Dyslipidemia and rupture risk of intracranial aneurysms—a systematic review

Abstract

Dyslipidemia is a well-established risk factor for coronary artery disease. However, the effect on cerebral artery disease, and more specifically the rupture risk of intracranial aneurysms, is unclear and has not yet been reviewed. We therefore performed a systematic review to investigate associations between different types of dyslipidemia and incidence of aneurysmal subarachnoid hemorrhage (aSAH). We used the MEDLINE, Embase, and Web of Science databases to identify clinical trials that compared the rupture risk among SAH patients with or without dyslipidemia. The risk of bias in each included study was evaluated using the Critical Appraisal Skills Program (CASP). Of 149 unique citations from the initial literature search, five clinical trials with a case-control design met our eligibility criteria. These studies compared aSAH patients to patients with unruptured aneurysms and found an overall inverse relationship between hypercholesterolemia and rupture risk of intracranial aneurysms. The quality assessment classified all included studies as high risk of bias. The evidence indicates that hypercholesterolemia is associated with a reduced rupture risk of intracranial aneurysms. However, it is not clear whether this relation is due to the dyslipidemic condition itself or the use of antihyperlipidemic medication.

Effect of Renin-Angiotensin-Aldosterone System Inhibitors on the Rupture Risk Among Hypertensive Patients With Intracranial Aneurysms

“…This result supports previous studies into the inverse association between hyperlipidemia and aneurysm rupture. 32,33 Particularly, the effect was more profound for hyperlipidemia treated with antihyperlipidemic agents. Similarly, growing evidence from experimental animal models and retrospective clinical studies supported the concept that the inverse association is more dependent on the use of antihyperlipidemic agents as statins have vascular protective effects by antioxidative stress and anti-inflammation.…”

Integrate prediction of machine learning for single ACoA rupture risk: a multicenter retrospective analysis

“…In MLR, diabetes mellitus, dyslipidemia ( 19 ), ischemic stroke history, hemorrhagic stroke history and age stratification for those aged 60–69 years were all independent protective factors. This is consistent with the results of Olivia Rousseau and his colleagues working on the ICAN project study in the UK 6 .…”

Lower incidence of diabetes mellitus in patients with aneurysmal subarachnoid hemorrhage: a large case–control study with propensity score matching

“…This may be because most patients with hypertension undergo antihypertensive treatment and tend to have normal blood pressure after antihypertensive treatment; antihypertensive drugs may further prevent aneurysm rupture through other mechanisms ( 22 ). A recent review study including five case–control studies found that hypercholesterolemia is associated with a lower rupture risk of IAs ( 23 ). By contrast, in this study, an inverse relationship was observed; hypercholesterolemia increased the risk of aneurysm rupture.…”

“…Statin therapy has been increasingly used not only for lowering blood lipid levels but also for treating cardiovascular and cerebrovascular diseases. Patients with hypercholesterolemia may gain a protective benefit for aneurysm rupture from statin use ( 23 ). Further studies with rigorous inclusion and exclusion criteria should be conducted to determine these associations.…”