High serum levels of remnant lipoproteins predict ischemic stroke in patients with metabolic syndrome and mild carotid atherosclerosis

Background and objectiveMetabolic syndrome is prevalently associated with stroke. Triglyceride-rich lipoproteins contribute to atherothrombotic complications in metabolic syndrome. This study examined whether high levels of remnant lipoprotein, atherogenic triglyceride-rich lipoprotein, may be associated with future ischemic stroke in metabolic syndrome.Methods and resultsWe followed up 292 consecutive patients with metabolic syndrome meeting ATP III criteria and mild carotid plaques for a period of ≤24 months until occurrence of an ischemic stroke. Remnant lipoprotein (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method. Twenty-two ischemic stroke events occurred during follow-up. A multivariate Cox proportional hazards models showed that high RLP-C levels were a significant and independent predictor of ischemic stroke events (p < 0.01). Echolucent carotid plaques were also a significant predictor of ischemic stroke that was independent of other carotid ultrasound parameters in Cox proportional hazards models (p < 0.01). High RLP-C levels were intimately and independently associated with carotid plaque echolucency (p < 0.01).ConclusionsHigh RLP-C levels are an independent risk factor for future ischemic strokes in metabolic syndrome. High RLP-C levels may be related to echolucent carotid plaque, partly accounting for high risk for ischemic stroke in metabolic syndrome.