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

Ramírez-Moreno, J.M.; Casado-Naranjo, Ignacio; Portilla, Juan Carlos; Calle, María Luisa; Tena, David; Falcón, Alfonso; Serrano, Ana

doi:10.1161/strokeaha.108.536698

Cited by 45 publications

(35 citation statements)

References 12 publications

(14 reference statements)

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“…[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. 13 The mechanism by which statin increases ICH risk could also be independent of its lipid-lowering effect and may be related to its pleiotropic and antithrombotic properties.…”

Section: Discussionmentioning

confidence: 99%

Statins May Increase Intracerebral Hemorrhage Volume

Ricard

Garant

Carrier

et al. 2010

Can. j. neurol. sci.

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Several epidemiological studies have demonstrated an association between hypocholesterolemia and the incidence of intracerebral hemorrhage (ICH).1-3 HMG-CoA reductase inhibitors (statin) may theoretically increase the risk of cerebral hemorrhage, given its cholesterol-lowering effect. In addition, statins have been associated with decreased platelet function via direct influence on platelet membrane and inhibition of PAR-1, which is a cell-bound protein that links platelet activation. [4][5][6] An exploratory analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial found that statins overall effect included an increase in the number of treated patients having hemorrhagic stroke (n 55 for active treatment vs n 33 for placebo) with an unadjusted HR 1.68. 7 The Heart Protection Study (HPS) earlier described this ABSTRACT: Background: Some studies have suggested an association between hypocholesterolemia and intracerebral hemorrhage (ICH). In the SPARCL trial, statin use increased ICH risk. We tested the hypothesis that use of statins affects the volume of spontaneous ICH and contributes to the progression of ICH volume between baseline and follow-up CT scans. Methods: Consecutive cases of spontaneous ICH were reviewed. Secondary causes were excluded. We measured ICH volume on the baseline and follow-up CT scans using the AxBxC/2 method. Multivariate analysis and logistic regression modeling were used. The primary outcome was the ICH volume on the baseline CT scan. Secondary outcomes included volume variation between the baseline and the first follow up CT scans and death. Results: Of 303 subjects, 71 were taking a statin at the time of the ICH (23%). Statin users were significantly more likely to be younger, to have co-morbidities and take anticoagulant or anti-platelet medication. They also had a higher baseline ICH volume than non-statin users (median 31.

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Section: Discussionmentioning

confidence: 99%

Statins May Increase Intracerebral Hemorrhage Volume

Ricard

Garant

Carrier

et al. 2010

Can. j. neurol. sci.

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“…23 Furthermore, available evidence from clinical trials suggests a link between statin use and increased risk of recurrent ICH. 24 While the lipid-lowering effect of statins could explain their detrimental long-term effect on ICH risk, we did not identify interactions between cholesterol levels and short-term benefit on functional outcome.…”

Section: Statin Use and Neuroimaging Predictors Of Ich Outcomementioning

confidence: 99%

Statin use and outcome after intracerebral hemorrhage

Biffi

Devan²,

Anderson³

et al. 2011

Neurology

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Objectives: Intracerebral hemorrhage (ICH) is a highly lethal disease of the elderly. Use of statins is increasingly widespread among the elderly, and therefore common in patients who develop ICH. Accumulating data suggests that statins have neuroprotective effects, but their association with ICH outcome has been inconsistent. We therefore performed a meta-analysis of all available evidence, including unpublished data from our own institution, to determine whether statin exposure is protective for patients who develop ICH. Methods:In our prospectively ascertained cohort, we compared 90-day functional outcome in 238 pre-ICH statin cases and 461 statin-free ICH cases. We then meta-analyzed results from our cohort along with previously published studies using a random effects model, for a total of 698 ICH statin cases and 1,823 non-statin-exposed subjects. Conclusion: Antecedent use of statins prior to ICH is associated with favorable outcome and reduced mortality after ICH. This phenomenon appears to be a class effect of statins. Further studies are required to clarify the biological mechanisms underlying these observations. Results Neurology® 2011;76:1581-1588 GLOSSARY CI ϭ confidence interval; GCS ϭ Glasgow Coma Scale score; ICH ϭ intracerebral hemorrhage; LDL ϭ low-density lipoprotein; MGH ϭ Massachusetts General Hospital; mRS ϭ modified Rankin Scale; OR ϭ odds ratio.Intracerebral hemorrhage (ICH) accounts for 15% of all acute strokes, with societal and public health ramifications largely determined by the associated prognosis. 1 Despite substantial advances in the field of neurocritical care, more than half of patients with ICH face the prospect of death or severe disability.2 New research directions are therefore crucially needed in order to understand the complex pathophysiology of ICH outcome and recovery and exploit this understanding to benefit patients. 3Several studies investigating animal models of ICH suggest that statins exert a beneficial effect on functional recovery. [4][5][6] These findings could be explained by the effect of statins on lipid metabolism, or by other effects including neuroprotection and stimulation of neurogenesis and synaptogenesis. 7,8 Evidence from observational studies in patients, however, is conflicting, with some groups

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“…[2][3][4] Other studies have, on the contrary, found statins to be associated with reduced disability and mortality after ICH. 5,6 Also low serum cholesterol, 7 low-density lipoprotein (LDL) cholesterol, [7][8][9][10] and triglyceride levels 7 were associated with an increased risk of ICH and ICH mortality, although not in all studies. 4 Because of these controversial results, we decided to study the associations of premorbid statin usage and baseline lipid profiles on the functional outcome and mortality in consecutive ICH patients.…”

mentioning

confidence: 98%

Association of Prestroke Statin Use and Lipid Levels With Outcome of Intracerebral Hemorrhage

Mustanoja

Strbian

Putaala

et al. 2013

Stroke

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We analyzed only patients with data on pre-ICH statin use. Patients having multiple ICH during the study period were included only once. Fasting blood tests for lipid levels that is, total cholesterol, LDL, high-density lipoprotein cholesterol, and triglyceride levels were drawn on the first working-day morning after admission.Initial stroke severity was assessed on the National Institutes of Health Stroke Scale and Glasgow Coma Scale (GCS), and baseline ICH volume was calculated. Good outcome was defined as modified Background and Purpose-It is unclear whether blood lipid profiles and statin use before intracerebral hemorrhage (ICH) are associated with its outcome. Methods-The Helsinki ICH Study, a single-center observational registry of consecutive ICH patients, was used to study the associations between premorbid statin use, baseline lipid levels, and clinical outcome. Results-The registry includes 964 ICH patients. Statin users (n=187; 19%) were significantly older, had more frequent comorbidities and medication, lower lipid levels, and higher admission Glasgow Coma Scale compared with nonusers.

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

Cited by 45 publications

References 12 publications

Statins May Increase Intracerebral Hemorrhage Volume

Statins May Increase Intracerebral Hemorrhage Volume

Statin use and outcome after intracerebral hemorrhage

Association of Prestroke Statin Use and Lipid Levels With Outcome of Intracerebral Hemorrhage

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