stroke in elderly subjects. , 1995, Arteriosclerosis, thrombosis, and vascular biology.

[7]  G. Siest,et al.  Apolipoprotein E: an important gene and protein to follow in laboratory medicine. , 1995, Clinical chemistry.

[8]  J. Gardenier.  Letter , 1995 .

[9]  P. Ridker,et al.  Plasma concentration of lipoprotein(a) and the risk of future stroke. , 1995, JAMA.

[10]  P. de Knijff,et al.  ApoE polymorphism and predisposition to coronary heart disease in youths of different European populations. The EARS Study. European Atherosclerosis Research Study. , 1994, Arteriosclerosis and thrombosis : a journal of vascular biology.

[11]  G. Boysen,et al.  Influence of total cholesterol, high density lipoprotein cholesterol, and triglycerides on risk of cerebrovascular disease: the Copenhagen city heart study , 1994, BMJ.

[12]  Y. Shinohara,et al.  Lipoprotein(a) and Ischemic Cerebrovascular Disease in Young Adults , 1994, Stroke.

[13]  A. Roses,et al.  Apolipoprotein E4 allele frequency, ischemic cerebrovascular disease, and Alzheimer's disease. , 1993, Stroke.

[14]  H. Hamaguchi,et al.  High Serum Lipoprotein (a) Levels Are an Independent Risk Factor for Cerebral Infarction , 1993, Stroke.

[15]  G. Fénelon,et al.  Prevalence of Apolipoprotein E Phenotypes in Ischemic Cerebrovascular Disease: A Case‐Control Study , 1993, Stroke.

[16]  L. Kuller,et al.  Relation of apolipoprotein E phenotype to myocardial infarction and mortality from coronary artery disease. , 1993, The American journal of cardiology.

[17]  M. Sentí,et al.  Lipoprotein and Apolipoprotein Profile in Men With Ischemic Stroke: Role of Lipoprotein (a), Triglyceride‐Rich Lipoproteins, and Apolipoprotein E Polymorphism , 1992, Stroke.

[18]  D. Jacobs,et al.  Serum cholesterol level and mortality findings for men screened in the multiple risk factor intervention trial , 1992 .

[19]  A. Scanu.  Lipoprotein(a). A genetic risk factor for premature coronary heart disease. , 1992, JAMA.

[20]  D. Reed,et al.  Will lowering population levels of serum cholesterol affect total mortality? Expectations from the Honolulu Heart Program. , 1992, Journal of clinical epidemiology.

[21]  R. Sridharan.  Risk factors for ischemic stroke: a case control analysis. , 1992, Neuroepidemiology.

[22]  M. Marmot,et al.  Plasma cholesterol concentration and mortality. The Whitehall Study. , 1992, JAMA.

[23]  C. Sing,et al.  The gender-specific apolipoprotein E genotype influence on the distribution of lipids and apolipoproteins in the population of Rochester, MN. I. Pleiotropic effects on means and variances. , 1991, American journal of human genetics.

[24]  F. Dati,et al.  International Federation of Clinical Chemistry standardization project for measurements of apolipoproteins A-I and B. , 1991, Clinical chemistry.

[25]  C. Warlow,et al.  Fibrinogen and lipid concentrations as risk factors for transient ischaemic attacks and minor ischaemic strokes. , 1991, BMJ.

[26]  K. Yano,et al.  Serum cholesterol and mortality among Japanese-American men. The Honolulu (Hawaii) Heart Program. , 1991, Archives of internal medicine.

[27]  J. Woo,et al.  Hypertension, lipoprotein(a), and apolipoprotein A-I as risk factors for stroke in the Chinese. , 1991, Stroke.

[28]  E. Boerwinkle,et al.  Relation of serum lipoprotein(a) concentration and apolipoprotein(a) phenotype to coronary heart disease in patients with familial hypercholesterolemia. , 1990, The New England journal of medicine.

[29]  D. Reed.  The paradox of high risk of stroke in populations with low risk of coronary heart disease. , 1990, American journal of epidemiology.

[30]  D. T. Vernier,et al.  Restriction isotyping of human apolipoprotein E by gene amplification and cleavage with HhaI. , 1990, Journal of lipid research.

[31]  R. Collins,et al.  Serum cholesterol levels and stroke mortality. , 1989, The New England journal of medicine.

[32]  D. Jacobs,et al.  Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. , 1989, The New England journal of medicine.

[33]  M. Nieminen,et al.  Apoprotein E Polymorphism and Coronary Artery Disease: Increased Prevalence of Apolipoprotein E‐4 in Angiographically Verified Coronary Patients , 1989, Arteriosclerosis.

[34]  E. Chen,et al.  cDNA sequence of human apolipoprotein(a) is homologous to plasminogen , 1987, Nature.

[35]  E. Schaefer,et al.  Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. , 1987, Clinica chimica acta; international journal of clinical chemistry.

[36]  J Bamford,et al.  The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. , 1987, Stroke.

[37]  N. Morton,et al.  Lp(a) lipoprotein as a risk factor for myocardial infarction. , 1986, JAMA.

[38]  F. D. Hollanders,et al.  Serum lipid changes following the completed stroke syndrome , 1975, Postgraduate medical journal.

[39]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.