Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Jul;69(1):29–33. doi: 10.1136/jnnp.69.1.29

Serum lipids in young patients with ischaemic stroke: a case-control study

J Albucher 1, J Ferrieres 1, J Ruidavets 1, B Guiraud-Chaumeil 1, B Perret 1, F Chollet 1
PMCID: PMC1736997  PMID: 10864600

Abstract

OBJECTIVES—The relation betweem serum lipids and ischaemic stroke remains controversial. Studies of lipid related risk factors in cerebrovascular disease have varied greatly in their findings and also in their definition of the cerebrovascular end points. Serum lipids are thought to interact with the pathogenesis of stroke through an atherosclerosis mechanism. Stroke in young patients have been shown to be related to non-atherosclerotic causes most of the time. The aim was to determine the serum lipid profile and the vascular risk factors for ischaemic stroke in a series of patients under 45 with an ischaemic stroke and to compare them with a series of controls of the same age.
METHODS—Ninety four consecutive patients with ischaemic stroke were compared with 111 controls of the same age recruited from a regional electoral list. Vascular risk factors were recorded and serum lipid profile was determined in all of them.
RESULTS—Multivariate analyses showed that low HDL cholesterol, male sex, smoking, hypertension, and oral contraceptives were risk factors for intracerebral arterial occlusion.
CONCLUSION—Low HDL cholesterol was the only serum lipid index to be associated to an increased risk of stroke in this population. Low HDL cholesterol must be considered in the care management of young patients regardless of the detectable presence of atherosclerosis.



Full Text

The Full Text of this article is available as a PDF (109.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams H. P., Jr, Bendixen B. H., Kappelle L. J., Biller J., Love B. B., Gordon D. L., Marsh E. E., 3rd Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993 Jan;24(1):35–41. doi: 10.1161/01.str.24.1.35. [DOI] [PubMed] [Google Scholar]
  2. Adams H. P., Jr, Kappelle L. J., Biller J., Gordon D. L., Love B. B., Gomez F., Heffner M. Ischemic stroke in young adults. Experience in 329 patients enrolled in the Iowa Registry of stroke in young adults. Arch Neurol. 1995 May;52(5):491–495. doi: 10.1001/archneur.1995.00540290081021. [DOI] [PubMed] [Google Scholar]
  3. Aronow W. S., Gutstein H., Lee N. H., Edwards M. Three-year follow-up of risk factors correlated with new atherothrombotic brain infarction in 708 elderly patients. Angiology. 1988 Jul;39(7 Pt 1):563–566. doi: 10.1177/000331978803900701. [DOI] [PubMed] [Google Scholar]
  4. Atkins D., Psaty B. M., Koepsell T. D., Longstreth W. T., Jr, Larson E. B. Cholesterol reduction and the risk for stroke in men. A meta-analysis of randomized, controlled trials. Ann Intern Med. 1993 Jul 15;119(2):136–145. doi: 10.7326/0003-4819-119-2-199307150-00008. [DOI] [PubMed] [Google Scholar]
  5. Bogousslavsky J., Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992 Feb;10(1):113–124. [PubMed] [Google Scholar]
  6. Bucher H. C., Griffith L. E., Guyatt G. H. Effect of HMGcoA reductase inhibitors on stroke. A meta-analysis of randomized, controlled trials. Ann Intern Med. 1998 Jan 15;128(2):89–95. doi: 10.7326/0003-4819-128-2-199801150-00002. [DOI] [PubMed] [Google Scholar]
  7. Ericsson C. G. Results of the Bezafibrate Coronary Atherosclerosis Intervention Trial (BECAIT) and an update on trials now in progress. Eur Heart J. 1998 Jul;19 (Suppl H):H37–H41. [PubMed] [Google Scholar]
  8. FELDMAN R. G., ALBRINK M. J. SERUM LIPIDS AND CEREBROVASCULAR DISEASE. Arch Neurol. 1964 Jan;10:91–100. doi: 10.1001/archneur.1964.00460130095013. [DOI] [PubMed] [Google Scholar]
  9. Frank J. W., Reed D. M., Grove J. S., Benfante R. Will lowering population levels of serum cholesterol affect total mortality? Expectations from the Honolulu Heart Program. J Clin Epidemiol. 1992 Apr;45(4):333–346. doi: 10.1016/0895-4356(92)90034-k. [DOI] [PubMed] [Google Scholar]
  10. Gautier J. C., Pradat-Diehl P., Loron P., Lechat P., Lascault G., Juillard J. B., Grosgogeat Y. Accidents vasculaires cérébraux des sujets jeunes. Une étude de 133 patients âgés de 9 à 45 ans. Rev Neurol (Paris) 1989;145(6-7):437–442. [PubMed] [Google Scholar]
  11. HEYMAN A., NEFZGER M. D., ESTES E. H., Jr Serum cholesterol level in cerebral infarction. Arch Neurol. 1961 Sep;5:264–268. doi: 10.1001/archneur.1961.00450150030003. [DOI] [PubMed] [Google Scholar]
  12. Hachinski V., Graffagnino C., Beaudry M., Bernier G., Buck C., Donner A., Spence J. D., Doig G., Wolfe B. M. Lipids and stroke: a paradox resolved. Arch Neurol. 1996 Apr;53(4):303–308. doi: 10.1001/archneur.1996.00550040031011. [DOI] [PubMed] [Google Scholar]
  13. Hebert P. R., Gaziano J. M., Chan K. S., Hennekens C. H. Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. JAMA. 1997 Jul 23;278(4):313–321. [PubMed] [Google Scholar]
  14. Hebert P. R., Gaziano J. M., Hennekens C. H. An overview of trials of cholesterol lowering and risk of stroke. Arch Intern Med. 1995 Jan 9;155(1):50–55. [PubMed] [Google Scholar]
  15. Hessler J. R., Robertson A. L., Jr, Chisolm G. M., 3rd LDL-induced cytotoxicity and its inhibition by HDL in human vascular smooth muscle and endothelial cells in culture. Atherosclerosis. 1979 Mar;32(3):213–229. doi: 10.1016/0021-9150(79)90166-7. [DOI] [PubMed] [Google Scholar]
  16. Iso H., Jacobs D. R., Jr, Wentworth D., Neaton J. D., Cohen J. D. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med. 1989 Apr 6;320(14):904–910. doi: 10.1056/NEJM198904063201405. [DOI] [PubMed] [Google Scholar]
  17. Jürgens G., Költringer P. Lipoprotein(a) in ischemic cerebrovascular disease: a new approach to the assessment of risk for stroke. Neurology. 1987 Mar;37(3):513–515. doi: 10.1212/wnl.37.3.513. [DOI] [PubMed] [Google Scholar]
  18. Kannel W. B., Gordon T., Dawber T. R. Role of lipids in the development of brain infarction: the Framingham study. Stroke. 1974 Nov-Dec;5(6):679–685. doi: 10.1161/01.str.5.6.679. [DOI] [PubMed] [Google Scholar]
  19. Kelso G. J., Stuart W. D., Richter R. J., Furlong C. E., Jordan-Starck T. C., Harmony J. A. Apolipoprotein J is associated with paraoxonase in human plasma. Biochemistry. 1994 Jan 25;33(3):832–839. doi: 10.1021/bi00169a026. [DOI] [PubMed] [Google Scholar]
  20. Lewis M. A. Myocardial infarction and stroke in young women: what is the impact of oral contraceptives? Am J Obstet Gynecol. 1998 Sep;179(3 Pt 2):S68–S77. doi: 10.1053/ob.1998.v179.a93122. [DOI] [PubMed] [Google Scholar]
  21. Lidegaard O. Thrombotic diseases in young women and the influence of oral contraceptives. Am J Obstet Gynecol. 1998 Sep;179(3 Pt 2):S62–S67. doi: 10.1053/ob.1998.v179.a91674. [DOI] [PubMed] [Google Scholar]
  22. Lindenstrøm E., Boysen G., Nyboe J. Influence of total cholesterol, high density lipoprotein cholesterol, and triglycerides on risk of cerebrovascular disease: the Copenhagen City Heart Study. BMJ. 1994 Jul 2;309(6946):11–15. doi: 10.1136/bmj.309.6946.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Lindgren A., Nilsson-Ehle P., Norrving B., Johansson B. B. Plasma lipids and lipoproteins in subtypes of stroke. Acta Neurol Scand. 1992 Dec;86(6):572–578. doi: 10.1111/j.1600-0404.1992.tb05489.x. [DOI] [PubMed] [Google Scholar]
  24. Lisovoski F., Rousseaux P. Cerebral infarction in young people. A study of 148 patients with early cerebral angiography. J Neurol Neurosurg Psychiatry. 1991 Jul;54(7):576–579. doi: 10.1136/jnnp.54.7.576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Mackness M. I., Arrol S., Abbott C., Durrington P. N. Protection of low-density lipoprotein against oxidative modification by high-density lipoprotein associated paraoxonase. Atherosclerosis. 1993 Dec;104(1-2):129–135. doi: 10.1016/0021-9150(93)90183-u. [DOI] [PubMed] [Google Scholar]
  26. Mant J., Painter R., Vessey M. Risk of myocardial infarction, angina and stroke in users of oral contraceptives: an updated analysis of a cohort study. Br J Obstet Gynaecol. 1998 Aug;105(8):890–896. doi: 10.1111/j.1471-0528.1998.tb10235.x. [DOI] [PubMed] [Google Scholar]
  27. Murai A., Miyahara T., Fujimoto N., Matsuda M., Kameyama M. Lp(a) lipoprotein as a risk factor for coronary heart disease and cerebral infarction. Atherosclerosis. 1986 Feb;59(2):199–204. doi: 10.1016/0021-9150(86)90048-1. [DOI] [PubMed] [Google Scholar]
  28. Nagayama M., Shinohara Y., Nagayama T. Lipoprotein(a) and ischemic cerebrovascular disease in young adults. Stroke. 1994 Jan;25(1):74–78. doi: 10.1161/01.str.25.1.74. [DOI] [PubMed] [Google Scholar]
  29. Noma A., Matsushita S., Komori T., Abe K., Okabe H., Kuramoto K., Murakami M. High and low density lipoprotein cholesterol in myocardial and cerebral infarction. Atherosclerosis. 1979 Mar;32(3):327–331. doi: 10.1016/0021-9150(79)90176-x. [DOI] [PubMed] [Google Scholar]
  30. Nubiola A. R., Masana L., Masdeu S., Rubiés-Prat J. High-density lipoprotein cholesterol in cerebrovascular disease. Arch Neurol. 1981 Jul;38(7):468–468. doi: 10.1001/archneur.1981.00510070102026. [DOI] [PubMed] [Google Scholar]
  31. Parra H. J., Arveiler D., Evans A. E., Cambou J. P., Amouyel P., Bingham A., McMaster D., Schaffer P., Douste-Blazy P., Luc G. A case-control study of lipoprotein particles in two populations at contrasting risk for coronary heart disease. The ECTIM Study. Arterioscler Thromb. 1992 Jun;12(6):701–707. doi: 10.1161/01.atv.12.6.701. [DOI] [PubMed] [Google Scholar]
  32. Plehn J. F., Davis B. R., Sacks F. M., Rouleau J. L., Pfeffer M. A., Bernstein V., Cuddy T. E., Moyé L. A., Piller L. B., Rutherford J. Reduction of stroke incidence after myocardial infarction with pravastatin: the Cholesterol and Recurrent Events (CARE) study. The Care Investigators. Circulation. 1999 Jan 19;99(2):216–223. doi: 10.1161/01.cir.99.2.216. [DOI] [PubMed] [Google Scholar]
  33. Postiglione A., Napoli C. Hyperlipidaemia and atherosclerotic cerebrovascular disease. Curr Opin Lipidol. 1995 Aug;6(4):236–242. doi: 10.1097/00041433-199508000-00008. [DOI] [PubMed] [Google Scholar]
  34. Qizilbash N. Are risk factors for stroke and coronary disease the same? Curr Opin Lipidol. 1998 Aug;9(4):325–328. doi: 10.1097/00041433-199808000-00007. [DOI] [PubMed] [Google Scholar]
  35. Qizilbash N., Jones L., Warlow C., Mann J. Fibrinogen and lipid concentrations as risk factors for transient ischaemic attacks and minor ischaemic strokes. BMJ. 1991 Sep 14;303(6803):605–609. doi: 10.1136/bmj.303.6803.605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. ROBINSON R. W., HIGANO N., COHEN W. D. COMPARISON OF SERUM LIPID LEVELS IN PATIENTS WITH CEREBRAL THROMBOSIS AND IN NORMAL SUBJECTS. Ann Intern Med. 1963 Aug;59:180–185. doi: 10.7326/0003-4819-59-2-180. [DOI] [PubMed] [Google Scholar]
  37. Rouhart F., Zagnoli F., Goas J. Y., Mocquard Y. Accidents artériels ischémiques cérébraux de l'adulte jeune. 40 cas. Rev Neurol (Paris) 1993;149(10):547–553. [PubMed] [Google Scholar]
  38. Röschlau P., Bernt E., Gruber W. Enzymatische Bestimmung des Gesamt-Cholesterins im Serum. Z Klin Chem Klin Biochem. 1974 Sep;12(9):403–407. [PubMed] [Google Scholar]
  39. Rössner S., Kjellin K. G., Mettinger K. L., Sidén A., Söderström C. E. Normal serum-cholesterol but low H.D.L.-cholesterol concentration in young patients with ischaemic cerebrovascular disease. Lancet. 1978 Mar 18;1(8064):577–579. doi: 10.1016/s0140-6736(78)91026-7. [DOI] [PubMed] [Google Scholar]
  40. Sirtori C. R., Gianfranceschi G., Gritti I., Nappi G., Brambilla G., Paoletti P. Decreased high density lipoprotein-cholesterol levels in male patients with transient ischemic attacks. Atherosclerosis. 1979 Feb;32(2):205–211. doi: 10.1016/0021-9150(79)90084-4. [DOI] [PubMed] [Google Scholar]
  41. Smith G. D., Shipley M. J., Marmot M. G., Rose G. Plasma cholesterol concentration and mortality. The Whitehall Study. JAMA. 1992 Jan 1;267(1):70–76. [PubMed] [Google Scholar]
  42. Sridharan R. Risk factors for ischemic stroke: a case control analysis. Neuroepidemiology. 1992;11(1):24–30. doi: 10.1159/000110903. [DOI] [PubMed] [Google Scholar]
  43. Taggart H., Stout R. W. Reduced high density lipoprotein in stroke: relationship with elevated triglyceride and hypertension. Eur J Clin Invest. 1979 Jun;9(3):219–221. doi: 10.1111/j.1365-2362.1979.tb00926.x. [DOI] [PubMed] [Google Scholar]
  44. Tell G. S., Crouse J. R., Furberg C. D. Relation between blood lipids, lipoproteins, and cerebrovascular atherosclerosis. A review. Stroke. 1988 Apr;19(4):423–430. doi: 10.1161/01.str.19.4.423. [DOI] [PubMed] [Google Scholar]
  45. Tilvis R. S., Erkinjuntti T., Sulkava R., Färkkilä M., Miettinen T. A. Serum lipids and fatty acids in ischemic strokes. Am Heart J. 1987 Feb;113(2 Pt 2):615–619. doi: 10.1016/0002-8703(87)90642-9. [DOI] [PubMed] [Google Scholar]
  46. Westlund K., Nicolaysen R. Ten-year mortality and morbidity related to serum cholesterol. A follow-up of 3.751 men aged 40-49. Scand J Clin Lab Invest Suppl. 1972;127:1–24. [PubMed] [Google Scholar]
  47. Wolf P. A., Kannel W. B., Dawber T. R. Prospective investigations: the Framingham study and the epidemiology of stroke. Adv Neurol. 1978;19:107–120. [PubMed] [Google Scholar]
  48. Woo J., Lau E., Lam C. W., Kay R., Teoh R., Wong H. Y., Prall W. Y., Kreel L., Nicholls M. G. Hypertension, lipoprotein(a), and apolipoprotein A-I as risk factors for stroke in the Chinese. Stroke. 1991 Feb;22(2):203–208. doi: 10.1161/01.str.22.2.203. [DOI] [PubMed] [Google Scholar]
  49. Yatsu F. M., Fisher M. Atherosclerosis: current concepts on pathogenesis and interventional therapies. Ann Neurol. 1989 Jul;26(1):3–12. doi: 10.1002/ana.410260102. [DOI] [PubMed] [Google Scholar]
  50. Zenker G., Költringer P., Boné G., Niederkorn K., Pfeiffer K., Jürgens G. Lipoprotein(a) as a strong indicator for cerebrovascular disease. Stroke. 1986 Sep-Oct;17(5):942–945. doi: 10.1161/01.str.17.5.942. [DOI] [PubMed] [Google Scholar]
  51. van Lunsen H. W. Recent oral contraceptive use patterns in four European countries: evidence for selective prescribing of oral contraceptives containing third-generation progestogens. Eur J Contracept Reprod Health Care. 1996 Mar-May;1(1):39–45. doi: 10.3109/13625189609150654. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES