Higher Total Serum Cholesterol Levels Are Associated With Less Severe Strokes and Lower All-Cause Mortality

Abstract

Background and Purpose-Evidence of a causal relation between serum cholesterol and stroke is inconsistent. We investigated the relation between total serum cholesterol and both stroke severity and poststroke mortality to test the hypothesis that hypercholesterolemia is primarily associated with minor stroke. Methods-In the study, 652 unselected patients with ischemic stroke arrived at the hospital within 24 hours of stroke onset.A measure of total serum cholesterol was obtained in 513 (79%) within the 24-hour time window. Stroke severity was measured with the Scandinavian Stroke Scale (0ϭworst, 58ϭbest); a full cardiovascular risk profile was established for all. Death within 10 years after stroke onset was obtained from the Danish Registry of Persons. Results-MeanϮSD age of the 513 patients was 75Ϯ10 years, 54% were women, and the meanϮSD Scandinavian Stroke Scale score was 39Ϯ17. Serum cholesterol was inversely and almost linearly related to stroke severity: an increase of 1 mmol/L in total serum cholesterol resulted in an increase in the Scandinavian Stroke Scale score of 1.32 (95% CI, 0.28 to 2.36, Pϭ0.013), meaning that higher cholesterol levels are associated with less severe strokes. A survival analysis revealed an inverse linear relation between serum cholesterol and mortality, meaning that an increase of 1 mmol/L in cholesterol results in a hazard ratio of 0.89 (95% CI, 0.82 to 0.97, Pϭ0.01). Conclusions-The results of our study support the hypothesis that a higher cholesterol level favors development of minor strokes. Because of selection, therefore, major strokes are more often seen in patients with lower cholesterol levels. Poststroke mortality, therefore, is inversely related to cholesterol.

Serum Cholesterol LDL and 90-Day Mortality in Patients With Intracerebral Hemorrhage

“…3,4 Additionally, higher cholesterol levels have been associated with better short-term health outcome after stroke, including ICH. 5 However, most of these studies did not measure cholesterol fractions nor investigate whether HDL-C or LDL-C levels affected mortality or outcome. We studied the association between levels of LDL-C and mortality in ICH.…”

Serum Lipids and Statin Treatment During Acute Stroke

“…They found a high mortality rate (p=0.002) and a poorer one month outcome (p<0.01) in correlation with low levels of total cholesterol. The association between low serum level of total cholesterol and worse outcome as well as with mortality rate was described also by Dyker et al in 977 patients [1997] and by Olsen et al [2007] when measuring the total cholesterol in 513 patients within 24 hour time window. The neurological score used for evaluation was the Scandinavian Stroke Score (SSS).…”

Statins after ischemic stroke of undetermined etiology in young adults

“…Furthermore, it has been shown that statins initiated before or immediately after ischemic stroke improved early and long-term survival and functional outcomes. 5 Second, higher serum total cholesterol and triglycerides are shown to be associated with better functional outcome and reduced long-term mortality after ischemic stroke, 3,4 but not with decreased risk for recurrent vascular events in the long term, which was the scope in our study. Third, our study included only patients with undetermined stroke etiology with no signs of smallvessel disease or any other probable or possible cause.…”

“…3 Furthermore, an inverse relation between cholesterol and stroke severity and poststroke mortality has recently been reported, suggesting that higher cholesterol favors the development of small-vessel disease and therefore less severe strokes are associated with lower mortality. 4 Therefore, we question the usefulness and safety of long-term treatment with statins on all young patients with stroke of unknown etiology. Regarding cholesterol and outcomes after stroke, perhaps more is better.…”