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Stroke and Lp(a)
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Stroke and Lipoprotein(a) - clinical studies.

Epidemiological Studies/Meta-Analyses

Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality

Emerging Risk Factors Collaboration, Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, White IR, Marcovina SM, Collins R, Thompson SG, Danesh J.

Under a wide range of circumstances, there are continuous, independent, and modest associations of Lp(a) concentration with risk of CHD and stroke that appear exclusive to vascular outcomes.

Lipoprotein (a) as a risk factor for ischemic stroke: a meta-analysis.

Atherosclerosis. 2015 Oct;242(2):496-503. doi: 10.1016/j.atherosclerosis.2015.08.021. Epub 2015 Aug 15.

Nave AH1, Lange KS2, Leonards CO2, Siegerink B2, Doehner W3, Landmesser U4, Steinhagen-Thiessen E5, Endres M6, Ebinger M7.

Elevated Lp(a) is an independent risk factor for ischemic stroke and may be especially relevant for young stroke patients. Sex-specific risk differences remain conflicting. Further studies in these subgroups may be warranted.

Trends in Stroke Hospitalizations

Ramirez L. et al. Trends in Stroke Hospitalizations. J AM Heart Assoc. 2016;5:e003233; originally published May 11, 2016; doi 10.1161/JAHA.116.003233 https://www.ncbi.nlm.nih.gov/labs/articles/27169548/

Age-specific AIS hospitalization rates decreased for individuals aged 65 to 84 years (846 to 605 per 100 000) and ≥85 years (2077 to 1618 per 100 000), but increased for individuals aged 25 to 44 years (16 to 23 per 100 000) and 45 to 64 years (149 to 156 per 100 000).

Lipoprotein(a) level, apolipoprotein (a) size, and risk of unexplained ischemic stroke in young and middle-aged adults

Beheshtian A. et al. Lipoprotein (a) level, apolipoprotein (a) size, and risk of unexplained ischemic stroke in young and middle-aged adults Atherosclerosis Volume 253, Pages 47-53 (October 2016) DOI: 10.1016/j.atherosclerosis.2016.08.013 https://www.ncbi.nlm.nih.gov/pubmed/27575936

CONCLUSIONS:

This study underscores the importance of Lp(a) level, but not apo(a) size, as an independent risk factor for unexplained ischemic stroke in young and middle-aged white adults. Given the emergence of effective Lp(a)-lowering therapies, these findings support routine testing for Lp(a) in this setting, along with further research to assess the extent to which such therapies improve outcomes in this population.

Heart Disease and Stroke Statistics - 2016 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. https://www.ncbi.nlm.nih.gov/pubmed/26673558

Elevated lipoprotein(a), small apolipoprotein(a), and the risk of arterial ischemic stroke in North American Children

Goldenberg N. A. et al. Elevated lipoprotein(a), small apolipoprotein(a), and the risk of arterial ischemic stroke in North American children. Haematologica. 2013 ; 98(5) DOI:10.3324.haematol.2012.073833 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640128/

In conclusion, elevated lipoprotein (a) and small apolipoprotein (a) potently increase the risk of recurrent arterial ischemic stroke in children, with a mechanism only partially attributable to impaired fibrinolysis. Collaborative studies are warranted to investigate these findings further and, more broadly, to establish key risk factors for incident and recurrent arterial ischemic stroke in children.

 

Lp(a) (Lipoprotein(a)) Levels Predict Progression of Carotid Atherosclerosis in Subjects With Atherosclerotic Cardiovascular Disease on Intensive Lipid Therapy: An Analysis of the AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) Carotid Magnetic Resonance Imaging Substudy.

Hippe DSet al.  2018 Jan 4. pii: ATVBAHA.117.310368. doi: 10.1161/ATVBAHA.117.310368. [Epub ahead of print]

Despite intensive lipid therapy, aimed at aggressively lowering LDL-C to <70 mg/dL, carotid atherosclerosis continued to progress as assessed by carotid magnetic resonance imaging and that elevated Lp(a) levels were independent predictors of increases in atherosclerosis burden.

 

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