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Association of Dyslipidaemia in Young Patients with Recent Ischaemic Stroke

Background: The relation between serum lipids and ischemic stroke remains controversial in young patients. The aim was to determine the serum lipid profile and the vascular risk factors for ischaemic stroke in a series of patients under 45 with an ischemic stroke and to compare them with a series of controls of the same age. Material and method: This case-control study was conducted in the Department of Neurology and Department of Biochemistry of BSMMU, Dhaka, between the period of July 2007 and June 2009 for duration of two years. A total number of 50 patients presented with recent ischemic stroke and 50 control person were enrolled in this study. All patients of both sexes, aged between 15 to 45 years presented with ischemic stroke, from 0 day to 1 month that was confirmed by CT scan of head/MRI of brain. Vascular risk factors were recorded and blood sample was collected from the cases and the controls and analyzed at the Dept. of Biochemistry, BSMMU for estimation of serum fasting lipid profile. Result: Multivariate analyses showed that other than serum lipidsfamily history of dyslipidaemia, family history of stroke or TIA, history of HTN and smoking habit are found significant risks for stroke in young adult. Conclusion: The present study does not confirm the role of serum lipids as risk factors for ischemic stroke in young adult. Other than serum lipidsfamily history of dyslipidaemia, family history of stroke or TIA, history of HTN and smoking habit are found significant risks for stroke in young adult.

Data were collected in a structured questionnaire at stroke clinic and neurology ward in BSMMU. Collection of blood sample & estimation of serum lipid profile from the cases and the controls were done at the department of Biochemistry, BSMMU.

Statistical analysis:
The relationships between different variables of both case and control group was analyzed with the Chisquared test; Student's t test where applicable. Risk factor was analyzed by multiple logistic regression model. The findings of the study are presented here. Table 1, showed the distribution of the respondents by age. Mean ± SD of age of the cases was 39.88 ±7.26 years. Among the cases most common age group was 36-45 years (82.0%) followed by [26][27][28][29][30][31][32][33][34][35] and [16][17][18][19][20][21][22][23][24][25]. Mean ± SD of age of the control was 39.68 ± 5.90 years. There is statistically no significant difference in age between the case and control (p>0.05). Table II showed the sex distribution of the respondents of both case and control group. Male and female ratio was approximately 2:1 in each group. There is statistically no significant difference in sex between the case and control (p>0.05). Table III revealed that out of all respondent of case and control group 40.0% and 10.0% had family history of diabetes mellitus, 34.0% and 16.0% had hypertension, 12% and 8.0% had familial history of                10 . In a population-based case-control study of Japanese men and women aged 20 to 70 years, the risk of ischemic stroke was significantly increased in those with a FHS in any first-or seconddegree relative (Kubota 1997) 11 . In a large prospective study conducted in Finland, an adjusted RR of 1.   19 .

Results:
In the present study respondents not having hypertension were 14.48 times more prone to develop stroke than respondents not having hypertension. In multivariate analysis this risk reached 11.70 times. In Albucher et al (2000) 14 series Odds ratio for development of stroke for hypertensive patients were 18.67.About 60% patients of stroke group and 20% respondents of control group were hypertensive in Jalal Uddin series (2006) (P<0.05). Hypertensive persons showed a risk of having ischemic stroke 6 times higher than those of non-hypertensive persons in their series. Similar observation was also made in the present series.
In the present series among all respondents of case and control group 48.0% and 26.0% were smoker respectively. Smoker had 2.63 in bivariate analysis and 4.71 in multivariate analysis, times more chance to develop stroke than non smoker.
In Jalal Uddin series, 54% of case and 52% of the control group were smokers (p>0.05). Smokers showed a risk of having ischemic stroke 1.084 times higher than those of non-smokers in his series 13 . Similar result was found by Khan (2000) 20 . In his series 55% of ischemic stroke patients were smoker but in control group, only 33% were smoker.
Smoking is associated with increased risk of cerebral infarction (Pancioli 1998) 21 . In Safeer et al (2008) 15 study smoking was found in 31% of patients. The figure is slightly higher than other reported studies in Pakistan (Javed 1998) 22 and much lower than studies reported in Greenland (81%) (Kjaergaard and Gelvan 2004) 23 .
The serum cholesterol-stroke association remains an enigma. If low serum cholesterol concentration is associated with an increased risk of hemorrhagic stroke Yano et al., 1989) 24,25 , increased cholesterol is associated with an increased risk of ischemic stroke Knuiman and Vu, 1996) 24,26 . Studies in men subsequently showed increases in ischemic stroke rates at higher levels of total cholesterol, particularly for levels above 240 to 270 mg/dl  In this study bivariate analysis showed lower level of HDL-cholesterol and higher value of total cholesterol and LDL-c as risk factors for stroke but after adjusted these variables by other known risk factors no significant result has come out. So, this study does not conclude having any relation between ischemic stroke in young patients and serum lipid profile.

Conclusion :
The present study does not confirm the role for lipids as risk factors for ischemic stroke in young adult. Rather than lipids, family history of dyslipidaemia, family history of stroke or TIA, personal history of HTN and smoking habit were found significant risks for stroke. As the present study conducted in a single center in Dhaka city with small sample size, to find out such potential risk factors, more study is needed to see association of serum lipids as a risk factor for young ischemic stroke in our ethnic population.