Yen-Ju Lung1, Wei-Chieh Weng1, Chia-Lun Wu1, Wen-Yi Huang2. 1. Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. 2. Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. Electronic address: wenyihuang2003@yahoo.com.tw.
Abstract
BACKGROUND: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence. METHODS: One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups. RESULTS: 117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio) = 1.88, 95% CI (confidence interval) = 1.09-3.23, P = .023). CONCLUSIONS: Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some stroke patients.
BACKGROUND: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in strokepatients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic strokepatients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence. METHODS: One-hundred and ninety-six acute ischemic strokepatients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups. RESULTS: 117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio) = 1.88, 95% CI (confidence interval) = 1.09-3.23, P = .023). CONCLUSIONS: Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic strokepatients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some strokepatients.
Authors: Anastasia V Poznyak; Dmitry A Kashirskikh; Vasily N Sukhorukov; Vladislav Kalmykov; Andrey V Omelchenko; Alexander N Orekhov Journal: Int J Mol Sci Date: 2022-01-25 Impact factor: 5.923