Deep cerebral microbleeds are negatively associated with HDL-C in elderly first-time ischemic stroke patients Michiya Igase a, ⁎, Katsuhiko Kohara a , Keiji Igase b , Shiro Yamashita c , Mutsuo Fujisawa c , Ryosuke Katagi c , Tetsuro Miki a a Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Ehime, Japan b Department of Neurosurgery, Washokai Sadamoto Hospital, Ehime, Japan c Ryotenkai Katagi Neurosurgery, Ehime, Japan abstract article info Article history: Received 12 November 2012 Accepted 13 December 2012 Available online xxxx Keywords: Cerebral microbleeds HDL-C Risk factor Ischemic stroke MRI PVH Background: Cerebral microbleeds (CMBs) detected on T2*-weighted MRI gradient-echo have been associat- ed with increased risk of cerebral infarction. We evaluated risk factors for these lesions in a cohort of first-time ischemic stroke patients. Methods: Presence of CMBs in consecutive first-time ischemic stroke patients was evaluated. The location of CMBs was classified by cerebral region as strictly lobar (lobar CMBs) and deep or infratentorial (deep CMBs). Logistic regression analysis was performed to determine the contribution of lipid profile to the presence of CMBs. Results: One hundred and sixteen patients with a mean age of 70 ± 10 years were recruited. CMBs were pres- ent in 74 patients. The deep CMBs group had significantly lower HDL-C levels than those without CMBs. In univariable analysis, advanced periventricular hyperintensity grade (PVH > 2) and decreased HDL-C were significantly associated with the deep but not the lobar CMB group. On logistic regression analysis, HDL-C (beta =-0.06, p =0.002) and PVH grade >2 (beta=3.40, p = 0.005) were independent determinants of deep CMBs. Conclusions: Low HDL-C may be a risk factor of deep CMBs, including advanced PVH status, in elderly patients with acute ischemic stroke. Management of HDL-C levels might be a therapeutic target for the prevention of recurrence of stroke. © 2012 Elsevier B.V. All rights reserved. 1. Introduction Cerebral microbleeds (CMBs) appear as small hypo-intense lesions on T2*-weighted gradient echo (T2*-weighted GRE) MRI. CMBs are asymptomatic themselves but are considered to predict cerebral hemorrhage [1,2]. Because associations among CMBs, white matter lesions (WMLs), and asymptomatic ischemic stroke on imag- ing have been reported, these lesions are considered to be associated with a similar microvascular abnormality [3–5]. Furthermore, the presence of CMBs in patients with first-time symptomatic ischemic stroke or transient ischemic attack (TIA) predicts recurrent disabling and fatal stroke [6]. Given these findings, CMBs in first-time ischemic stroke including TIA patients might be a marker of a vulnerable microvascular system. Indeed, recent reports have demonstrated that new CMBs can develop rapidly after acute ischemic stroke [7]. If confirmed, these findings would indicate the need for close attention to risk factors of CMBs as a treatment option for preventing recurrent ischemic stroke. A recent report showed that low levels of high-density lipoprotein (HDL-C) were associated with a significant independently increased risk of stroke [8]. With regard to vascular protection from ischemia, however, another clinical study showed that increased HDL-C might increase vulnerability to vascular rupture, including CMBs, as a “dual effect of HDL-C” [9]. To address this apparent discrepancy, we investigated whether HDL-C is risk factor of CMBs in first-time ischemic stroke or TIA patients. 2. Methods We prospectively examined a consecutive series of 216 acute stroke patients at Ryotenkai Katagi Neurosurgery, from April 2007 to March 2009. Patients with intracerebral hemorrhage (n = 31) and subarachnoid hemorrhage (n = 14) were excluded. Since enrollment was restricted to patients with first-time ischemic stroke or TIA, those with recurrent stroke (n = 45) were also excluded. Ten patients were not eligible for incomplete workup. Finally, we enrolled 116 Journal of the Neurological Sciences xxx (2013) xxx–xxx ⁎ Corresponding author at: Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Toon City, Ehime 791-0295, Japan. Tel.: +81 89 960 5851; fax: +81 89 960 5852. E-mail address: migase@m.ehime-u.ac.jp (M. Igase). JNS-12548; No of Pages 5 0022-510X/$ – see front matter © 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jns.2012.12.022 Contents lists available at SciVerse ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns Please cite this article as: Igase M, et al, Deep cerebral microbleeds are negatively associated with HDL-C in elderly first-time ischemic stroke patients..., J Neurol Sci (2013), http://dx.doi.org/10.1016/j.jns.2012.12.022