Yu Wang1,2, Jianwei Wu1,2, Hongqiu Gu1,2, Kaixuan Yang1,3,4, Ruixuan Jiang1,2, Zixiao Li1,2,5, Xingquan Zhao6,7,8, Yongjun Wang9,10,11. 1. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. 2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. 3. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. 4. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China. 5. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China. 6. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. zxq@vip.163.com. 7. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. zxq@vip.163.com. 8. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China. zxq@vip.163.com. 9. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. yongjunwang@ncrcnd.org.cn. 10. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. yongjunwang@ncrcnd.org.cn. 11. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China. yongjunwang@ncrcnd.org.cn.
Abstract
BACKGROUND AND PURPOSE: The relationship between lipid levels and the prognosis of acute intracerebral hemorrhage (ICH) remains controversial. Thus, we aimed to investigate whether lower low-density lipoprotein cholesterol (LDL-C) levels increased the risk of adverse outcomes, as well as the current situation of statin treatment in acute ICH patients with premorbid lipid-lowering therapy. METHODS: From August 1, 2015, to July 31, 2019, a total of 73,098 ICH patients were included in our study from the Chinese Stroke Center Alliance program. Patients were grouped by LDL-C levels of < 1.4 mmol/L, 1.4-1.8 mmol/L, 1.8-2.6 mmol/L, and > 2.6 mmol/L. Logistic regression was used to assess the association between LDL-C levels and the composite risk of hematoma expansion (HE) or in-hospital death. Moreover, statin treatment in ICH patients with cardio-cerebrovascular diseases was analyzed. RESULTS: In total, 6368 (8.7%) patients were identified as a composite of HE or in-hospital death with a mean LDL-C level of 2.9 ± 1.7 mmol/L. In the univariate analysis, patients who achieved lower LDL-C concentrations under 1.4 mmol/L had a 36% higher risk of adverse outcomes compared with the ≥ 2.6 mmol/L group (OR 1.36, 95%CI 1.23-1.51). Similar results were obtained in multivariate analyses, especially for patients with GCS scores of 9-15. For acute ICH patients with concomitant atherosclerotic disease, statin treatment was discontinued in the majority of Chinese population. CONCLUSIONS: Lower LDL-C levels (< 1.4 mmol/L) are associated with an increased risk of HE and ensuing mortality in acute ICH patients. Maintaining an optimal LDL-C range may have therapeutic potential against HE which merits further investigation.
BACKGROUND AND PURPOSE: The relationship between lipid levels and the prognosis of acute intracerebral hemorrhage (ICH) remains controversial. Thus, we aimed to investigate whether lower low-density lipoprotein cholesterol (LDL-C) levels increased the risk of adverse outcomes, as well as the current situation of statin treatment in acute ICH patients with premorbid lipid-lowering therapy. METHODS: From August 1, 2015, to July 31, 2019, a total of 73,098 ICH patients were included in our study from the Chinese Stroke Center Alliance program. Patients were grouped by LDL-C levels of < 1.4 mmol/L, 1.4-1.8 mmol/L, 1.8-2.6 mmol/L, and > 2.6 mmol/L. Logistic regression was used to assess the association between LDL-C levels and the composite risk of hematoma expansion (HE) or in-hospital death. Moreover, statin treatment in ICH patients with cardio-cerebrovascular diseases was analyzed. RESULTS: In total, 6368 (8.7%) patients were identified as a composite of HE or in-hospital death with a mean LDL-C level of 2.9 ± 1.7 mmol/L. In the univariate analysis, patients who achieved lower LDL-C concentrations under 1.4 mmol/L had a 36% higher risk of adverse outcomes compared with the ≥ 2.6 mmol/L group (OR 1.36, 95%CI 1.23-1.51). Similar results were obtained in multivariate analyses, especially for patients with GCS scores of 9-15. For acute ICH patients with concomitant atherosclerotic disease, statin treatment was discontinued in the majority of Chinese population. CONCLUSIONS: Lower LDL-C levels (< 1.4 mmol/L) are associated with an increased risk of HE and ensuing mortality in acute ICH patients. Maintaining an optimal LDL-C range may have therapeutic potential against HE which merits further investigation.
Authors: Pierre Amarenco; Julien Bogousslavsky; Alfred Callahan; Larry B Goldstein; Michael Hennerici; Amy E Rudolph; Henrik Sillesen; Lisa Simunovic; Michael Szarek; K M A Welch; Justin A Zivin Journal: N Engl J Med Date: 2006-08-10 Impact factor: 91.245
Authors: Jason J Chang; Aristeidis H Katsanos; Yasser Khorchid; Kira Dillard; Ali Kerro; Lucia Goodwin Burgess; Nitin Goyal; Anne W Alexandrov; Andrei V Alexandrov; Georgios Tsivgoulis Journal: Atherosclerosis Date: 2017-12-06 Impact factor: 5.162
Authors: Joji B Kuramatsu; Stefan T Gerner; Peter D Schellinger; Jörg Glahn; Matthias Endres; Jan Sobesky; Julia Flechsenhar; Hermann Neugebauer; Eric Jüttler; Armin Grau; Frederick Palm; Joachim Röther; Peter Michels; Gerhard F Hamann; Joachim Hüwel; Georg Hagemann; Beatrice Barber; Christoph Terborg; Frank Trostdorf; Hansjörg Bäzner; Aletta Roth; Johannes Wöhrle; Moritz Keller; Michael Schwarz; Gernot Reimann; Jens Volkmann; Wolfgang Müllges; Peter Kraft; Joseph Classen; Carsten Hobohm; Markus Horn; Angelika Milewski; Heinz Reichmann; Hauke Schneider; Eik Schimmel; Gereon R Fink; Christian Dohmen; Henning Stetefeld; Otto Witte; Albrecht Günther; Tobias Neumann-Haefelin; Andras E Racs; Martin Nueckel; Frank Erbguth; Stephan P Kloska; Arnd Dörfler; Martin Köhrmann; Stefan Schwab; Hagen B Huttner Journal: JAMA Date: 2015-02-24 Impact factor: 56.272
Authors: L B Goldstein; P Amarenco; M Szarek; A Callahan; M Hennerici; H Sillesen; J A Zivin; K M A Welch Journal: Neurology Date: 2007-12-12 Impact factor: 9.910
Authors: François Mach; Colin Baigent; Alberico L Catapano; Konstantinos C Koskinas; Manuela Casula; Lina Badimon; M John Chapman; Guy G De Backer; Victoria Delgado; Brian A Ference; Ian M Graham; Alison Halliday; Ulf Landmesser; Borislava Mihaylova; Terje R Pedersen; Gabriele Riccardi; Dimitrios J Richter; Marc S Sabatine; Marja-Riitta Taskinen; Lale Tokgozoglu; Olov Wiklund Journal: Eur Heart J Date: 2020-01-01 Impact factor: 29.983