HYPERTENSION, LIPOPROTEIN(A), AND APOLIPOPROTEIN-A-I AS RISK-FACTORS FOR STROKE IN THE CHINESE

We analyzed the serum concentrations of lipids and lipoproteins and the prevalence of other risk factors in a case-control study of 304 consecutive Chinese patients with acute stroke (classified as cerebral infarction, lacunar infarction, or intracerebral hemorrhage) and 304 age- and sex-matched controls. For all strokes we identified the following risk factors: a history of ischemic heart disease, diabetes mellitus, or hypertension; the presence of atrial fibrillation or left ventricular hypertrophy; a glycosylated hemoglobin A1 concentration of > 9.1%; a fasting plasma glucose concentration 3 months after stroke of > 6.0 mmol/l; a serum triglyceride concentration 3 months after stroke of > 2.1 mmol/l; and a serum lipoprotein (a) concentration of > 29.2 mg/dl. We found the following protective factors: a serum high density lipoprotein-cholesterol concentration of > 1.59 mmol/l and a serum apolipoprotein A-I concentration of greater-than-or-equal-to 106 mg/dl. The patterns of risk factors differed among the three stroke subtypes. When significant risk factors were entered into a multiple logistic regression model, we found a history of hypertension, a high serum lipoprotein(a) concentration, and a low apolipoprotein A-I concentration to be independent risk factors for all strokes. The attributable risk for hypertension was estimated to be 24% in patients aged greater-than-or-equal-to 60 years. In this population, in which cerebrovascular diseases are the third commonest cause of mortality, identification of risk factors will allow further studies in risk factor modification for the prevention of stroke.