Sally Sultan1, Michael Dowling2, Adam Kirton3, Gabrielle DeVeber4, Alexandra Linds5, Mitchell S V Elkind6. 1. Department of Pediatrics, Columbia University Medical Center, New York, New York. Electronic address: sms92@columbia.edu. 2. Department of Pediatrics and Neurology & Neurotherapeutics, Division of Pediatric Neurology, University of Texas Southwestern Medical Center, Dallas, Texas. 3. Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada. 4. Division of Neurology and Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada. 5. Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada. 6. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York.
Abstract
BACKGROUND: Risk factors for pediatric stroke are poorly understood and require study to improve prevention. Total cholesterol and triglyceride values peak to near-adult levels before puberty, a period of increased stroke incidence. The role of lipids in childhood arterial ischemic stroke has been minimally investigated. METHODS: We performed a cross-sectional analysis of lipid and Lp(a) concentrations in children with arterial ischemic stroke in the International Pediatric Stroke Study to compare the prevalence of dyslipidemia and high- or low-ranking lipid values in our dataset with reported population values. We analyzed sex, body mass index, race, ethnicity, family history, and stroke risk factors for associations with dyslipidemia, high non-high-density lipoprotein cholesterol, and hypertriglyceridemia. RESULTS: Compared with the National Health and Nutrition Examination Survey, a higher proportion of children ≥5 years with arterial ischemic stroke had dyslipidemia (38.4% versus 21%), high total cholesterol (10.6% versus 7.4%), high non-high-density lipoprotein cholesterol (23.1% versus 8.4%), and low high-density lipoprotein cholesterol (39.8% versus 13.4%). The lipid values that corresponded to one standard deviation above the mean (84th percentile) in multiple published national studies generally corresponded to a lower ranking percentile in children aged five years or older with arterial ischemic stroke. Dyslipidemia was more likely associated with an underweight, overweight, or obese body mass index compared with a healthy weight. Ethnic background and an acute systemic illness were also associated with abnormal lipids. CONCLUSIONS: Dyslipidemia and hypertriglyceridemia may be more prevalent in children with arterial ischemic stroke compared with stroke-free children.
BACKGROUND: Risk factors for pediatric stroke are poorly understood and require study to improve prevention. Total cholesterol and triglyceride values peak to near-adult levels before puberty, a period of increased stroke incidence. The role of lipids in childhood arterial ischemic stroke has been minimally investigated. METHODS: We performed a cross-sectional analysis of lipid and Lp(a) concentrations in children with arterial ischemic stroke in the International Pediatric Stroke Study to compare the prevalence of dyslipidemia and high- or low-ranking lipid values in our dataset with reported population values. We analyzed sex, body mass index, race, ethnicity, family history, and stroke risk factors for associations with dyslipidemia, high non-high-density lipoprotein cholesterol, and hypertriglyceridemia. RESULTS: Compared with the National Health and Nutrition Examination Survey, a higher proportion of children ≥5 years with arterial ischemic stroke had dyslipidemia (38.4% versus 21%), high total cholesterol (10.6% versus 7.4%), high non-high-density lipoprotein cholesterol (23.1% versus 8.4%), and low high-density lipoprotein cholesterol (39.8% versus 13.4%). The lipid values that corresponded to one standard deviation above the mean (84th percentile) in multiple published national studies generally corresponded to a lower ranking percentile in children aged five years or older with arterial ischemic stroke. Dyslipidemia was more likely associated with an underweight, overweight, or obese body mass index compared with a healthy weight. Ethnic background and an acute systemic illness were also associated with abnormal lipids. CONCLUSIONS:Dyslipidemia and hypertriglyceridemia may be more prevalent in children with arterial ischemic stroke compared with stroke-free children.
Authors: Heather J Fullerton; Gabrielle A deVeber; Nancy K Hills; Michael M Dowling; Christine K Fox; Mark T Mackay; Adam Kirton; Jerome Y Yager; Timothy J Bernard; Eldad A Hod; Max Wintermark; Mitchell S V Elkind Journal: Stroke Date: 2016-08-04 Impact factor: 7.914
Authors: S Matthijs Boekholdt; Benoit J Arsenault; Samia Mora; Terje R Pedersen; John C LaRosa; Paul J Nestel; R John Simes; Paul Durrington; Graham A Hitman; K M A Welch; David A DeMicco; Aeilko H Zwinderman; Michael B Clearfield; John R Downs; Andrew M Tonkin; Helen M Colhoun; Antonio M Gotto; Paul M Ridker; John J P Kastelein Journal: JAMA Date: 2012-03-28 Impact factor: 56.272
Authors: Sally M Sultan; Nicole Schupf; Michael M Dowling; Gabrielle A Deveber; Adam Kirton; Mitchell S V Elkind Journal: Int J Stroke Date: 2013-10-22 Impact factor: 5.266