To investigate the relation between elevated levels of lipoprotein(a) [Lp-(a)] and stroke subtype in young patients with stroke.

An elevated level of Lp-(a) is an independent risk factor for atherosclerotic cardiovascular disease (CAD). The aim of this study is to determine the association between elevated Lp-(a) and underlying mechanism of stroke in young (age < 60 years) patients with undetermined etiology in a tertiary hospital in Saudi Arabia.

A cohort of 90 patients with ischemic stroke of undetermined etiology under the age of 60 years were analyzed retrospectively (36 Females, 54 males, mean age 42.9 years for cases and 40.3 years for controls), 30 of which had elevated Lp-(a) (>125 nmol/L), to investigate for a relationship between Lp(a) concentrations and stroke subtypes.

Large vessel strokes were significantly more frequent in cases (66.7% vs. 33.3%, p<0.001). No significant association was identified in relation to other risk factors (HbA1c, BMI, lipid profile and comorbid conditions). Large vessel disease was significantly more common in cases (53.3% vs. 26.7%, p=0.013) Cases had higher rates of diffuse atheroma (23.3% vs. 8.3%) and ICAD (20.0% vs. 6.7) compared to controls (p=0.008). 

Patients with large vessel strokes also had significantly higher mean Lp(a) levels (164.71 nmol/L, SD 89.48) compared to those with small vessel (95.91 nmol/L, SD 57.50) and cryptogenic strokes (58.72 nmol/L, SD 57.43) (p < 0.001). 

Patients with high Lp-(a) levels had significantly higher incidence of large artery atherosclerosis and occlusion. In contrast, they were less likely to have small vessel disease-associated stroke. These findings highlight the key role Lp-(a) plays in the risk stratification and management of stroke, and the need for further studies to explore the mechanism and potential therapeutic implications.