Association between low-density cholesterol change and outcomes in acute ischemic stroke patients who underwent reperfusion therapy

Abstract

Background Low-density lipoprotein cholesterol (LDL-C) can increase cardiovascular risk. However, the association between LDL-C change and functional outcomes in acute ischemic stroke (AIS) patients who underwent reperfusion therapy remains unclear. Methods Patients who received reperfusion therapy were consecutively enrolled. LDL-C measurement was conducted at the emergency department immediately after admission and during hospitalization. The change of LDL-C level (ΔLDL-C) was calculated by subtracting the lowest LDL-C among all measurements during hospitalization from the admission LDL-C. Poor functional outcome was defined as modified Rankin Scale (mRS) > 2 at 90 days. Results A total of 432 patients were enrolled (mean age 69.2 ± 13.5 years, 54.6 % males). The mean LDL-C level at admission was 2.55 ± 0.93 mmol/L. The median ΔLDL-C level was 0.43 mmol/L (IQR 0.08–0.94 mmol/L). A total of 263 (60.9 %) patients had poor functional outcomes at 90 days. There was no significant association between admission LDL-C level and functional outcome (OR 0.99, 95 % CI 0.77–1.27, p = 0.904). ΔLDL-C level was positively associated with poor functional outcome (OR 1.80, 95 % CI 1,12-2.91, p = 0.016). When patients were divided into tertiles according to ΔLDL-C, those in the upper tertile (T3, 0.80–3.98 mmol/L) were positively associated with poor functional outcomes compared to patients in the lower tertile (T1, -0.91-0.13 mmol/L) (OR 2.56, 95 % CI 1.22–5.36, p = 0.013). The risk of poor functional outcome increased significantly with ΔLDL-C tertile (P-trend = 0.010). Conclusions In AIS patients who underwent reperfusion therapy, the decrease in LDL-C level during hospitalization was significantly associated with poor functional outcomes at 90 days.

Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis

“…Interestingly, higher blood HDL and LDL levels at admission were correlated with lower mRS scores ( P < 0.05). There are studies showing an association between high blood LDL cholesterol levels and favorable functional outcomes in AIS patients after reperfusion therapy ( 17 , 18 ), although the actual relationship between serum LDL and the clinical outcome in AIS patients needs further investigation.…”

Impact of lipid profiles on parenchymal hemorrhage and early outcome after mechanical thrombectomy

“…The mechanism by which HDL-C levels directly affect ENI remains uncertain. Previous studies found that cholesterol may reduce oxidative damage in phospholipid membranes, improve the tolerance to anoxic damage during reperfusion, 41,42 promote axonal regeneration and synapse development at the acute phase of ischemic stroke. 43 Higher serum levels of HDL-C were associated with increased cholesterol efflux from infarcted tissue and decreased cellular cholesterol content, thereby weakening the protective effect of cholesterol, and potentially increasing the risk of failure of ENI after MT.…”