Published online before print December 26, 2007
(Neurology 2007, doi:10.1212/01.wnl.0000294323.48661.a9)

Association of serum lipid indices with large artery atherosclerotic
stroke

O. Y. Bang MD, PhD, J. L. Saver MD, D. S. Liebeskind MD, S. Pineda BS,
and B. Ovbiagele MD*

From the Department of Neurology, School of Medicine, Samsung Medical
Center, Sungkyunkwan University, Suwon, Korea (O.Y.B.); and Department
of Neurology, UCLA Medical Center, Los Angeles, CA (O.Y.B., J.L.S.,
D.S.L., S.P., B.O.).

* To whom correspondence should be addressed. E-mail:
ovibes@mednet.ucla.edu.

Background: Low-density lipoprotein cholesterol (LDL) is the primary
lipid target for vascular risk reduction in stroke patients, but
emerging data suggest that other lipid indices may better predict
vascular hazard. We evaluated the relationship between several
measures of the classically obtained serum lipid panel and the
occurrence of large artery atherosclerotic stroke.

Methods: Data prospectively collected over a 4-year period on subjects
admitted with ischemic stroke or TIA to a university medical center
were analyzed. Independent associations of fasting serum lipid indices
with large artery atherosclerotic (LAA) stroke mechanism were
evaluated.

Results: Of 1,049 patients, 247 (23.5%) were classified with LAA, 224
(21.4%) were classified with small vessel disease (SVD), and 578 (55%)
were non-LAA, non-SVD subtype. Lipid levels were similar between LAA
and SVD patients. Total cholesterol, triglycerides, LDL, non-high-
density lipoprotein cholesterol (HDL), and triglyceride:HDL ratio were
significantly higher in LAA vs non-LAA, non-SVD patients. After
adjustment for age, hypertension, diabetes, smoking, body mass index,
and premorbid statin use, significant odds ratios (ORs) for LAA
compared with all other ischemic stroke subtypes for patients in the
uppermost lipid quartiles (vs lowest) were triglycerides (OR 2.69, 95%
CI 1.44 to 5.02) and non-HDL (OR 2.39, 95% CI 1.40 to 4.11). LDL was
not associated with LAA.

Conclusions: Compared with all other ischemic stroke subtypes,
elevated levels of serum triglycerides and non-high-density
lipoprotein, but not low-density lipoprotein (LDL), are associated
with large artery atherosclerotic stroke. These non-LDL lipid measures
may have utility in delineating atherosclerotic stroke risk.

*  *  *

Non-HDL cholesterol = LDL + VLDL + IDL