Low Cholesterol Levels Increase Symptomatic Intracranial Hemorrhage Rates After Intravenous Thrombolysis: A Multicenter Cohort Validation Study

Sheng-Feng Lin; A-Ching Chao; Han-Hwa Hu; Ruey-Tay Lin; Chih-Hung Chen; Lung Chan; Huey-Juan Lin; Yu Sun; Yung-Yang Lin; Po-Lin Chen; Shinn-Kuang Lin; Cheng-Yu Wei; Yu-Te Lin; Jiunn-Tay Lee; Chyi-Huey Bai; on behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

doi:10.5551/jat.46151

Original Article

Low Cholesterol Levels Increase Symptomatic Intracranial Hemorrhage Rates After Intravenous Thrombolysis: A Multicenter Cohort Validation Study

Sheng-Feng Lin, A-Ching Chao, Han-Hwa Hu, Ruey-Tay Lin, Chih-Hung Chen, Lung Chan, Huey-Juan Lin, Yu Sun, Yung-Yang Lin, Po-Lin Chen, Shinn-Kuang Lin, Cheng-Yu Wei, Yu-Te Lin, Jiunn-Tay Lee, Chyi-Huey Bai, on behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

Author information

Sheng-Feng Lin
School of Public Health, College of Public Health, Taipei Medical University
Department of Clinical Pathology, Far Eastern Memorial Hospital
A-Ching Chao
Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University
Department of Neurology, Kaohsiung Medical University Hospital
Han-Hwa Hu
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University
Research Center of Cerebrovascular Disease Treatment, College of Medicine, Taipei Medical University
Department of Neurology, Taipei Medical University-Shaung Ho Hospital
Ruey-Tay Lin
Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Kaohsiung Medical University
Department of Neurology, Kaohsiung Medical University Hospital
Chih-Hung Chen
Department of Neurology, National Cheng Kung University Hospital
Department of Neurology, National Cheng Kung University
Lung Chan
Department of Neurology, Taipei Medical University-Shaung Ho Hospital
Huey-Juan Lin
Department of Neurology, Chi Mei Medical Center
Yu Sun
Department of Neurology, En Chu Kong Hospital
Yung-Yang Lin
Department of Neurology, Taipei Veterans General Hospital
Po-Lin Chen
Department of Neurology, Taichung Veterans General Hospital
Shinn-Kuang Lin
Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
Cheng-Yu Wei
Department of Neurology, Show Chwan Memorial Hospital
Yu-Te Lin
Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital
Jiunn-Tay Lee
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
Chyi-Huey Bai
School of Public Health, College of Public Health, Taipei Medical University
Department of Public Health, College of Medicine, Taipei Medical University
on behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

Keywords: Stroke, Cholesterol, Low-density lipoprotein cholesterol (LDL-C), Thrombolysis, Intracranial hemorrhage

JOURNAL OPEN ACCESS

2019 Volume 26 Issue 6 Pages 513-527

DOI https://doi.org/10.5551/jat.46151

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Abstract

Aim: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis.

Methods: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24-36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings.

Results: For enrolled 1845 patients, SICH rates were ≥2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281–0.846], p=0.0106), the ECASS II (adjusted RR: 0.318 [0.130-0.776], p=0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048-0.957], p=0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of ＜130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24-36 h.

Conclusions: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of ＜130 mg/dL is supposed to a candidate marker for predicting SICH within 24-36 h.

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