XVII. European Stroke Conference
Nice, France

Poster Session: Stroke and diabetes
 

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
VLDL Quantification Using Lipid Subfraction Analysis in Cerebral Artherosclerosis
S.M.Park    D.-W.Kang    S.U.Kwon     J.S.Kim                                            
 
Asan Medical Center

SOUTH KOREA

Background and Objectives. Dyslipidemia is one of the risk factor for cerebral artherosclerosis. Although therapeutic target for dyslipidemia had been based on the canonical criteria using the absolute level of total cholesterol or LDL, recent datas are pointing to the abnormalities in metabolism of triglyceride-rich lipoproteins as important etiologic factors in artherosclerosis. In addition, the role of VLDL was well known as an export vehicle of triglyceride. From this point of view, we started to look into lipid particle size. We did lipid quantitation using subfraction analysis and identified quantitation of specific lipid subfraction as a surrogate marker associated with the high risk group for cerebral artherosclerosis. Subjects and Method: We prospective included patients without history of dyslipidemia who visited to neurology clinic in Asan Medical Center between May 2007 and Sep 2007. We screened MR angiography for evaluation of cerebral artherosclerosis. We excluded the patients with recent stroke history. Total 104 patients were recruited and analysed mean lipid particle size and quantitation of lipid subfraction using Tube Polyacrylamide Gel Electrophoresis. lipid particle size were divided into 12 subgroups(VLDL, 3 classes of IDL, 7 classes of LDL, and HDL). 24 patients had significant(> 50%) large vessel stenosis and 80 patients had normal or minmal stenosis. Results There were no stastical difference in risk factors between the two groups. Total cholesterol, LDL and HDL levels were not correlated with the patients with large vessel stenosis (Total cholesterol;p=0.092, LDL;p=0.185, HDL;p=0.609). Triglyceride level was slightly higher in patients with large vessel stenosis(163.21 ±90.79mg/dl) than controls(153.56 ±77.48mg/dl)(p=0.080).VLDL level using lipid subfraction was lower in the patients with large vessel stenosis (large vessel stenosis=67.63 ± 33.60mg/dl, control=67.63 ±49.81mg/dl,p=0.013). Conclusion VLDL level quantitation using lipid subfraction analysis can be a good surrogate marker for large vessel stenosis.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Effect of Pre-existing Statin Therapy on Presentation of Cervical Carotid Occlusion.
D. Yavagal    H. Gardener    S. Newsome     D. Drazin     R. Edgell    A. Boulos     G. Bernardini     T. Rundek             
 
Albany Medical Center, Albany, NY, USA & University of Miami Miller School of Medicine, Miami, FL

USA

Background: Cervical internal carotid artery (ICA) occlusion increases the risk of ipsilateral stroke (IS) with an annual incidence of 2-4 %. We sought to find out if pre-existing statin use has a protective effect in preventing IS in cervical ICA occlusion. We also studied the combined effect of statins with antihypertensives, in preventing IS. Methods: A single institutional retrospective study of patients with new diagnosis of ICA occlusion on CT angiogram(CTA) from January 2002 - November 2007 was done. We recorded presenting diagnosis, demographics, stroke risk factors, current medications, contralateral carotid stenosis & vertebral artery stenosis. Patients presenting with IS were compared to the patients presenting without IS. The relation between pre-existing medications for vascular prophylaxis including statin use & presentation with IS was assessed with multiple logistic regression, adjusting for age, sex, & risk factors that were associated with IS (p<0.10).Results: A total of 144 patients had ICA occlusion from amongst 2459 patients who underwent cervical CTA. Complete medical records could be retrieved for 108. 62 patients presented with ispilateral carotid stroke. Those who presented with IS had a significantly higher frequency of previous CAD or MI. There was no difference in the demographic variables or other risk factors in the two groups. 13 out of 62 (21%) patients with IS were on statins as compared to 26/46 (57%) patients without IS (OR= 0.31, 95% CI= 0.12-0.83). Also, 6 (10%) patients with IS were on anti-hypertensive medication as compared to 33 (72%) patients without IS (OR= 0.05, 95% CI= 0.02-0.17). 4 out of 62 patients (6.4%) patients with IS were on both statins and anti-hypertensives as compared to 24 out of 46 (52%) without IS (OR =0.09, 95% CI= 0.03-0.33). There was no significant difference in the use of anti-platelet or coumadin in the two groups. Discussion: Pre-existing statin use may have protective effect in preventing ipsilateral carotid stroke. This effect is enhanced when statin use is combined with antihypertensives.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
The role of hemoglobin A1c in Acute Ischemic Stroke
G.S.Silva    F.O.Lima    S. Sonni     M.K.Parides     D.M.Greer    K.L.Furie                             
 
Massachusetts General Hospital

USA

Background and purpose: Diabetes is a known risk factor for ischemic stroke. The relation of hemoglobin A1c (HbA1c) at stroke admission, a marker of the past 90 days' mean glycemia, to components of the metabolic syndrome (obesity, hypertriglyceridemia, hypertension and low HDL levels) and to stroke prognosis has not been established. Our aim was to compare the frequency of risk factors, stroke etiologies and prognosis, and frequency of newly diagnosed diabetes at six months in patients with and without elevated HbA1c. Methods: We prospectively evaluated 916 consecutive patients with acute ischemic stroke from a biomarker study in a University-based hospital. Stroke characteristics, demographics, medical history were obtained at baseline, discharge, and at 6 month follow-up. Results: We included 397 patients who had HbA1c measured within 24 hours of admission (44% female, mean age 66.3 +/- 15 yo). Diabetes was present in 22%, amongst whom 82% had an elevated HbA1c (>=7%) at admission, compared to 14% of non-diabetics (p<0.01). NIHSS was not related to HbA1c levels. Lacunar and large artery etiologies (TOAST classification) were more frequent in patients with HbA1c>=7% (p<0.01). Hypertension, obesity, hypertriglyceridemia and low levels of HDL were more frequent with high HbA1c levels (p<0.01 for all comparisons). Admission glycemia explained 28% of the variance in HbA1c (p<0.01). The frequency of newly diagnosed diabetes at six months was higher in patients with elevated HbA1c (p<0.01). HbA1c was a predictor of independence (modified Rankin scale <=2) at six months in non-diabetic patients (p=0.04), but not in diabetics. Discussion: Admission glucose can explain in part levels of HbA1c. The additional information contained in the HbA1c values is associated with other stroke risk factors, including the components of the metabolic syndrome. HbA1c elevation can help in differentiating diabetics from non diabetics with stress-related elevation of blood glucose. HbA1c is able to predict 6-month independence in patients without a previous diagnosis of diabetes.