Association Between Low-Density Lipoprotein Cholesterol (LDL-C) Level and Unfavorable Outcomes in Participants of Ischemic Stroke without Diabetes: A Multi-Center Retrospective Study

Abstract

Background The impact of low-density lipoprotein cholesterol (LDL-C) levels on outcomes in patients with non-diabetic acute ischemic stroke remains uncertain. The objective of this study was to explore whether LDL-C could refine outcomes after acute ischemic stroke in patients with non-diabetic acute ischemic stroke. Material/Methods A multi-center, retrospective, clinical-based study was conducted within eight hospitals between January 2015 and August 2016. Adjusted odds ratio (aOR) was used for measurement of unfavorable outcome which was evaluated by the modified Rankin Scale (mRS) score at 6 months after acute ischemic stroke, estimated categorically according to multivariate logistic regression. Results A total of 1614 participants with non-diabetic acute ischemic stroke were enrolled, of which 376 patients (23.3%) had unfavorable neurologic outcomes at 6 months. After multivariate analysis comparing 4 LDL-C levels by quartiles (Q), we found that compared to Q1 (LDL-C level ≤2.41 mmol/L), there was a significant association between the frequency of unfavorable outcomes and levels of LDL-C (Q3: 2.95–3.54 mmol/L) for all participants (adjusted odds ratio [aOR]=0.63; 95% CI: 0.44–0.92, P =0.016) and patients with first ever strokes (aOR=0.52; 95% CI: 0.31–0.87, P =0.013). Conclusions Compared to lower LDL-C levels, non-diabetic patients with LDL-C levels in Q3 (2.95–3.54 mmol/L), were less likely to have unfavorable functional outcomes at 6 months after acute ischemic stroke. Managing HDL-C is one of the most important steps for the recovery of acute ischemic stroke.

Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

“…In contrast, other studies reported no clear relationship between LDL-C and ischemic stroke (40,41). Moreover, in contrast to the present results, a multi-center retrospective study revealed that compared with lower LDL-C levels, levels in the third quartile were less likely to exhibit unfavorable outcomes after ischemic stroke (42). Another national cohort study also supports this point, reporting that among the middle-aged and elderly Chinese population, a lower LDL-C level was associated with increased all-cause mortality risk (43).…”

Inverse Problem Algorithm Application to Semi-Quantitative Analysis of 272 Patients With Ischemic Stroke Symptoms: Carotid Stenosis Risk Assessment for Five Risk Factors

“…These findings contradict the results of Roy-O'Reilly et al, which claimed that either age or LDL-C factors dominated the carotid stenosis. [14][15][16] The IPA capability of integrating individual factors with their probable cross-interaction improved the program convergence and yielded a high value of r 2 ¼ 0:9352.…”

“…14 (2) LDL-C. Epidemiologists have reported that LDL-C level strongly promoted carotid stenosis in elderly patients with cerebral infarction. 15,16 (3) MAP. This is the mean pressure per one complete cardiac cycle in human arteries, which indicates the perfusion to organs more clearly than systolic or diastolic blood pressures (SBP and DBP, respectively: MAP ¼ ðSBP þ 2 Á DBPÞ=3.…”

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

“…There was a discrepancy in the prognostic significance between LDL-C level and outcomes in AIS patients [ 1 – 11 ]. Some studies found that higher LDL-C level was associated with poor outcomes in AIS patients [ 1 – 3 ], while some studies found that lower LDL-C was associated with poor outcome in AIS patients [ 4 , 5 ], others failed to find a significant association between LDL-C and outcome [ 6 – 11 ]. The inconsistent results might be explained by differences in sample size, patient selection, potential confounder, outcome assessment, and different measurement times of LDL-C. Several studies suggested that LDL got oxidized into oxLDL under oxidative stress [ 19 ], and oxLDL may contribute to exacerbate free-radical damage in the acute phase of AIS [ 20 , 32 – 35 ].…”