Low Level of Low-Density Lipoprotein Cholesterol Increases Hemorrhagic Transformation in Large Artery Atherothrombosis but Not in Cardioembolism

Abstract

Background and Purpose-Low cholesterol level is known to be associated with increased cerebral hemorrhage.However, the associations of hemorrhagic transformation (HTf) after acute ischemic stroke and the low levels of total cholesterol (TC) or low-density lipoprotein cholesterol (LDLC) are largely undiscovered. Methods-Of the 1034 patients with acute ischemic stroke who were consecutively admitted to our hospital, 377 patients with stroke attributable to large artery atherothrombosis (LAA; nϭ210) or cardioembolism (nϭ167) were selected for this study. Demographic and clinical information was collected and HTf was evaluated through follow-up T2*-weighted gradient-echo MRI performed usually within 1 week after stroke. Measurement of lipid parameters included TC, LDLC, high-density lipoprotein cholesterol, and triglyceride. Results-Of the 377 patients, HTf was noted in 74 patients (19.6%). When patients were divided into 4 groups according to their TC and LDLC levels, the incidence of HTf was significantly elevated in the lowest quartile of each TC (PϽ0.01) and LDLC (PϽ0.01) level in LAA subgroup, but not in cardioembolism. After adjusting covariates, a low level of LDLC (OR, 0.46 per 1 mmol/L-increase; 95% CI, 0.22-0.98) was independently associated with HTf in LAA, but not in cardioembolism. There was no significant association between low levels of TC (OR, 0.63 per 1 mmol/L-increase; 95% CI, 0.35-1.15) and HTf in LAA. Conclusions-Low levels of LDLC, and possibly TC, are associated with greater risk of hemorrhagic transformation after acute ischemic stroke attributable to LAA.

Statins May Increase Intracerebral Hemorrhage Volume

“…[1][2][3] Similarly, Bang et al's retrospective study reported a relationship between recanalization therapy, low cholesterol, and hemorrhagic infarction 15 while low LDL levels were reported by some as associated with hemorrhagic transformation after large artery stroke 16 or increased mortality in ICH. 17 The investigators in the SPARCL trial, however, found no relationship between ICH risk and low-density lipoprotein or total cholesterol levels.…”

Ischemic Stroke During Sleep

“…[13][14][15] Additionally, we gathered patients' laboratory information, including serum glucose level, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. Stroke characteristics included stroke subtype, time of onset, circumstances at time of onset, National Institutes of Health Stroke Scale (NIHSS) score at admission, duration of hospitalization, modified Rankin Scale (mRS) score at discharge, thrombolytic treatment during the hyperacute period, initiation of anticoagulation during hospitalization, and vascular intervention (carotid stent insertion or endarterectomy during hospitalization).…”

Lipid Profile, Lipid-lowering Medications, and Intracerebral Hemorrhage After tPA in Get With The Guidelines–Stroke

“…13 Subsequently, multiple studies have found no association between LDL and sICH after thrombolysis for ischemic stroke. 14,15,23 A study of 252 patients treated with IV tPA noted an opposite effect of TRG; higher TRG was associated with a higher risk of sICH in multivariable analysis, but our study is substantially larger.…”

“…2,[4][5][6][7][8] There have been conflicting studies that have looked for an association among lipid levels, lipid-lowering medication, and brain hemorrhages, and it is uncertain whether these factors affect the decision to treat an individual patient with tPA. [9][10][11][12][13][14][15][16][17][18] Get With The Guidelines-Stroke (GWTG-Stroke) program was undertaken by the American Heart Association/American Stroke Association (AHA/ASA) as a national quality improvement initiative to advance the treatment of patients with stroke and transient ischemic attack. We evaluated the relationship among lipid subtypes, lipid-lowering medications, and risk of sICH after tPA in GWTG-Stroke.…”