Impact of LDL-C levels on severity and outcome of intracranial haemorrhage: a single-centre retrospective study

Background and purpose: The relationship between dyslipidaemia and ischaemic stroke is well known. However, its relationship towards intracranial haemorrhage (ICH) remains controversial. Additionally, it remains uncertain whether the relationship between dyslipidaemia, deep and lobar ICH differs. The study aimed to uncover the interplay between low-density lipoprotein cholesterol (LDL-C) level, ICH pattern, severity, short-term and long-term outcomes. Methods and results: In this retrospective observational cohort study using the Taipei Veterans General Hospital Stroke Registry, we enrolled patients who had experienced an ICH and were receiving LDL-C tests on admission. Baseline characteristics, ICH severity, discharge functional outcome and mortality were compared and analysed according to patients' LDL-C levels (LDL-C<1.423 mmol/L, 1.423 mmol/L ≤LDL-C<1.811 mmol/L, 1.811 mmol/L ≤LDL-C<2.586 mmol/L, 2.586 mmol/L ≤LDL-C<3.363 mmol/L, 3.363 mmol/L ≤LDL-C<4.144 mmol/L and LDL-C>4.144 mmol/L). Our results confirmed that LDL-C is independently correlated with more severe ICH, poorer discharge functional status and higher short-term and long-term mortality in ICH patients. However, this correlation is only significant for patients with deep ICH, not in those with lobar haemorrhage. Moreover, statin use is associated with better long-term outcome and may attenuate the effects of initial LDL-C in ICH patients. Conclusions: In patients with ICH, particularly those with deep ICH, lower LDL-C levels are associated with more severe ICH and higher short-term and long-term mortality rates. Further randomised controlled trials are warranted to determine the optimal LDL-C levels in patients with ICH and dyslipidaemia.