Abstract
The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160–200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41–2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11–1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76–8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.
Highlights
Hypercholesterolemia is associated with increased risks of coronary artery events, coronary revascularization and ischemic stroke
Previous epidemiologic studies showed that hypercholesterolemia was associated with a lower risk of intracerebral hemorrhage (ICH) [2], while the low low-density lipoprotein cholesterol (LDL-C) level increased the risk of ICH mortality [3, 4]
A meta-analysis of randomized controlled trials showed that statins, the medication of choice for hypercholesteremia, may reduce the overall incidence of stroke [8], but conflicting results were found in the impact of prior use of statins on the prognosis of ICH; it could be neutral [4], favorable with reduced mortality [9], or even worse [10]
Summary
Hypercholesterolemia is associated with increased risks of coronary artery events, coronary revascularization and ischemic stroke. Reduction of low-density lipoprotein cholesterol (LDL-C) with lipid-lowering agents has been demonstrated to significantly reduce the cardiovascular risks [1]. Previous epidemiologic studies showed that hypercholesterolemia was associated with a lower risk of intracerebral hemorrhage (ICH) [2], while the low LDL-C level increased the risk of ICH mortality [3, 4]. There were conflicting study findings on the association between lipid-lowering medications and the risk of ICH [6, 7]. A meta-analysis of randomized controlled trials showed that statins, the medication of choice for hypercholesteremia, may reduce the overall incidence of stroke [8], but conflicting results were found in the impact of prior use of statins on the prognosis of ICH; it could be neutral [4], favorable with reduced mortality [9], or even worse [10]. This study used a multi-center stroke registry to investigate the relationship between serum cholesterol level and the severity and prognosis of acute ICH, and functional outcome and deaths at 3 month after stroke
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