Lower low-density lipoprotein cholesterol levels are associated with an increased risk of hematoma expansion and ensuing mortality in acute ICH patients

• Published in: Neurological sciences Vol. 43; no. 5; pp. 3121 - 3129
• Main Authors: Wang, Yu, Wu, Jianwei, Gu, Hongqiu, Yang, Kaixuan, Jiang, Ruixuan, Li, Zixiao, Zhao, Xingquan, Wang, Yongjun
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2022; Springer Nature B.V
• Subjects: Arteriosclerosis; Cerebral Hemorrhage - complications; Cerebrovascular diseases; Cholesterol; Cholesterol, LDL; Hematoma; Hematoma - complications; Hemorrhage; Hospital Mortality; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Low density lipoprotein; Medicine; Medicine & Public Health; Mortality; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Patients; Psychiatry; Statins; Vascular diseases; Lipoprotein; Hematoma expansion; Intracerebral hemorrhage; Risk factor
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-021-05742-w

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.