Abstract Details

Title Impact of Lipoprotein(a) on Recurrent Stroke Risk: A Stratified Analysis by Stroke Etiology.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-002

Objective To investigate the association between Lipoprotein(a) [Lp(a)] levels and stroke recurrence, stratified by stroke etiology.

Background Elevated Lp(a) is associated with increased cardiovascular disease (CVD) risk including stroke. The association between Lp(a) and stroke recurrence risk especially embolic stroke of undetermined etiologies (ESUS) remains unclear.

Design/Methods

This is a retrospective cohort analysis of patients with CVD who had Lp(a) tested as part of their workup at our institution. We included adult stroke patients and categorized them by stroke etiology: large artery atherosclerosis (LAA), embolic stroke of undetermined source (ESUS), cardioembolic (CE), small vessel disease (SVD), and others. The association between Lp(a) levels (both numeric levels and thresholds of ≥ 30 mg/dl, ≥50 mg/dl, ≥70 mg/dl and ≥100 mg/dl), the presence of stroke recurrence and the number of recurrent strokes were analyzed using logistic and Poisson regression models stratified by stroke etiology and adjusted for race, hypertension, diabetes, smoking history and LDL levels.

Results Among 685 CVD patients, 104 patients (15%) had ischemic stroke. There was no significant difference in Lp(a) levels among the stroke etiology subgroups (p=0.42). Lp(a) ≥50 mg/dL was significantly associated with stroke recurrence among patients regardless of stroke etiology (OR=3.02, p=0.048). In the ESUS subgroup, Lp(a) numeric levels were significantly associated with stroke recurrence (p=0.038), with odds ratios of 2.87, 2.99, 3.18, and 8.27 for the respective thresholds (≥30 mg/dL, ≥50 mg/dL, ≥70 mg/dL, and ≥100 mg/dL). Additionally, Lp(a) levels ≥30 mg/dL significantly correlated with the number of stroke recurrences, with higher Lp(a) levels showing progressively stronger associations with the number of stroke recurrences (p=0.044, 0.032, 0.0281, and 0.0275, respectively).

Conclusions

Higher Lp(a) levels were associated with an increased risk of stroke recurrence and the number of stroke recurrences, particularly in ESUS subgroup. The independent impact of Lp(a) on stroke recurrence risk needs to be determined, particularly in ESUS patients.

Authors/Disclosures
Xueqing Zhang, MD PRESENTER	Dr. Zhang has nothing to disclose.
Hamid Ali, MBBS (Medical University of South Carolina)	Dr. Ali has nothing to disclose.
Marc-Andre Cornier, MD	Dr. Cornier has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for novo nordisk. Dr. Cornier has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Regeneron. Dr. Cornier has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Biophytis. Dr. Cornier has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Zyversa. The institution of Dr. Cornier has received research support from Novartis. The institution of Dr. Cornier has received research support from Amgen. The institution of Dr. Cornier has received research support from Kaneka. The institution of Dr. Cornier has received research support from Ionis.
Ashley Waring, MD	Dr. Waring has nothing to disclose.
Ghada A. Mohamed, MD	Dr. Mohamed has nothing to disclose.

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