CORRELATION BETWEEN SERUM LOW DENSITY LIPOPROTEIN (LDL) LEVELS AND HEMORRHAGIC STROKE SEVERITY: A RETROSPECTIVE REVIEW (PRELIMINARY FINDINGS)

Abstract

<h3>Background</h3> The relationship between serum LDL level and hemorrhagic stroke is inconclusive. Several epidemiological Studies have noted that low LDL is a risk factor for ICH, however very few studies have defined the link between LDL and hemorrhagic stroke severity. <h3>Aim</h3> We hypothesized that low serum LDL levels may have association with intracerebral hemorrhage (ICH) severity at admission and worse outcomes. <h3>Methods</h3> This retrospective study reviewed data obtained from SIREN - the largest multicenter stroke study in Africa. We categorized patients with acute spontaneous ICH based on their baseline levels of LDL measured at admission, into 4 groups: <70, 70–100, 100-125 and >125 mg/dL of LDL. We evaluated initial stroke severity, using the GCS, ICH Score, NIHSS and unfavorable outcomes using modified Rankin Scale [mRS] score. Pearson's correlation analysis was used to correlate LDL levels with indices of hemorrhagic stroke severity (GCS, NIHSS, ICH score, ICH volume, age) and a linear regression analysis was then performed. <h3>Results</h3> A total of 1162 patients with ICH (mean age 54.42±13.63 years; 62.5% men) were included in this study of which nearly all subjects 1125 (96.8%) had hypertension as a risk factor. 766 (65.9%) had fatal outcomes with mean GCS, NIHSS, ICH Score and MRS of 11.12±3.90, 16.84±11.69, 1.74±1.39 and 4.11±1.11 respectively. 992 had serum LDL assessed at admission of which 565 (56.95%) of them had baseline LDL<125 mg/dL, 427 (43.04%) had LDL >125mg/dl. Patients that died had a lower mean serum LDL level than those that survived (121.19±47.60 vs 125.17±53.56), although not statistically significant (P= 0.275). The percentage of men with serum LDL levels <70mg/dl (70.6%), 70-100mg/dl (62.1%), >100mg/dl (66%) was significantly higher than that of men with LDL >125mg/dl (57.6%) - (P = 0.030). In a similar vein, patients with LDL <70 mg/dl were younger (mean age: 52.43<i>±13.06</i>) than those with LDL 70-100, 100-125, >125 who had mean age±SD 53.78<i>±13.73,</i> 56.74<i>±13.26,</i> 53.59<i>±13.00 respectively (P:</i>0.011). As expected, the cohort of patients with LDL <70 had a lower BMI (25.59<i>±4.59</i>) as compared with those with LDL >125mg/dl BMI: 27.06<i>±5.27</i> (P value 0.017). The presence of hypertension as a risk factor among the 4 different LDL sub-categories was not statistically significant (p = 0.648). Interestingly, patients with LDL <70 mg/dL presented with more severe stroke, with a mean GCS±SD of 9.46±3.77 when compared with patients with LDL of 70-100, 100-125, >125 who had a mean GCS 11.42±3.75, 10.11±4.30 and 11.79±3.73 respectively (P-value: 0.007). In the correlation analysis, there was a positive correlation between LDL levels and the GCS (P value: 0.014) and a negative correlation between LDL and the ICH score as well as the NIHSS score at baseline, although not statistically significant. <h3>Conclusion</h3> Mortality of ICH remains high in Africa. LDL<125mg/dl is more common in African subjects with ICH and those with LDL <70mg/dl happened to be much younger men with a good metabolic profile. LDL level < 70 mg/dL was associated with worse Glasgow Coma Score at presentation. A follow up study on the association between LDL levels and hematoma volume is imperative as it may explain this association.