Lipids and Stroke: A Paradox Resolved

doi:10.1001/archneur.1996.00550040031011

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Vol. 53 No. 4, April 1996

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Lipids and Stroke

A Paradox Resolved

Vladimir Hachinski, MD, FRCPC, MSc, DSc(Med); Carmelo Graffagnino, MD, FRCPC; Michel Beaudry, MD, FRCPC; Gilles Bernier, MD, FRCPC; Carol Buck, MD, PhD; Allan Donner, PhD; J. David Spence, MD, FRCPC; Gordon Doig, MSc; Bernard M. J. Wolfe, MD, FRCPC

Arch Neurol. 1996;53(4):303-308.

Abstract

Background
Although dyslipidemia is a wellestablished risk factor for coronaryartery disease, its relationship to ischemic cerebrovasculardisease has remained unclear, perhaps because of the heterogeneousnature of strokes.

Methods
In a case-control study, we measured the serum concentrationsof total cholesterol, low-density lipoprotein cholesterol, high-densitylipoprotein cholesterol, serum triglycerides, and lipoprotein(a)levels and determined the apolipoprotein E phenotype and serumferritin level in 90 consecutive systematically investigatedpatients with stroke or transient ischemic attack of atherothromboticorigin. Ninety age-, sex-, and community-matched subjects servedas controls.

Results
Plasma total cholesterol (5.99 vs 5.45 mmol/L [232 vs 211 mg/dL],P=.003), low-density lipoprotein cholesterol (3.96 vs 3.45 mmol/L[153 vs 133 mg/dL], P=.004), and serum triglyceride (2.09 vs1.82 mmol/L [81 vs 70 mg/dL], P=.03) levels were significantlyhigher among the patients with atherothrombotic strokes andtransient ischemic attacks than among the control subjects.The inverse was true for high-density lipoprotein cholesterol(1.07 vs 1.18 mmol/L [41 vs 46 mg/dL], P=.02) levels. No significantdifferences were found in lipoprotein(a) levels or in the distributionof apolipoprotein E phenotypes or allele frequency. Serum ferritinlevels did not differ significantly between patients and controlsubjects.

Conclusions
Elevated low-density lipoprotein cholesterol and triglyceridelevels are significant independent risk factors in patientswith proven atherothrombotic cerebrovascular disease manifestingas stroke or transient ischemic attack. The level of storedserum iron, as reflected by serum ferritin levels, does notcorrelate with the presence of atherothrombotic cerebrovascularor coronary disease.

Author Affiliations

From the Departments of Clinical Neurological Sciences (Drs Hachinski and Spence) and Medicine (Dr Wolfe), London Health Sciences Centre—University Campus, London, Ontario; Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario (Drs Hachinski, Buck, and Donner and Mr Doig); Division of Neurology, Department of Medicine, Duke University Medical Center, Durham, NC (Dr Graffagnino); Hôpital de Chicoutimi, Chicoutimi, Quebec (Dr Beaudry); Hôpital Notre-Dame, Montreal, Quebec (Dr Bernier); and Department of Medicine, London Health Sciences Centre—Victoria Campus, London, Ontario (Dr Spence).

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