Admission LDL-cholesterol, statin pretreatment and early outcomes in acute ischemic stroke

Joon Tae Kim, Ji Sung Lee, Beom Joon Kim, Jihoon Kang, Keon Joo Lee, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Jae Kwan Cha, Dae Hyun Kim, Tai Hwan Park, Kyungbok Lee, Jun Lee, Keun Sik Hong, Yong Jin Cho, Hong Kyun Park, Byung Chul Lee, Kyung Ho Yu, Mi Sun OhDong Eog Kim, Wi Sun Ryu, Jay Chol Choi, Jee Hyun Kwon, Wook Joo Kim, Dong Ick Shin, Kyu Sun Yum, Sung Il Sohn, Jeong Ho Hong, Sang Hwa Lee, Man Seok Park, Kang Ho Choi, Juneyoung Lee, Kwang Yeol Park, Hee Joon Bae

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission. Objective: This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes. Patients and methods: This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored. Results: A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (Pnon-linearity<0.001), with substantial relationships in the no pretreatment subgroup. Conclusions: The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted.

Original languageEnglish
Pages (from-to)612-621
Number of pages10
JournalJournal of Clinical Lipidology
Volume17
Issue number5
DOIs
StatePublished - 1 Sep 2023

Keywords

  • Acute ischemic stroke
  • Early vascular outcome
  • LDL-cholesterol
  • Lipid paradox
  • Statin pretreatment

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