The role of von Willebrand factor in determining the risk of ischemic stroke in Hawler city: a case-control study

Abstract

IntroductionIschemic stroke is sudden neurologic deficits that result from focal cerebral ischemia associated with permanent brain infarction. It is a major cause of disability and death worldwide which occurs as a result of atherothrombotic occlusion of large arteries; cerebral embolism; nonthrombotic occlusion of small, deep cerebral arteries; and proximal arterial stenosis with hypotension that decreases cerebral blood flow in arterial watershed zones.1 A multifunctional multimeric plasma glycoprotein von Willebrand factor (vWF), has long been known to be a key player in thrombus formation at sites of vascular damage, vWF act as a carrier protein for blood clotting FVIII and promotes platelet adhesion and aggregation at sites of vascular injury. The release of vWF is increased when endothelial cells are activated or damaged. Therefore, plasma vWF level is considered a marker of endothelial dysfunction, a condition that predisposes to atherosclerosis and thrombosis. Because of its direct role in hemostasis, and its indirect role as a marker of endothelial dysfunction, vWF is a potential risk indicator for cerebrovascular disease.2 Recent studies revealed that abnormal elevation of any or all lipids and/or lipoproteins which known as hyperlipidemia is considered a modifiable risk factors that play a crucial role in the pathogenesis of atherosclerosis and biological etiology of the ischemic stroke. Hyperlipidemia usually classified as either familial caused by specific genetic abnormalities, or acquired when resulting from endocrine, renal or hepatic diseases. 4 Deposition of cholesterol and cholesteryl ester from the plasma lipoproteins into Background and objective: Ischemic stroke is classically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause, it occurs as a result of obstruction by a blood clot (thrombus) or plugs within a blood vessel supplying blood to the brain. In this study, we investigated the association of von Willebrand factor-antigen and serum lipids with ischemic stroke. Methods: The following retrospective study was conducted on 138 participants; 88 patients with ischemic stroke and 50 healthy controls. Results: In crude analyses, Plasma von Willebrand factor antigen, fasting serum Total cholesterol, Triglycerides and LDL-C were significantly higher in patients with ischemic stroke than in controls (P <0.001, P <0.001, P = 0.003, P <0.001, respectively), while the difference in the level of serum HDL-C between patients with ischemic stroke and control was significantly lower (P = 0.023). Conclusion: These data suggest that von Willebrand factor, total cholesterol, triglycerides, LDL-C and HDL-C gives some contribution to stroke risk even in the elderly and that von Willebrand factor antigen and lipid profile assessment must be taken into account in estimating the individual risks of stroke.