Sex differences in outcomes after stroke among patients with low total cholesterol levels: a large hospital-based prospective study

Abstract

BackgroundPrevious studies have shown that total cholesterol (TC) levels are associated with stroke outcomes, but sex differences in the association between TC levels, especially a low TC level, and ischemic stroke outcomes are unknown. We aimed to assess the sex differences in stroke outcomes among patients with atherothrombotic infarctions and low TC levels in China.MethodsThis study recruited patients with atherothrombotic infarctions from Tianjin, China, between May 2005 and September 2014. Patients with low TC levels (defined as TC <4.22 mmol/L) were analyzed in this study. Sex differences in stroke subtypes, severity, risk factors, and outcomes at 3 and 12 months after stroke were compared.ResultsOverall, 1587 patients with low TC levels were recruited to this study from among 6407 patients with atherothrombotic infarctions listed in a stroke registry. Women were more likely than men to have posterior circulation infarcts, severe stroke, hypertension, and obesity but less likely to be current smokers or to consume alcohol. There were no sex differences in stroke outcomes. Older age and severe stroke were common risk factors for poor outcomes after stroke in this study. The presence of diabetes mellitus was an independent predictor of low mortality at 12 months after stroke, possibly because a drug commonly used to treat diabetes, metformin, enhances angiogenesis. Obesity was the determinant of the recurrence and dependency rates at 12 months after stroke.ConclusionsThese findings suggest that patients (both men and women) with atherothrombotic infarction who have low TC levels would not benefit from receiving statin treatment. Therefore, it is crucial to explore the impact of statin treatment on outcomes in Asian patients, especially Chinese patients with atherothrombotic and low TC levels, in order to improve outcomes after stroke and reduce the disease burden.

Baseline Objective Malnutritional Indices as Immune-Nutritional Predictors of Long-Term Recurrence in Patients with Acute Ischemic Stroke

“…Low TC levels in stroke patients may act as a double-edged sword, lowering the risk of ischemic stroke while increasing the risk of hemorrhagic stroke [ 38 , 39 ]. Additionally, Zhou, et al have reported that patients with atherosclerotic infarction and low cholesterol levels treated with statins had increased long-term dependency and recurrence risk after AIS [ 40 ]. TC may represent the individual nutritional status to some extent and a non-linear relationship may correlate with adverse outcomes in AIS patients [ 39 ].…”

Recurrence Rate and Relevant Associated Factors of Stroke among Patients with Small Artery Occlusion in Northern China

“…All patients in this study were recruited from the stroke unit at Tianjin Huanhu Hospital, China between May 2005 and September 2014.The procedure used to establish the stroke registry has been described previously 47–49 . In brief, all consecutive patients with acute ischemic stroke were entered into the registry system, and detailed information, including clinical features and outcomes, were collected.…”

Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients

“…Six months post stroke treatment, women are known to present with more severe disabilities when compared with recovering men AIS patients. [ 4 ] The Framingham Heart Study found that AIS women presented with more disability, and are 3.5 times more likely to be institutionalized at 3 to 6 months post-stroke compared with men. [ 5 ] Findings from this study also indicate that women present with a higher lifetime risk for stroke, likelihood of presenting with a recurrent stroke, and are more likely to have more severe strokes when compared with men.…”