Sheng-Feng Lin1,2, A-Ching Chao3,4, Han-Hwa Hu5,6,7, Ruey-Tay Lin3,4, Chih-Hung Chen8,9, Lung Chan7, Huey-Juan Lin10, Yu Sun11, Yung-Yang Lin12, Po-Lin Chen13, Shinn-Kuang Lin14, Cheng-Yu Wei15, Yu-Te Lin16, Jiunn-Tay Lee17, Chyi-Huey Bai1,18. 1. School of Public Health, College of Public Health, Taipei Medical University. 2. Department of Clinical Pathology, Far Eastern Memorial Hospital. 3. Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University. 4. Department of Neurology, Kaohsiung Medical University Hospital. 5. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University. 6. Research Center of Cerebrovascular Disease Treatment, College of Medicine, Taipei Medical University. 7. Department of Neurology, Taipei Medical University-Shaung Ho Hospital. 8. Department of Neurology, National Cheng Kung University Hospital. 9. Department of Neurology, National Cheng Kung University. 10. Department of Neurology, Chi Mei Medical Center. 11. Department of Neurology, En Chu Kong Hospital. 12. Department of Neurology, Taipei Veterans General Hospital. 13. Department of Neurology, Taichung Veterans General Hospital. 14. Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation. 15. Department of Neurology, Show Chwan Memorial Hospital. 16. Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital. 17. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center. 18. Department of Public Health, College of Medicine, Taipei Medical University.
Abstract
AIM: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. METHODS: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24-36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. RESULTS: For enrolled 1845 patients, SICH rates were ≥2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281-0.846], p=0.0106), the ECASS II (adjusted RR: 0.318 [0.130-0.776], p=0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048-0.957], p=0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of ＜130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24-36 h. CONCLUSIONS: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of ＜130 mg/dL is supposed to a candidate marker for predicting SICH within 24-36 h.
AIM: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. METHODS: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24-36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. RESULTS: For enrolled 1845 patients, SICH rates were ≥2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281-0.846], p=0.0106), the ECASS II (adjusted RR: 0.318 [0.130-0.776], p=0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048-0.957], p=0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of ＜130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24-36 h. CONCLUSIONS: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of ＜130 mg/dL is supposed to a candidate marker for predicting SICH within 24-36 h.
Authors: Nils Wahlgren; Niaz Ahmed; Antoni Dávalos; Gary A Ford; Martin Grond; Werner Hacke; Michael G Hennerici; Markku Kaste; Sonja Kuelkens; Vincent Larrue; Kennedy R Lees; Risto O Roine; Lauri Soinne; Danilo Toni; Geert Vanhooren Journal: Lancet Date: 2007-01-27 Impact factor: 79.321
Authors: Elisabet Zia; Hélène Pessah-Rasmussen; Farhad Ali Khan; Bo Norrving; Lars Janzon; Goran Berglund; Gunnar Engstrom Journal: Cerebrovasc Dis Date: 2005-11-08 Impact factor: 2.762
Authors: O Y Bang; J L Saver; D S Liebeskind; S Starkman; P Villablanca; N Salamon; B Buck; L Ali; L Restrepo; F Vinuela; G Duckwiler; R Jahan; T Razinia; B Ovbiagele Journal: Neurology Date: 2006-12-20 Impact factor: 9.910
Authors: M L Bots; P C Elwood; Y Nikitin; J T Salonen; A Freire de Concalves; D Inzitari; J Sivenius; V Benetou; J Tuomilehto; P J Koudstaal; D E Grobbee Journal: J Epidemiol Community Health Date: 2002-02 Impact factor: 3.710
Authors: Jared D Sturgeon; Aaron R Folsom; W T Longstreth; Eyal Shahar; Wayne D Rosamond; Mary Cushman Journal: Stroke Date: 2007-08-30 Impact factor: 7.914