Abstract WP288: High Non-HDL Cholesterol Is Associated With Acute Neurological Deterioration In Ischemic Stroke Patients: the Fukuoka Stroke Registry (FSR)

Abstract

Background and Purpose: Several studies have shown that non-HDL cholesterol, defined as total cholesterol minus HDL cholesterol, was one of the risk factors for coronary heart diseases. However, the relationship between non-HDL cholesterol and cerebrovascular diseases remains unclear. We assessed the hypothesis that high non-HDL cholesterol may affect the outcome in acute ischemic stroke patients. Methods: The FSR is a multicenter prospective registry of acute stroke patients admitted to seven stroke centers in Fukuoka, Japan. From June 2007 to March 2012, 5995 patients were enrolled. Among them, 1915 patients who fulfilled the following criteria were included in the present study: (1) first-ever, (2) ischemic stroke, (3) hospitalization within 24 hours after onset, (4) modified Rankin scale (mRS) of 0 or 1 before onset. Patients were divided into quartiles based on the value of non-HDL cholesterol (mg/dL); G1 (non-HDL <120), G2 (120 ≤non-HDL <140), G3 (140 ≤non-HDL <160), G4 (non-HDL ≥160). Neurological severity was evaluated by National Institute of Health Stroke Scale (NIHSS). A NIHSS increase of ≥1-point during the first 21 hospital days was defined as an acute neurological deterioration, and a mRS of 2 or more at discharge as a functional dependence. Results: The worse the non-HDL cholesterol grade became (from G1 to G4), the lower age (p<0.0001), the frequency of male (p=0.003) and initial NIHSS score (p<0.001) were, and the higher blood pressure (p<0.0001), body mass index (p<0.0001) on admission, and the frequency of dyslipidemia (p<0.0001) were. As non-HDL cholesterol grade was worse, the frequency of acute neurological deterioration (p=0.008) and functional dependence at discharge increased (p=0.036). Multivariate logistic regression analysis revealed that as non-HDL cholesterol grade was worse, acute neurological deterioration was more prevalent (p for trend = 0.016) and the worst grade (G4) was independently associated with acute neurological deterioration (Odds Ratio 1.66; 95% CI 1.06-2.61; p=0.026) compared to G1. Conclusion: The frequency of acute neurological deterioration is significantly higher in ischemic stroke patients with higher plasma non-HDL cholesterol on admission.