High Levels of Remnant Lipoprotein Cholesterol Is a Risk Factor for Large Artery Atherosclerotic Stroke

Background and Purpose Remnant lipoproteins (RLPs) are products of partially catabolized chylomicrons and very-low-density lipoprotein, from which some triglycerides have been removed. These particles are smaller and denser than the parent particles and are believed to be strongly atherogenic. We explored the association between RLP cholesterol (RLP-C) and ischemic stroke, including stroke subtypes. Methods A cohort of 142 ischemic stroke patients (90 men and 52 women; age, 65.2 +/- 12.8 years, mean +/- SD) was enrolled; all had acute infarcts confirmed by diffusion-weighted MRI, and had fasting lipograms. A full stroke-related evaluation was conducted on each patient. An outpatient population of 88 subjects without a history of cerebrovascular or cardiovascular disease served as a control group. Serum RLP fractions were isolated using an immunoaffinity gel containing specific antiapolipoprotein (anti-apo)B-100 and anti-apoA-I antibodies. RLP-C values were considered to be high when they were in the highest quartile of all values in the study. Results High RLP-C values were more common in stroke patients than in control patients (31.0% vs. 14.8%, p=0.01), when 5.6 mg/dL (>75th percentile) was used as the cutoff value. Multivariable analyses indicated that RLP-C was a risk factor for stroke, with an odds ratio of 2.54 (p=0.045). The RLP-C level was higher in the large artery atherosclerosis subgroup (5.7 +/- 3.9 mg/dL) than in any other stroke subgroup (small vessel occlusion, 4.9 +/- 5.9 mg/dL; cardioembolism, 1.8 +/- 2.3 mg/dL; stroke of undetermined etiology, 3.1 +/- 2.9 mg/dL). Conclusions We have found an association between high RLP-C levels and ischemic stroke, and in particular large artery atherosclerotic stroke. J Clin Neurol 2011;7:203-209