High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis

Neurology. 2004 Jul 13;63(1):27-32. doi: 10.1212/01.wnl.0000132637.30287.b4.


Background: Lipoprotein (a) (Lp[a]) has important atherothrombogenic properties, but its role in intracranial atherosclerosis remains unclear.

Objective: To investigate the relationship between Lp(a) level and the extent of intracranial large-artery occlusive disease.

Methods: Between June 2001 and August 2003, 166 consecutive first-ever TIA or stroke patients had intracranial stenoses on transcranial Doppler, of which 100 fulfilled all inclusion criteria. The extent of intracranial large-artery occlusive disease was assessed by the number of angiographically confirmed intracranial stenoses. Serum Lp(a) was determined a minimum of 3 months after stroke onset.

Results: Two hundred eighty-one intracranial stenoses were documented. Fifty-one (51%) patients had three or more stenoses (greater-extent group). Patients in the highest Lp(a) quartile had a higher adjusted odds ratio (OR) for a greater extent than those in the lowest quartile (OR 3.43, 95% CI 1.04 to 11.33, p = 0.04). A positive correlation was found between Lp(a) concentration and the number of stenoses (r = 0.310, p = 0.002). Moreover, Lp(a) level increased gradually with the number of stenoses (p = 0.02). A multiple logistic regression model identified diabetes (OR 2.4, 95% CI 1.04 to 5.57, p = 0.04) and high Lp(a) (OR 2.52, 95% CI 1.03 to 6.18, p = 0.043) as independent markers of a greater extent of intracranial large-artery occlusive disease.

Conclusions: High Lp(a) level and diabetes mellitus are independent markers of a greater extent of intracranial large-artery occlusive disease. These findings support a role for Lp(a) in intracranial stenotic atherogenesis and might be useful for the selection of high-risk patients.

MeSH terms

  • Aged
  • Biomarkers
  • Cohort Studies
  • Comorbidity
  • Cross-Sectional Studies
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology*
  • Diagnostic Imaging / methods
  • Female
  • Humans
  • Intracranial Arteriosclerosis / blood
  • Intracranial Arteriosclerosis / diagnosis
  • Intracranial Arteriosclerosis / epidemiology*
  • Ischemic Attack, Transient / blood
  • Ischemic Attack, Transient / epidemiology
  • Lipoprotein(a) / blood*
  • Logistic Models
  • Male
  • Middle Aged
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Smoking / epidemiology
  • Spain / epidemiology
  • Stroke / blood
  • Stroke / epidemiology


  • Biomarkers
  • Lipoprotein(a)