Increased plasma concentrations of atherogenic lipoproteins, especially Lp (a) play an important role in the development of atherosclerosis leading to premature myocaridial infarction and stroke. Lp (a) is a novel risk factor for atherosclerosis, whose role in multiracial populations has been debated. The significance of different lipid variables in cardiovascular disease and cerebrovascular disease has been extensively studied but the role of Lp (a) in Indian population is yet to be determined.
Objective: To determine the role of Lipoprotein (a) as a marker for ischemic stroke, with regard to Indian scenario.
Design: This is a case-control study.
Duration: One year (2019-2020).
Setting: Department of Medicine, Osmania General Hospital, Hyderabad.
Participants: Hundred patients admitted in Osmania General Hospital, Hyderabad.
Methods: Diagnosis of ischemic stroke was based on clinical evidence of ischemic stroke and CT scan/MRI. Some exclusions were made. 50 age and sex matched healthy subjects were used as controls. In all patients, a detailed history, general physical examination, a detailed neurological examination and other risk factor variables were entered on a pre-designed proforma. SBP ≥140mm Hg, DBP ≥90mm Hg were considered hypertensive levels; any patient with FBS ≥126mg/dl (or) RBS ≥200mg/dl was defined diabetic. Each case underwent the investigations – Plasma Lipoprotein (a) Levels, Lipid Profile, Complete Hemogram, Complete Urine Examination, Blood Sugars, Renal Function Tests, Serum Electrolytes, ECG, Echocardiography*, X-Ray, CT-Brain*, MRI-Brain*. Lp (a) was measured by a Hitachi model 717 (7160) automated analyser using Lp (a) Latex DIACHI kit. *Denotes whenever required.
Results: In the present study, cases of ischemic stroke (n = 100) had a mean plasma Lp (a) value of 38.034 mg/dl with a S.D. of 17.423, which was significantly higher (p = 0.001) than in healthy controls, in whom it was 24.308 mg/dl with a S.D. of 11.469, indicating that serum lipoprotein (a) levels are a risk factor of ischemic stroke.
Conclusion: Elevated serum Lp (a) is an independent risk factor of ischemic stroke. Measurement of serum Lp (a) has to be considered as a screening tool for the risk of vascular events in patients with various known risk factors. It is imperative to strictly control additional risk factors in individuals with elevated Lp (a).