Anil Can1, Victor M Castro2, Dmitriy Dligach3,4, Sean Finan3, Sheng Yu5,6, Vivian Gainer2, Nancy A Shadick7, Guergana Savova3, Shawn Murphy2,8, Tianxi Cai9, Scott T Weiss5,10, Rose Du11,10. 1. From the Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.C., R.D.). 2. Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M. 3. Boston Children's Hospital Informatics Program, MA (D.D., S.F., G.S.). 4. Department of Computer Science, Loyola University, Chicago, IL (D.D.). 5. Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.Y., S.T.W.). 6. Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.). 7. Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (N.A.S.). 8. Department of Neurology, Massachusetts General Hospital, Boston (S.M.). 9. Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA (T.C.). 10. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA (S.T.W., R.D.). 11. From the Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.C., R.D.) rdu@bwh.harvard.edu.
Abstract
BACKGROUND AND PURPOSE: Growing evidence from experimental animal models and clinical studies suggests the protective effect of statin use against rupture of intracranial aneurysms; however, results from large studies detailing the relationship between intracranial aneurysm rupture and total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and lipid-lowering agent use are lacking. METHODS: The medical records of 4701 patients with 6411 intracranial aneurysms diagnosed at the Massachusetts General Hospital and the Brigham and Women's Hospital between 1990 and 2016 were reviewed and analyzed. Patients were separated into ruptured and nonruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the effects of lipids (total cholesterol, LDL, and HDL) and lipid-lowering medications on intracranial aneurysm rupture risk. Propensity score weighting was used to account for differences in baseline characteristics of the cohorts. RESULTS: Lipid-lowering agent use was significantly inversely associated with rupture status (odds ratio, 0.58; 95% confidence interval, 0.47-0.71). In a subgroup analysis of complete cases that includes both lipid-lowering agent use and lipid values, higher HDL levels (odds ratio, 0.95; 95% confidence interval, 0.93-0.98) and lipid-lowering agent use (odds ratio, 0.41; 95% confidence interval, 0.23-0.73) were both significantly and inversely associated with rupture status, whereas total cholesterol and LDL levels were not significant. A monotonic exposure-response curve between HDL levels and risk of aneurysmal rupture was obtained. CONCLUSIONS: Higher HDL values and the use of lipid-lowering agents are significantly inversely associated with ruptured intracranial aneurysms.
BACKGROUND AND PURPOSE: Growing evidence from experimental animal models and clinical studies suggests the protective effect of statin use against rupture of intracranial aneurysms; however, results from large studies detailing the relationship between intracranial aneurysm rupture and total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and lipid-lowering agent use are lacking. METHODS: The medical records of 4701 patients with 6411 intracranial aneurysms diagnosed at the Massachusetts General Hospital and the Brigham and Women's Hospital between 1990 and 2016 were reviewed and analyzed. Patients were separated into ruptured and nonruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the effects of lipids (total cholesterol, LDL, and HDL) and lipid-lowering medications on intracranial aneurysm rupture risk. Propensity score weighting was used to account for differences in baseline characteristics of the cohorts. RESULTS:Lipid-lowering agent use was significantly inversely associated with rupture status (odds ratio, 0.58; 95% confidence interval, 0.47-0.71). In a subgroup analysis of complete cases that includes both lipid-lowering agent use and lipid values, higher HDL levels (odds ratio, 0.95; 95% confidence interval, 0.93-0.98) and lipid-lowering agent use (odds ratio, 0.41; 95% confidence interval, 0.23-0.73) were both significantly and inversely associated with rupture status, whereas total cholesterol and LDL levels were not significant. A monotonic exposure-response curve between HDL levels and risk of aneurysmal rupture was obtained. CONCLUSIONS: Higher HDL values and the use of lipid-lowering agents are significantly inversely associated with ruptured intracranial aneurysms.
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