Natural vs. Drug-Modified Cholesterol Levels and the Incidence of Ischemic Stroke (P06.228)

Abstract

Objective: To determine whether naturally low LDL and high HDL levels are associated with a lower incidence of first-time ischemic stroke compared to drug-modified low LDL and high HDL levels. Background High LDL and low HDL levels have been associated with a higher risk of ischemic stroke. However, most studies investigating this relationship are a subset of drug clinical trials where variation in cholesterol levels is considered only as a factor in drug-related reduction of stroke incidence. Clinical observation reveals that patients with a very low burden of cerebrovascular disease share low LDL and high HDL levels and, frequently, these patients are not taking any cholesterol-modifying drug. Design/Methods: In this cross-sectional study we included patients 55 years or older admitted to an academic institution with a diagnosis of ischemic stroke (stroke) or any other diagnosis (control) and who had MRI brain with diffusion-weighted and T2/FLAIR sequences. We excluded patients who had negative DWI (stroke group) or T2/FLAIR lesions suggestive of previous stroke as well as patients with a reported history of stroke. Univariate analysis and logistic regression were performed for statistical analysis. Results: Older age, hypertension, atrial fibrillation, higher LDL and triglycerides levels were associated with increased incidence of ischemic stroke in the univariate analysis. In the logistic regression analysis, after matching LDL values and age, patients who were on cholesterol-modifying drugs had a lower incidence of ischemic stroke compared to patients who weren9t. After dividing LDL levels in 3 groups, the preventive effect of not being on a cholesterol-modifying drug was strong and significant in the group with the lowest LDL values ( Conclusions: Patients in the group with the lowest LDL-cholesterol who are not on a cholesterol-modifying drug (i.e who have naturally low LDL-cholesterol) have a lower incidence of first-time ischemic stroke compared to patients who have drug-modified low LDL-cholesterol levels. Disclosure: Dr. Osorio Flores has nothing to disclose. Dr. Venkatesh has nothing to disclose.