Key result
Intensive lipid-lowering therapy (LDL-C < 1.80 mmol/L) did not significantly affect favorable outcomes at discharge (OR 0.84) but was associated with limited improvements in neurological deficits compared to LDL-C ≥ 1.80 mmol/L in patients with intracerebral hemorrhage.
Why the study?
Intensive lipid-lowering therapy targeting LDL-C < 1.80 mmol/L is important for secondary prevention of cerebrovascular disease, but its associations with outcomes after intracerebral hemorrhage remain unclear.
Does intensive lipid-lowering therapy (LDL-C < 1.80 mmol/L) improve neurological outcomes in patients with acute intracerebral hemorrhage and prior ischemic stroke?
Cohort (n=197)
No
Does intensive lipid-lowering therapy (LDL-C < 1.80 mmol/L) improve neurological outcomes in patients with acute intracerebral hemorrhage and prior ischemic stroke?
Odds Ratio: 0.84 (95% CI 0.49–1.45)
Absolute Event Rate: 55% vs 59%
p-value: p=0.54
Achieving LDL-C < 1.80 mmol/L was associated with limited neurological improvement and a higher risk of secondary intraventricular hemorrhage in patients with acute ICH and prior ischemic stroke.
Intensive LDL-C lowering warrants caution in acute ICH due to IVH risk; leaves open net neurological benefit.
Background: The intensive lipid-lowering therapy (ILLT), targeting an low-density lipoprotein cholesterol (LDL-C) < 1.80 mmol/L, was a crucial strategy for the secondary prevention of cerebrovascular diseases. But the associations between ILLT and the outcomes after intracerebral hemorrhage (ICH) were unclear. Materials and Methods: Data of the consecutive patients with acute ICH and past medical histories of ischemic stroke from 2017 to 2019 at an academic stroke center in China were analyzed. The study patients were classified according to their baseline LDL-C levels: < 1.80 mmol/Lvs. ≥ 1.80 mmol/L. The outcomes of ICH were compared between the two groups. Multivariate linear mixed effect model with repeated measures adjusting for ICH scores were used to determine the associations between LDL-C levels and the change in NIHSS scores; baseline ICH scores were adjusted in the multi-variable models Results: A total of 197 patients were included in the study, 31 of them had LDL-C < 1.80 mmol/L and 166 had LDL-C ≥ 1.80 mmol/L. We did not test any significant differences regarding the demographic characteristics or vascular risk factors. Medians of the baseline National Institutes of Health Stroke Scale (NIHSS) scores (8 vs. 9, P = 0.79) and ICH scores (1 vs.1, P = 0.26) were similar. But the patients with LDL-C < 1.80 mmol/L had higher risks of secondary intraventricular hemorrhage (13% vs. 4%, P = 0.03). Outcomes of the hemorrhagic stroke at discharge were similar, except the patients with LDL-C ≥ 1.80 mmol/L had significant improvements in their NIHSS scores at discharge (estimated change in means: -2.4, 95% CI: [-4.3, -0.5]), while patients with LDL-C < 1.80 mmol/L did not (estimated change in means: -1.4, 95% CI: [-5.9, 3.0]). Conclusion: ILLT achieved LDL-C < 1.80 mmol/L was associated with limited improvements in the neurological deficits in the patients with ICH.
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Tianping Tang (2021) conducted a cohort in Acute spontaneous intracerebral hemorrhage with a history of ischemic stroke (n=197). Intensive lipid-lowering therapy (baseline LDL-C < 1.80 mmol/L) vs. Baseline LDL-C ≥ 1.80 mmol/L was evaluated on Favorable outcomes at discharge (mRS 0-3) (OR 0.84, 95% CI 0.49-1.45, p=0.54). Intensive lipid-lowering therapy (LDL-C < 1.80 mmol/L) did not significantly affect favorable outcomes at discharge (OR 0.84) but was associated with limited improvements in neurological deficits compared to LDL-C ≥ 1.80 mmol/L in patients with intracerebral hemorrhage.
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