High levels of remnant lipoprotein cholesterol is a risk factor for large artery atherosclerotic stroke

Abstract

Background and purpose: Remnant lipoproteins (RLPs) are products of partially catabolized chylomicrons and very-low-density lipoprotein, from which some triglycerides have been removed. These particles are smaller and denser than the parent particles and are believed to be strongly atherogenic. We explored the association between RLP cholesterol (RLP-C) and ischemic stroke, including stroke subtypes.

Methods: A cohort of 142 ischemic stroke patients (90 men and 52 women; age, 65.2±12.8 years, mean±SD) was enrolled; all had acute infarcts confirmed by diffusion-weighted MRI, and had fasting lipograms. A full stroke-related evaluation was conducted on each patient. An outpatient population of 88 subjects without a history of cerebrovascular or cardiovascular disease served as a control group. Serum RLP fractions were isolated using an immunoaffinity gel containing specific antiapolipoprotein (anti-apo)B-100 and anti-apoA-I antibodies. RLP-C values were considered to be high when they were in the highest quartile of all values in the study.

Results: High RLP-C values were more common in stroke patients than in control patients (31.0% vs. 14.8%, p=0.01), when 5.6 mg/dL (>75th percentile) was used as the cutoff value. Multivariable analyses indicated that RLP-C was a risk factor for stroke, with an odds ratio of 2.54 (p=0.045). The RLP-C level was higher in the large artery atherosclerosis subgroup (5.7±3.9 mg/dL) than in any other stroke subgroup (small vessel occlusion, 4.9±5.9 mg/dL; cardioembolism, 1.8±2.3 mg/dL; stroke of undetermined etiology, 3.1±2.9 mg/dL).

Conclusions: We have found an association between high RLP-C levels and ischemic stroke, and in particular large artery atherosclerotic stroke.

Keywords: ischemic stroke; large artery atherosclerosis; remnant lipoprotein cholesterol.

Fig. 1

Correlation between remnant lipoprotein cholesterol (RLP-C) and triglyceride levels.

Fig. 2

Box plots of remnant lipoprotein cholesterol (RLP-C) levels of the control group and stroke subgroups. ^*p<0.05 for large-artery atherosclerotic (LAA) stroke vs. control by Mann-Whitney test, and LAA stroke vs. small-vessel occlusion (SVO), cardioembolism (CE), or stroke of undetermined etiology (SUE) by Kruskal-Wallis ANOVA with Mann-Whitney post hoc tests. TOAST: Trial of Org 10172 in Acute Stroke Treatment.