London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 749 763 Stroke prevention There Are Still Lots of Things We don’t Know, But it is Exciting to See What Can We Find Out. Cholesterol and Atherosclerosis-Reality or Dogma? The Past, the Presence and the Fu-ture D. Bartko1, P. Blazicek2, Z. Gombosova3, L. Danihel4, E. Drobna5, F. Rusnak6, J. Fabcin7, M. Hrouda8, J. Kubala9, 10, E. Kurca11, V. Nosal12, K. Zelenak13 Institue of Medical Sciences, Neurosci & Military Health, Central Military University Hospi-tal, Dept. of Neurology, Ruzomberok, SLOVAKIA1, Alpha Medical Comp., Bratislava, SLOVA-KIA2, Institute of Medical Sciences, Neurosciences & Military Health, Ruzomberok, SLOVAKIA3, Institute of Medical Sciences, Neurosciences & Military Health, Ruzomberok, SLOVAKIA4, Forced Army Academy, Lipt. Mikulas, SLOVAKIA5, Central Military University Hospital, Ruzomberok, SLOVAKIA6, MRI Center, Ruzomberok, SLOVAKIA7, Dia Dexus Comp, San.Francisco, USA8, In-stitute of Biochemistry and Immunology, Ruzomberok, SLOVAKIA9,10, University Hospital,Dept.of Neurology, Martin, SLOVAKIA11, University Hospital, Dept.of Neurology, Martin, SLOVAKIA12, MRI Center, University Hospital, Martin, SLOVAKIA13 Background Cholesterol has been considered as independent RF for AS. 27yrs ago Goldstein and Brown(No-bel prize) discovered lipoproteins.New era was starting with LDL subfractions. Strongly atherogen-ic are LDL3-7..Recently completely new marker, lipoprotein associate phosphoplipase A2 arived on the horizon. Prospective,multicenter,multidisciplinary study will monitor this 62yrs lasting history. Methods Material consists of 1202 subjects:1.ishemic cerebral infarction(iCI,n=334),mean age 72.6yrs,men 54.5%,2,coronary artery disease(CAD,n=295),mean age 71.8yrs, men 52.2%,3.arterial hyperten-sion( AH,n=252),mean age 69.7,men 49.2% and 4.controls (C,n=226) mean age 47.9yrs,men54.2%, In all subjects:neurological/cardiological examination, MRI/CT,NIHSS,BI,mRS,LDL subfrac-tions, LP-PLA2,other lipid,biochemical-hematological parameters,stiffness,MT, carotid USG. Results Theory that t-cholesterol is responsible for development of atherosclerisis started in 1950. After Ko-rean war(1953) 33 686 US soldiers died, and in 300 autopsies high t-cholesterol in arterial plaques was found out.New era since discovering lipoproteins(1985).Few yrs ago LDL subfractions -LDL3- 7 are strongly atherogenic Recently,specific inflammatory vascular marker-LP-PLA2 is starting new era.Our study showed significatly higher levels of LP-PLA2 in iCI, CAD and AH groups comparing to controls(p<0.001, <0.01 and p<0.02. Close correlations between LP-PLA2 and carotid atherosclerosis(stiffness,IMT, plaque morphology) was found in all groups. Conclusions Lp-PLA2 is a key inflammatory marker in AH,iCI and CAD. Significantky higher values in LP-PLA2,stifness, IMT and plaque morphology were found not only in iCI,CAD but also in AH(quasi candidates of iCI) comparing to controls,Close correlation with carotid atherosclerosis. It could signalize new era in understanding mechanisms of atherosclerosis and ist complications. Supp.by Intern/gov.grants ITMS26220220099,ITMS2622022153,APVV0586-06,LPP0186-06 764 Stroke prevention Clinical importance of aspirin and clopidogrel resistance after ischemic stroke M.C. Fernandez-Moreno1, L. Castilla-Guerra2, M. Romera Tellado3, J Alvarez-Suero4, F. Jimenez Gonzalo5, E Roldan Fontana6, J Marin Martin7, F Pozuelko del Rosal8, R. Fernandez-Bolaños9 Department of Neurology. Hospital de Valme, Seville, SPAIN1, Department of Internal Medicine. Hospital de la Merced., Osuna. Seville, SPAIN2, Department of Neurology. Hospital de Valme, Se-ville, SPAIN3, Department of Internal Medicine. Hospital de la Merced, Osuna. Seville., SPAIN4, Department of Hematology. Hospital de la Merced, Osuna, Seville, SPAIN5, Department of Hema-tology. Hospital de la Merced, Osuna. Seville., SPAIN6, Department of Internal Medicine. Hospital de la Merced, Osuna. Seville, SPAIN7, Depatment of Internal Medicine. Hospital de la Merced, Osu-na. Seville, SPAIN8, Department of Neurology. Hospital de Valme, Seville, SPAIN9 BACKGROUND: Aspirin (ASA) and clopidogrel are important components of medical therapy in the secondary prevention of ischemic stroke. ASA and clopidogrel resistance seems to be associated with poor clinical outcomes. Besides, specific treatment recommendations are not established for patients who exhibit high platelet reactivity during ASA therapy. OBJECTIVE: To assess the importance of ASA and Clopidogrel resistance in patients with recent ischemic stroke. METHODS: Fifty patients aged 48-85 years (mean age: 68) who had ischemic stroke in the previ-ous 6 months were assessed. ASA had been taken since the stroke episode. Resistance was analyzed using the PFA-100 aggregometer. In those patients with ASA resistance ASA was swithched to Clopidrogrel, and then Clopidogrel resistance was assessed. RESULTS: We included 43 (86%) lacunar strokes and 7 (14%) non-lacunar strokes. Thirty-seven (74%) patients were male. Twenty-nine (58%) patients received ASA in a daily dose of 300 mg, 5 (10%) 150 mg/day, and 16 (32%) 100 mg/day. Hypertension was the commonest risk factor (36 pa-tients, 72%). Other risk factors included hypercholesterolemia (34 patients, 68%), diabetes mellitus (24 patients, 48%), smoking (20 patients, 40%), obesity (21 patients, 42%), and previous stroke (6 patients, 12%). ASA resistance was observed in 16 (32%) patients. We found no correlation between diminished response to ASA and vascular risk factors, ASA dosage, type of ischemic stroke, or sex. However, patients with resistance to ASA presented a higher frequency of previous stroke (p=0.01). Clopidogrel resistance was tested in 12 of these ASA resistant patients. Six of these patients (50%) presented clopidogrel resistance. CONCLUSIONS: A diminished response to ASA and clopidogrel in patients with recent stroke is commonly observed. This phenomenon is clinically unpredictable. In patients with recent ischemic stroke and ASA resistance clopidogrel resistance should be also assessed.
Karger_ESC London_2013
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