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A low-density lipoprotein (LDL) cholesterol level of less than 70 mg/dL was associated with more severe stroke at presentation in patients with intracerebral hemorrhage (ICH), according to study findings presented at the 2022 American Academy of Neurology (AAN) Annual Meeting, held from April 2 to April 7 in Seattle, Washington, and virtually from April 24-26, 2022.


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The association between serum LDL levels and ICH has remained inconclusive. The researchers note that previous studies indicate low LDL levels may be a risk factor for ICH, yet many studies have not fully defined the link between ICH severity and LDL. For the current study, they hypothesized that low LDL levels may be linked to severe ICH at presentation and worse outcomes.

The researchers conducted a retrospective review of data from SIREN, which they noted is the largest multicenter stroke study that has been performed in Africa. They classified patients based on baseline levels of LDL measured at time of admission: less than 70 mg/dL, 70 to 100 mg/dL, 100 to 125 mg/dL, and more than 125 mg/dL. For the purposes of their study, the researchers assessed patients’ initial stroke severity with the Glasglow Coma Scale (GCS), ICH Score, National Institutes of Health Stroke Scale (NIHSS), and unfavorable outcomes with the modified Rankin scale (mRS).

The study cohort included 1162 patients with ICH (mean age, 54.42±13.63 years; 62.5% men). Approximately 96.8% (n=1125) of patients had hypertension. Additionally, 65.9% (n=766) of the population had fatal outcomes, as reflected by a mean GCS of 11.12±3.90, NIHSS of 16.84±11.69, ICH Score of 1.74±1.39, and MRS of 4.11±1.11.

Individuals in the study who had LDL less than 70 mg/dl were significantly younger (mean age, 52.43±13.06 years)than those with LDL 70 to 100 mg/dl (mean age, 53.78±13.73 years), 100 to 125 mg/dl (mean age, 56.74±13.26 years), and more than125 mg/dl (mean age, 53.59±13.00 years) (P =.011).

Patients who presented with an LDL of less than 70 mg/dL had more severe stroke according to the GCS. Specifically, those with an LDL of less than 70 mg/dL had a mean GCS of 9.46±3.77 compared with 11.42±3.75 in patients with LDL of 70 to 100 mg/dl, 10.11±4.30 in patients with LDL of 100 to 125 mg/dl, and 11.79±3.73 in patients with LDL more than 125 mg dl (P =.007).

The researchers reported a positive correlation between levels of LDL and the GCS (P =.014) as well as a negative correlation between levels of LDL and the ICH score and NIHSS score at baseline, although these negative correlations were not statistically significant.

“Mortality of ICH remains high in Africa. LDL <125 mg/dl is more common in African subjects with ICH and those with LDL <70 mg/dl happened to be much younger,” the researchers concluded.

Reference

Olalusi O, Akinyemi R, Owolabi M, Makanjuola A. Correlation between serum low density lipoprotein (LDL) levels and hemorrhagic stroke severity: A retrospective review from siren (preliminary findings). Presented at: the 2022 AAN Annual Meeting; April 2-7, 2022; Seattle, Washington; April 24-26, 2022; Virtual Meeting. Abstract S33.007.