Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

Background: Studies show that hyperuricemia is an element of the pathophysiology of many conditions. Therefore, the aim of this study was to assess primary care physicians’ knowledge and attitudes toward asymptomatic hyperuricemia and gout management. Methods: A survey-based cross-sectional study was conducted to assess the primary physicians’ attitudes, knowledge, and patient management regarding hyperuricemia and gout. Results: A total of 336 primary care physicians were included. Physicians who read at least one scientific paper covering the topic of hyperuricemia in the past year scored significantly higher in knowledge questions (N = 152, 6.5 ± 2.05 vs. N = 183, 7.04 ± 2.14, p = 0.019). Only around half of physicians correctly identified drugs that can lower or elevate serum uric acid levels. Furthermore, the analysis of correct answers to specific questions showed poor understanding of the pathophysiology of hyperuricemia and possible risk factors. Conclusions: This study identified gaps in primary care physicians’ knowledge essential for the adequate management of patients with asymptomatic hyperuricemia and gout. As hyperuricemia and gout are among the fastest rising non-communicable diseases, greater awareness of the available guidelines and more education about the causes and risks of hyperuricemia among primary care physicians may reduce the development of diseases that have hyperuricemia as risk factors.