Abstract 4147535: Cryptogenic stroke and Patent Foramen Ovale: Elevated Lipoprotein (a), a factor in the equation

Background: Despite the association between cryptogenic stroke and patent foramen ovale (PFO), data on the efficacy of PFO closure for secondary prevention remains limited. Guidelines recommend PFO closure only for patients with a prior stroke. As recent studies indicate a correlation between elevated Lipoprotein(a) levels and stroke, its measure could be relevant in evaluating the need for PFO closure. Aims/Hypothesis: This study aims to determine if elevated Lipoprotein (a) levels in patients with PFO increase the likelihood of stroke or transient ischemic attack (TIA). We hypothesize that elevated Lp(a) levels, given their known association with cryptogenic stroke, should be considered when evaluating patients for PFO closure. Methods: Case-control study on patients with PFO between January 2018 to April 2024. Patients with previous TIA or evidence of a prior stroke on CT/MRI were classified as “Stroke Group”. An Lp(a) level ≤ 30mg/dL was considered normal. Multivariate logistic regression was used to analyze the impact of age, gender, hypertension, diabetes, smoking status, coronary artery disease, hypothyroidism, dyslipidemia, and LP(a) levels on developing stroke or TIA. Results: A total of 96 patients were included (Stroke group=55; Control group=45). Significant differences were found between groups in age [46.38±11.06 vs 44.42±13.01; p=0.02], BMI [27.75(4.8) vs 25.34(4.8); p=0.02], hypertension [43.6% vs 17.1%; p<0.01], and migraine [27.3% vs 7.3%; p<0.01]. Elevated Lp(a)was more prevalent in the Stroke Group [60% vs 39.02%; p=0.04]. No significant differences were observed in LDL [94.80±33.95 vs 108.84±28.92; p=0.669], HDL (54.77±13.63 vs 63.89±15.16; p=0.205), Non-HDL (132.35±47.88 vs 156.23±38.86; p=0.651), and HbA1c [5.5%(0.35) vs 5.3%(0.30); p=0.143]. The logistic regression model revealed that besides the difference in baseline characteristics, only dyslipidemia (OR=4.02, 95% CI:1.145–14.125, p<0.002), migraine (OR=4.02, 95% CI:1.145–14.13, p<0.03), and elevated Lp(a) (OR=8.68, 95% CI: 2.15–35.02, p<0.002) were significantly associated with increased odds of TIA/Stroke. Conclusion: In patients with PFO, elevated LP(a) increases the odds of developing cerebrovascular events. Measure of Lp(a) should be included in the evaluation for PFO closure.