Lipoprotein(a) levels in patients with cryptogenic stroke and persistent foramen ovale

Abstract Background Elevated levels of lipoprotein(a) [Lp(a)] are an independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). However, it is not known whether high Lp(a) is associated with cryptogenic stroke. Methods We included 478 patients with cryptogenic stroke that underwent closure of a persistent foramen ovale and had Lp(a) measurement available. These patients were matched according to age and gender in a 1:3 ratio to 1434 controls. Results Mean age of patients was 49.9 +/-12.9 years and 275 patients (57.4%) were male. Median Lp(a) levels were significantly higher in cases (26 IQR 13 – 87 nmol/L) as compared to controls (16 IQR 2 – 61 nmol/L; p<0.00001). Lp(a) levels > 200 nmol/L were significantly more frequent in patients with cryptogenic stroke as compared to controls (10.0 % vs. 7.0 %; p<0.05). The odds-ratio for an increase of Lp(a) by 50nmol/L was 1.09 (95% CI 1.03 – 1.15) independent of age and gender. Conclusion Patients with cryptogenic stroke and persistent foramen ovale showed significantly higher plasma levels of Lp(a) and an increase of Lp(a) was associated with a significant increased risk for cryptogenic stroke. Whether high Lp(a) increases risk for deep vein thrombosis leading to embolization or for arterial thrombosis has to be elucidated in further studies.