JACC: This inconspicuous bad "blood lipid" actually increases the risk of stroke by 60%!

In 1963, geneticist Kare Berg discovered a lipoprotein particle similar to low- density lipoprotein cholesterol (LDL-C) and named it lipoprotein (a) (LPa)
.

In the past decade, some large contemporary studies have rekindled this interest.

Whether

Approximately 20% of people have high levels Approximately 20% of people have high levels

In addition, lipoproteins have covalently bound apolipoprotein A (aPOA) molecules with repetitive sequences similar to plasminogen, thereby potentially competing with plasminogen for receptors on endothelial cells, resulting in reduced plasmin formation And the delayed clot lysis that is conducive to thrombosis ; the fact that LPa is associated with low bleeding risk also supports the above view
.

thrombus

The current research has identified several risk factors for the development of stroke: such as age, male and Asian ancestry; life>Diabetes , atrial fibrillation, previous TIA attacks, and myocardial infarction
.

Several risk factors for stroke development: such as age, male and Asian ancestry; life>diabetes , atrial fibrillation, Previous TIA attacks and myocardial infarction
.

Several risk factors for stroke development: such as age, male and Asian ancestry; life>diabetes , atrial fibrillation, Previous TIA attacks and myocardial infarction

The relationship between high LPa and the risk of ischemic and hemorrhagic stroke has been studied in previous studies ; but the results are conflicting
.

To this end, from the University of Copenhagen, Copenhagen, Denmark and root Tuo Fute He Lefu hospital cardiac vascular specialists observe and deduce whether LPa associated with a higher risk of ischemic stroke from the perspective of human genetics, published in the journal JACC

Stroke, heart blood vessels

The study included 49,699 individuals from the Copenhagen General Population Study and 10,813 individuals from the Copenhagen City Heart Study.
The plasma LPa, LPA gene kringle Ⅳ type 2 (KIV-2) duplicate copy number (KIV-2), and LPA rs10455872 were measured
.

The endpoint of ischemic stroke was determined from the Danish National Health Registry

Multivariate adjusted ischemic stroke risk ratio based on lipoprotein(a) levels

Multivariate adjusted ischemic stroke risk ratio based on lipoprotein(a) levels

The results showed that compared with individuals with LP(a) level <10 mg/dl (<18 nmol/l: 1st to 50th percentile), for LP(a)> 93mg/dl (>199 nmol/L) : Individuals in the 96th to 100th percentile) have a 60% increased risk of ischemic stroke (multivariate adjusted OR=1.
60, 95% CI: 1.
24-2.
05)
.

The results showed that compared with individuals with LP(a) level <10 mg/dl (<18 nmol/l: 1st to 50th percentile), for LP(a)> 93mg/dl (>199 nmol/L) : Individuals in the 96th to 100th percentile) have a 60% increased risk of ischemic stroke (multivariate adjusted OR=1.
60, 95% CI: 1.
24-2.
05)
.

The results showed that compared with individuals with LP(a) level <10 mg/dl (<18 nmol/l: 1st to 50th percentile), for LP(a)> 93mg/dl (>199 nmol/L) : Individuals in the 96th to 100th percentile) have a 60% increased risk of ischemic stroke (multivariate adjusted OR=1.

The corresponding age- and sex-adjusted genetic hazard ratio for the number of KIV-2 repetitions was 1.

Cumulative incidence of ischemic stroke in different lipoprotein(a) level categories

Cumulative incidence of ischemic stroke in different lipoprotein(a) level categories

In addition, among smokers over 70 with hypertension and LP(a) levels> 93 mg/dl (>199 nmol/l: 96th to 100th percentile), the 10-year highest absolute risk of ischemic stroke is 17%
.

In the Copenhagen City Heart Study, the risk of high levels of lipoprotein (a) was estimated in the same direction, but it did not reach statistical significance

Among smokers over 70 with high blood pressure and LP(a) levels> 93 mg/dl (>199 nmol/l: 96th to 100th percentile), the 10-year maximum absolute risk of ischemic stroke is 17%

It can be seen from the observation of human genetics and causality that high LP(a) levels are associated with an increased risk of ischemic stroke

references:

Langsted A, Nordestgaard BG, Kamstrup PR.
Elevated Lipoprotein(a) and Risk of Ischemic Stroke.
J Am Coll Cardiol.
2019 Jul 9;74(1):54-66.

Elevated Lipoprotein(a) and Risk of Ischemic Stroke.
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