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

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. 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. 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. 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. Copyright © 2023. Published by Elsevier Inc.

Citation

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. Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes. Journal of clinical lipidology. 2024 Mar-Apr;18(2):e207-e217

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PMID: 38101971

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