© 1996 American Heart Association, Inc.
Articles |
`Silent' Cerebral Infarction Is Associated With Hypercoagulability, Endothelial Cell Damage, and High Lp(a) Levels in Elderly Japanese
From the Department of Internal Medicine (K.K.), Awaji-Hokudan Public Clinic, Hokudan, and the Departments of Internal Medicine (K.K., T.M.) and Central Laboratory (H.K., R.A., M.M.), Hyogo Prefectural Awaji Hospital, Sumoto, Hyogo, Japan.
Correspondence to Dr Kazuomi Kario, Department of Cardiology, Jichi Medical School, 3311-1, Yakushiji, Minami-kawachi, Kawachi, Tochigi 329-04, Japan.
Abstract "Silent" lacunar stroke, often found in the
elderly, has been proposed as a predisposing condition for clinically
overt stroke. However, the risk factors related to this condition have
not been studied thoroughly. We conducted brain magnetic resonance
imaging and measured the levels of fibrinogen, molecular markers of
coagulation activation [prothrombin fragment 1+2 (F1+2)] and
endothelial cell damage [von Willebrand factor
(vWF) and thrombomodulin], and lipid profiles including lipoprotein
(a) [Lp(a)] in 178 asymptomatic, high-risk,
Japanese subjects aged 44 to 93 years. We also studied 32
symptomatic patients with lacunar stroke
(symptomatic lacunar group). The prevalence of silent
lacunar stroke increased with age up to 85 years but decreased with age
in those 85 years old and older. Of the 160 elderly subjects (
60
years) 84 (53%) had 1 lacunar infarcts (silent lacunar group) and
the remaining 76 were considered as the nonlacunar group. Fibrinogen
and F1+2 levels in the silent lacunar group were significantly higher
than those in the nonlacunar group (P<.01). Mean Lp(a)
levels and the prevalence of subjects with an Lp(a) level >30 mg/dL
were significantly higher in the symptomatic lacunar group
than the nonlacunar group (P<.05), whereas these levels in
the silent lacunar group were intermediate to those of the other two
groups. When we further classified the silent lacunar group into three
subgroups based on the number of lacunes (few lacunes, 1 or 2; moderate
number of lacunes, 3 or 4; and numerous lacunes, 5), levels of Lp(a),
F1+2, vWF, and thrombomodulin were significantly higher and Lp(a)
levels >30 mg/dL more common in the numerous-lacune than in the
few-lacune subgroup. We conclude that silent lacunar stroke is
often found in asymptomatic, high-risk, elderly
Japanese patients and that silent multiple lacunar stroke is associated
with hypercoagulability, endothelial cell damage, and
high Lp(a) levels.
Key Words: elderly • hypercoagulability • endothelial cell damage • lipoprotein(a) • silent lacunar stroke
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