Increased fibrinogen, von Willebrand factor and tissue plasminogen activator levels in insulin resistant South Asian patients with ischaemic stroke

• Published in: Atherosclerosis Vol. 163; no. 2; pp. 371 - 376
• Main Authors: Kain, Kirti, Catto, Andrew J., Young, John, Bamford, John, Bavington, John, Grant, Peter J.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01-08-2002; Elsevier
• Subjects: Asia, Southeastern - ethnology; Biological and medical sciences; Cardiovascular risks; Coronary Thrombosis - etiology; Ethnicity; Female; Fibrinogen - metabolism; Haemostasis; Hemostasis; Humans; Insulin Resistance; Male; Medical sciences; Middle Aged; Neurology; Random Allocation; Risk Factors; South Asian; Stroke; Stroke - blood; Stroke - complications; Stroke - physiopathology; Tissue Plasminogen Activator - metabolism; Vascular diseases and vascular malformations of the nervous system; von Willebrand Factor - metabolism; Asia; South Asia; Asia, Southeastern; Cardiovascular risks; Stroke; Ethnicity; South Asian; Haemostasis; Endocrinopathy; Mongoloid; Cardiovascular disease; t-Plasminogen activator; Vascular disease; Ischemia; Fibrinogen; Cerebrovascular disease; Human; Nervous system diseases; Serine endopeptidases; Pathophysiology; Enzyme; Exploration; Insulin; Ethnic group; Cerebral disorder; Peptidases; Target tissue resistance; Concomitant disease; Central nervous system disease; Risk factor; Hydrolases; Willebrand factor; Comparative study; Brain (vertebrata)
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/S0021-9150(02)00025-4

The aim of this study was to determine differences in atherothrombotic risk factors in South Asian subjects with a history of ischaemic stroke and South Asian subjects free from personal and family history of clinically detectable stroke. Eighty South Asian patients with ischaemic stroke (confirmed on cranial computerised scan) and 80 South Asian controls with similar age and gender distributions were recruited at random. The frequency of hypertension (
P=<0.0001), myocardial infarction (
P=0.003) and diabetes mellitus (<0.0001) were significantly higher in stroke patients. Stroke patients had lower high-density lipoprotein cholesterol (0.95 vs. 1.1 mmol/l,
P=<0.0001), higher plasma glucose (8.1 vs. 6.6 mmol/l,
P=0.01) and trendwise higher HBA
1C (6.4 vs. 6.0%,
P=0.09). There was no difference in insulin levels but insulin resistance was significantly higher in stroke patients (3.75 vs. 2.66,
P=0.01). Stroke patients showed elevated levels of fibrinogen (3.78 vs. 3.41 mg/dl,
P=0.02), von Willebrand factor (1.78 vs. 1.50 IU/ml,
P=0.006) and tissue plasminogen activator (12.8 vs. 11.3 ng/ml,
P=0.04), but the differences did not persist after adjustment for glucose, triglycerides, HDL, WHR, and BMI. Higher levels of fibrinogen, von Willebrand factor and t-PA in South Asian stroke patients disappeared after adjustment for features of insulin resistance syndrome but persisted after adjustment for presence of diabetes, confirming that these changes are essentially dependant on features of insulin resistance syndrome. A prospective study would be required to elucidate the role of thrombotic risk factors in South Asians with ischaemic stroke.