Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes

Joon Tae Kim; Ji Sung Lee; Hyunsoo Kim; 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 Oh; Dong Eog Kim; 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; Wi Sun Ryu; Kwang Yeol Park; Juneyoung Lee; Hee Joon Bae

doi:10.1016/j.jacl.2023.11.012

Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes

Joon Tae Kim, Ji Sung Lee, Hyunsoo Kim, 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 YuMi Sun Oh, Dong Eog Kim, 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, Wi Sun Ryu, Kwang Yeol Park, Juneyoung Lee, Hee Joon Bae

Department of Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

BACKGROUND: Because ischemic stroke is heterogeneous, the associations between low-density lipoprotein (LDL)-cholesterol levels and early vascular outcomes might be different according to the stroke subtype in acute ischemic stroke patients. METHODS: This study was an analysis of a prospective, multicenter, stroke registry. Acute ischemic stroke patients previously not treated with statins were included. Admission LDL-cholesterol levels were divided into 7 groups at 20 mg/dl intervals for comparison. The primary early vascular outcome was a composite of stroke, myocardial infarction (MI) and all-cause mortality within 3 months. RESULTS: A total of 38,531 patients (age, 68.5 ± 12.8 yrs; male, 59.6%) were analyzed for this study. The 3-month cumulative incidences of the composite of stroke, MI, and all-cause mortality significantly differed among the LDL-cholesterol level groups, with the highest event rate (11.11%) in the lowest LDL-cholesterol group (<70 mg/dl). After adjustment, the U-shaped associations of LDL-cholesterol levels with primary outcome and all-cause mortality were observed. For the stroke subtypes, there were substantial interactions between the LDL-cholesterol groups and stroke subtype and all-cause mortality (P_interaction=0.07). Different patterns, with higher risks of all-cause mortality in the lower LDL-cholesterol in the large artery atherosclerosis subtype (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 0.98-1.69), but in the higher LDL-cholesterol in the cardioembolism subtype (aHR 1.71 95% CI [1.28-2.29]), were observed among stroke subtypes. CONCLUSION: We found that there were differential associations of admission LDL-cholesterol levels with all-cause mortality within 3 months among stroke subtypes. These results suggest that admission LDL-cholesterol and early vascular outcomes had complex relationships in patients with ischemic stroke according to the stroke subtypes.

Original language	English
Pages (from-to)	e207-e217
Journal	Journal of Clinical Lipidology
Volume	18
Issue number	2
DOIs	https://doi.org/10.1016/j.jacl.2023.11.012
State	Published - 1 Mar 2024

Keywords

Acute ischemic stroke
Early vascular outcome
LDL-cholesterol
Stroke subtype

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jacl.2023.11.012

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Kim, J. T., Lee, J. S., Kim, H., Kim, B. J., Kang, J., Lee, K. J., Park, J. M., Kang, K., Lee, S. J., Kim, J. G., Cha, J. K., Kim, D. H., Park, T. H., Lee, K., Lee, J., Hong, K. S., Cho, Y. J., Park, H. K., Lee, B. C., ... Bae, H. J. (2024). Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes. Journal of Clinical Lipidology, 18(2), e207-e217. https://doi.org/10.1016/j.jacl.2023.11.012

@article{4eb16eaa809f4b78be3101a85f6e1406,

title = "Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes",

abstract = "BACKGROUND: Because ischemic stroke is heterogeneous, the associations between low-density lipoprotein (LDL)-cholesterol levels and early vascular outcomes might be different according to the stroke subtype in acute ischemic stroke patients. METHODS: This study was an analysis of a prospective, multicenter, stroke registry. Acute ischemic stroke patients previously not treated with statins were included. Admission LDL-cholesterol levels were divided into 7 groups at 20 mg/dl intervals for comparison. The primary early vascular outcome was a composite of stroke, myocardial infarction (MI) and all-cause mortality within 3 months. RESULTS: A total of 38,531 patients (age, 68.5 ± 12.8 yrs; male, 59.6%) were analyzed for this study. The 3-month cumulative incidences of the composite of stroke, MI, and all-cause mortality significantly differed among the LDL-cholesterol level groups, with the highest event rate (11.11%) in the lowest LDL-cholesterol group (<70 mg/dl). After adjustment, the U-shaped associations of LDL-cholesterol levels with primary outcome and all-cause mortality were observed. For the stroke subtypes, there were substantial interactions between the LDL-cholesterol groups and stroke subtype and all-cause mortality (Pinteraction=0.07). Different patterns, with higher risks of all-cause mortality in the lower LDL-cholesterol in the large artery atherosclerosis subtype (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 0.98-1.69), but in the higher LDL-cholesterol in the cardioembolism subtype (aHR 1.71 95% CI [1.28-2.29]), were observed among stroke subtypes. CONCLUSION: We found that there were differential associations of admission LDL-cholesterol levels with all-cause mortality within 3 months among stroke subtypes. These results suggest that admission LDL-cholesterol and early vascular outcomes had complex relationships in patients with ischemic stroke according to the stroke subtypes.",

keywords = "Acute ischemic stroke, Early vascular outcome, LDL-cholesterol, Stroke subtype",

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

note = "Publisher Copyright: {\textcopyright} 2023",

year = "2024",

month = mar,

day = "1",

doi = "10.1016/j.jacl.2023.11.012",

language = "English",

volume = "18",

pages = "e207--e217",

journal = "Journal of Clinical Lipidology",

issn = "1933-2874",

publisher = "Elsevier Ltd",

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Kim, JT, Lee, JS, Kim, H, Kim, BJ, Kang, J, Lee, KJ, Park, JM, Kang, K, Lee, SJ, Kim, JG, Cha, JK, Kim, DH, Park, TH, Lee, K, Lee, J, Hong, KS, Cho, YJ, Park, HK, Lee, BC, Yu, KH, Oh, MS, Kim, DE, Choi, JC, Kwon, JH, Kim, WJ, Shin, DI, Yum, KS, Sohn, SI, Hong, JH, Lee, SH, Park, MS, Ryu, WS, Park, KY, Lee, J & Bae, HJ 2024, 'Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes', Journal of Clinical Lipidology, vol. 18, no. 2, pp. e207-e217. https://doi.org/10.1016/j.jacl.2023.11.012

TY - JOUR

T1 - Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes

AU - Kim, Joon Tae

AU - Lee, Ji Sung

AU - Kim, Hyunsoo

AU - Kim, Beom Joon

AU - Kang, Jihoon

AU - Lee, Keon Joo

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Lee, Soo Joo

AU - Kim, Jae Guk

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Park, Tai Hwan

AU - Lee, Kyungbok

AU - Lee, Jun

AU - Hong, Keun Sik

AU - Cho, Yong Jin

AU - Park, Hong Kyun

AU - Lee, Byung Chul

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Kim, Dong Eog

AU - Choi, Jay Chol

AU - Kwon, Jee Hyun

AU - Kim, Wook Joo

AU - Shin, Dong Ick

AU - Yum, Kyu Sun

AU - Sohn, Sung Il

AU - Hong, Jeong Ho

AU - Lee, Sang Hwa

AU - Park, Man Seok

AU - Ryu, Wi Sun

AU - Park, Kwang Yeol

AU - Lee, Juneyoung

AU - Bae, Hee Joon

PY - 2024/3/1

Y1 - 2024/3/1

N2 - BACKGROUND: Because ischemic stroke is heterogeneous, the associations between low-density lipoprotein (LDL)-cholesterol levels and early vascular outcomes might be different according to the stroke subtype in acute ischemic stroke patients. METHODS: This study was an analysis of a prospective, multicenter, stroke registry. Acute ischemic stroke patients previously not treated with statins were included. Admission LDL-cholesterol levels were divided into 7 groups at 20 mg/dl intervals for comparison. The primary early vascular outcome was a composite of stroke, myocardial infarction (MI) and all-cause mortality within 3 months. RESULTS: A total of 38,531 patients (age, 68.5 ± 12.8 yrs; male, 59.6%) were analyzed for this study. The 3-month cumulative incidences of the composite of stroke, MI, and all-cause mortality significantly differed among the LDL-cholesterol level groups, with the highest event rate (11.11%) in the lowest LDL-cholesterol group (<70 mg/dl). After adjustment, the U-shaped associations of LDL-cholesterol levels with primary outcome and all-cause mortality were observed. For the stroke subtypes, there were substantial interactions between the LDL-cholesterol groups and stroke subtype and all-cause mortality (Pinteraction=0.07). Different patterns, with higher risks of all-cause mortality in the lower LDL-cholesterol in the large artery atherosclerosis subtype (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 0.98-1.69), but in the higher LDL-cholesterol in the cardioembolism subtype (aHR 1.71 95% CI [1.28-2.29]), were observed among stroke subtypes. CONCLUSION: We found that there were differential associations of admission LDL-cholesterol levels with all-cause mortality within 3 months among stroke subtypes. These results suggest that admission LDL-cholesterol and early vascular outcomes had complex relationships in patients with ischemic stroke according to the stroke subtypes.

AB - BACKGROUND: Because ischemic stroke is heterogeneous, the associations between low-density lipoprotein (LDL)-cholesterol levels and early vascular outcomes might be different according to the stroke subtype in acute ischemic stroke patients. METHODS: This study was an analysis of a prospective, multicenter, stroke registry. Acute ischemic stroke patients previously not treated with statins were included. Admission LDL-cholesterol levels were divided into 7 groups at 20 mg/dl intervals for comparison. The primary early vascular outcome was a composite of stroke, myocardial infarction (MI) and all-cause mortality within 3 months. RESULTS: A total of 38,531 patients (age, 68.5 ± 12.8 yrs; male, 59.6%) were analyzed for this study. The 3-month cumulative incidences of the composite of stroke, MI, and all-cause mortality significantly differed among the LDL-cholesterol level groups, with the highest event rate (11.11%) in the lowest LDL-cholesterol group (<70 mg/dl). After adjustment, the U-shaped associations of LDL-cholesterol levels with primary outcome and all-cause mortality were observed. For the stroke subtypes, there were substantial interactions between the LDL-cholesterol groups and stroke subtype and all-cause mortality (Pinteraction=0.07). Different patterns, with higher risks of all-cause mortality in the lower LDL-cholesterol in the large artery atherosclerosis subtype (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 0.98-1.69), but in the higher LDL-cholesterol in the cardioembolism subtype (aHR 1.71 95% CI [1.28-2.29]), were observed among stroke subtypes. CONCLUSION: We found that there were differential associations of admission LDL-cholesterol levels with all-cause mortality within 3 months among stroke subtypes. These results suggest that admission LDL-cholesterol and early vascular outcomes had complex relationships in patients with ischemic stroke according to the stroke subtypes.

KW - Acute ischemic stroke

KW - Early vascular outcome

KW - LDL-cholesterol

KW - Stroke subtype

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U2 - 10.1016/j.jacl.2023.11.012

DO - 10.1016/j.jacl.2023.11.012

M3 - Article

C2 - 38101971

AN - SCOPUS:85180308007

SN - 1933-2874

VL - 18

SP - e207-e217

JO - Journal of Clinical Lipidology

JF - Journal of Clinical Lipidology

IS - 2

ER -

Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes

Abstract

Keywords

UN SDGs

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