Introduction

Materials and Methods

Results

Discussion

References

Abstract

Introduction: Elevated serum apolipoprotein B and the apolipoprotein B/A1 ratio have been associated with ischemic stroke and intracranial atherosclerotic disease. We sought to assess the relationship between serum levels of apolipoprotein B, apolipoprotein A1, and the apolipoprotein B/A1 ratio with ischemic stroke subtypes and large artery atherosclerosis location. Materials and Methods: We evaluated serum apolipoprotein B and apolipoprotein A1 levels in consecutive, statin-naïve, adult ischemic stroke patients admitted to an academic medical center in southern India. We evaluated for differences in the mean serum levels of apolipoprotein B, apolipoprotein A1, and the apolipoprotein B/A1 ratio between patients with ischemic stroke attributed to intracranial atherosclerotic disease, extracranial atherosclerotic disease, small vessel disease, and cardioembolism. In secondary analysis, we assessed for differences in these serum apolipoproteins between patients with moderate-severe intracranial atherosclerotic disease and extracranial atherosclerotic disease, irrespective of ischemic stroke subtype. Results: Among the 156 ischemic stroke patients enrolled in this study, there were no significant differences in serum levels of apolipoprotein B, apolipoprotein A1, and the apolipoprotein B/A1 ratio between patients with distinct ischemic stroke subtypes. No significant differences were found in serum levels of apolipoprotein B, A1 and the apolipoprotein B/A1 ratio between patients with moderate-severe intracranial atherosclerotic disease and moderate-severe extracranial atherosclerotic disease. Discussion: Serum levels of apolipoprotein B and A1 did not differ between ischemic stroke subtypes. Additional studies are needed to validate our findings and to better understand the relationship between serum apolipoproteins and stroke.

Introduction

Apolipoproteins (Apo) form the protein component of circulating lipoproteins and function in lipid transport and metabolism. Apo B is a major apolipoprotein component of the pro-atherogenic very low-, intermediate-, and low-density lipoproteins (LDL) whereas Apo A1 is the major apolipoprotein of high-density lipoprotein (HDL). Apo B has been suggested to be a better treatment target for statin therapy compared to LDL and a superior marker of cardiovascular disease risk.1 INTERSTROKE, an international case-control study, demonstrated that an elevated serum apolipoprotein (Apo) B/A1 ratio was associated with a higher odds of ischemic stroke. Elevated serum levels of Apo B and the Apo B/A1 ratio have been associated with ischemic stroke in case-control and population-based cohort studies, and have been demonstrated to be predictive of ischemic stroke in transient ischemic attack (TIA) patients. Elevated Apo B/A1 ratio has also been associated with carotid intima-media thickness among patients with cerebral infarction. Furthermore, higher serum Apo B and an elevated Apo B/A1 ratio have been shown to be independent predictors of intracranial atherosclerotic disease (ICAD) and have been associated with asymptomatic deep subcortical ischemia in patients with ICAD.