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Review of lipid and lipoprotein(a) abnormalities in childhood arterial ischemic stroke

Authors

  • Sally M. Sultan,

    Corresponding author
    1. Neurologic Institute, Department of Neurology, Columbia University Medical Center, New York, NY, USA
    • Correspondence: Sally Sultan*, Neurologic Institute, Columbia University Medical Center, 710 W 168th Street, 6th Floor, New York, NY 10032, USA.

      E-mail: sms92@columbia.edu

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  • Nicole Schupf,

    1. Taub Institute for Research and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
    2. Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
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  • Michael M. Dowling,

    1. Department of Pediatrics, Division of Pediatric Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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  • Gabrielle A. DeVeber,

    1. Department of Pediatrics, Division of Neurology and Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada
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  • Adam Kirton,

    1. Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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  • Mitchell S. V. Elkind

    1. Neurologic Institute, Department of Neurology, Columbia University Medical Center, New York, NY, USA
    2. Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
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  • Conflicts of interest: Dr. Elkind receives research support from diaDexus Inc., Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, and the NIH; serves on an event adjudication committee for Jarvik Heart; has received compensation for consulting from Biogen-Idec, Inc. and BMS-Pfizer Partnership, and for participation in litigation on behalf of Novartis, Organon, and Merck; and receives compensation from the American Academy of Neurology for service as Resident and Fellow Section Editor for the journal Neurology®. All other authors confirmed that they had no conflicts of interest.

    Funding: Sally Sultan, NIH-T32-NS07153.

Abstract

National organizations recommend cholesterol screening in children to prevent vascular disease in adulthood. There are currently no recommendations for cholesterol and lipoprotein (a) testing in children who experience an arterial ischemic stroke. While dyslipidemia and elevated lipoprotein (a) are associated with ischemic stroke in adults, the role of atherosclerotic risk factors in childhood arterial ischemic stroke is not known. A review of the literature was performed from 1966 to April 2012 to evaluate the association between childhood arterial ischemic stroke and dyslipidemia or elevated lipoprotein (a). Of 239 citations, there were 16 original observational studies in children (with or without neonates) with imaging-confirmed arterial ischemic stroke and data on cholesterol or lipoprotein (a) values. Three pairs of studies reported overlapping subjects, and two were eliminated. Among 14 studies, there were data on cholesterol in 7 and lipoprotein (a) in 10. After stroke, testing was performed at >three-months in nine studies, at ≤three-months in four studies, and not specified in one study. There were five case-control studies: four compared elevated lipoprotein (a) and one compared abnormal cholesterol in children with arterial ischemic stroke to controls. A consistent positive association between elevated lipoprotein (a) and stroke was found [Mantel–Haenszel OR 4·24 (2·94–6·11)]. There was no association in one study on total cholesterol, and a positive association in one study on triglycerides. The literature suggests that elevated lipoprotein (a) may be more likely in children with arterial ischemic stroke than in control children. The absence of confirmatory study on dyslipidemia should be addressed with future research.

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