Effect of Serum Lipid Levels on Stroke Outcome after rt-PA Therapy: SAMURAI rt-PA Registry

Abstract

Background: The effects of lipid levels on clinical outcomes after ischemic stroke are controversial. Whether admission lipid levels and prior statin use are associated with early intracerebral hemorrhage (ICH) and long-term functional outcome after recombinant tissue plasminogen activator (rt-PA) therapy for stroke patients was investigated. Methods: Ischemic stroke patients who received intravenous rt-PA from a multicenter registry were studied. Lipid levels on admission, including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglyceride levels, as well as prior statin use, were assessed. The primary outcome was favorable outcome at 3 months corresponding to a modified Rankin Scale score ≤1. The secondary outcome was any or symptomatic ICH within the initial 36 h. Results: Of 489 enrolled patients (171 women, 70.8 ± 11.6 years old), 60 used statins prior to stroke, 93 developed ICH (19.0%), and 188 (38.4%) had a favorable 3-month outcome. Of the lipid levels, only the HDL-C level was an independent predictor of favorable outcome after multivariate adjustment for baseline characteristics (OR 1.95, 95% CI 1.10–3.47 per 1 mmol/l; p = 0.023) and after further adjustment for pretreatment radiological findings (OR 2.03, 95% CI 1.07–3.84; p = 0.029). For the 187 stroke patients without cardioembolism, the HDL-C level was more strongly associated with favorable outcome (OR 4.94, 95% CI 1.91–12.76 per 1 mmol/l; p = 0.001). There were no significant associations between ICH and any lipid levels. Prior statin use was not associated with outcomes. Conclusions: The admission HDL-C level was associated with favorable outcome 3 months after intravenous rt-PA therapy in stroke patients without cardioembolism.

An engineered S1P chaperone attenuates hypertension and ischemic injury

“…In mouse models of stroke, HDL infusion and S1P 1 receptor activators can reduce neuronal I/R injury in animal models and in human clinical trials (8, 10, 42, 43, 47, 49, 50). Thus, ApoM-Fc–S1P may provide a novel strategy for treatment of stroke.…”

“…To determine dose-response relationships, a similar experiment was performed using PBS (vehicle control) or 30 µg (1.3 mg/kg) of either ApoM-Fc or ApoM-Fc–TM suspended in PBS. In addition, the S1P 1 antagonist W146 (10 mg/kg) (8) was used in similar experiments. W146 was administered by intraperitoneal injection at time 0 and then at 24-hour intervals (24 to 96 hours and then again at 168 hours).…”

High-density Lipoprotein–based Therapy Reduces the Hemorrhagic Complications Associated With Tissue Plasminogen Activator Treatment in Experimental Stroke

“…40 Recently, among 489 patients with acute IS treated with tPA within 3 hours of stroke onset, high HDL-C levels were significantly associated with a good outcome at 3 months. 41 This suggests that HDL supplementation may be beneficial at the acute stage of stroke. Raising HDL levels encompasses 2 different strategies: HDL infusion and HDL-raising drugs.…”

Factors Associated with Early Recanalization Failure following Intravenous rt-PA Therapy for Ischemic Stroke

“…HDL cholesterol also has a potential to improve fibrinolytic activity derived from vascular endothelial cell [33]. We previously reported that the admission HDL cholesterol level was associated with favorable outcome 3 months after intravenous rt-PA therapy [34]. HDL cholesterol may play an important role to improve thrombolysis in patients treated with rt-PA.…”