High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis

Background: Lipoprotein (a) (Lp[a]) has important atherothrombogenic properties, but its role in intracranial atherosclerosis remains unclear. Objective: To investigate the relationship between Lp( a) level and the extent of intracranial large-artery occlusive disease. Methods: Between June 2001 and August 2003, 166 consecutive first-ever TIA or stroke patients had intracranial stenoses on transcranial Doppler, of which 100 fulfilled all inclusion criteria. The extent of intracranial large-artery occlusive disease was assessed by the number of angiographically confirmed intracranial stenoses. Serum Lp( a) was determined a minimum of 3 months after stroke onset. Results: Two hundred eighty-one intracranial stenoses were documented. Fifty-one (51%) patients had three or more stenoses (greater-extent group). Patients in the highest Lp( a) quartile had a higher adjusted odds ratio ( OR) for a greater extent than those in the lowest quartile ( OR 3.43, 95% CI 1.04 to 11.33, p = 0.04). A positive correlation was found between Lp( a) concentration and the number of stenoses (r = 0.310, p = 0.002). Moreover, Lp(a) level increased gradually with the number of stenoses (p = 0.02). A multiple logistic regression model identified diabetes (OR 2.4, 95% CI 1.04 to 5.57, p = 0.04) and high Lp(a) (OR 2.52, 95% CI 1.03 to 6.18, p = 0.043) as independent markers of a greater extent of intracranial large-artery occlusive disease. Conclusions: High Lp( a) level and diabetes mellitus are independent markers of a greater extent of intracranial large-artery occlusive disease. These findings support a role for Lp( a) in intracranial stenotic atherogenesis and might be useful for the selection of high-risk patients.