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Lower low-density lipoprotein cholesterol levels are associated with an increased risk of hematoma expansion and ensuing mortality in acute ICH patients

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A Correction to this article was published on 09 April 2022

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Abstract

Background and purpose

The relationship between lipid levels and the prognosis of acute intracerebral hemorrhage (ICH) remains controversial. Thus, we aimed to investigate whether lower low-density lipoprotein cholesterol (LDL-C) levels increased the risk of adverse outcomes, as well as the current situation of statin treatment in acute ICH patients with premorbid lipid-lowering therapy.

Methods

From August 1, 2015, to July 31, 2019, a total of 73,098 ICH patients were included in our study from the Chinese Stroke Center Alliance program. Patients were grouped by LDL-C levels of < 1.4 mmol/L, 1.4–1.8 mmol/L, 1.8–2.6 mmol/L, and > 2.6 mmol/L. Logistic regression was used to assess the association between LDL-C levels and the composite risk of hematoma expansion (HE) or in-hospital death. Moreover, statin treatment in ICH patients with cardio-cerebrovascular diseases was analyzed.

Results

In total, 6368 (8.7%) patients were identified as a composite of HE or in-hospital death with a mean LDL-C level of 2.9 ± 1.7 mmol/L. In the univariate analysis, patients who achieved lower LDL-C concentrations under 1.4 mmol/L had a 36% higher risk of adverse outcomes compared with the ≥ 2.6 mmol/L group (OR 1.36, 95%CI 1.23–1.51). Similar results were obtained in multivariate analyses, especially for patients with GCS scores of 9–15. For acute ICH patients with concomitant atherosclerotic disease, statin treatment was discontinued in the majority of Chinese population.

Conclusions

Lower LDL-C levels (< 1.4 mmol/L) are associated with an increased risk of HE and ensuing mortality in acute ICH patients. Maintaining an optimal LDL-C range may have therapeutic potential against HE which merits further investigation.

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Data availability

Data are available to researchers on request for purpose of reproducing the results or replicating the procedure by directly contacting the corresponding author.

Code availability

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Acknowledgements

We gratefully appreciate all the participating centers in the CSCA program for their hard work in data collection.

Funding

The Chinese Stroke Center Alliance program was supported by grants from the National Science and Technology Major Project (2017ZX09304018), Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2019-I2M-5–029), and Beijing Natural Science Foundation (Z200016).

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Authors and Affiliations

  1. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Yu Wang, Jianwei Wu, Hongqiu Gu, Kaixuan Yang, Ruixuan Jiang, Zixiao Li, Xingquan Zhao & Yongjun Wang

  2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Yu Wang, Jianwei Wu, Hongqiu Gu, Ruixuan Jiang, Zixiao Li, Xingquan Zhao & Yongjun Wang

  3. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China

    Kaixuan Yang

  4. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China

    Kaixuan Yang

  5. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China

    Zixiao Li, Xingquan Zhao & Yongjun Wang

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  1. Yu Wang
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on behalf of the Chinese Stroke Center Alliance Investigators

Contributions

Y. Wang performed the experiments, interpreted the results of statistical analysis, and drafted the manuscript. H. Gu and K. Yang conducted the statistical analysis and interpreted the data. J. Wu, R. Jiang, and Z. Li revising the manuscript for intellectual content. Y. Wang and X. Zhao had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Xingquan Zhao or Yongjun Wang.

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Ethical approval

The study was conducted in accordance with guidelines from the Helsinki Declaration. All participating hospitals received research approval to collect data without requiring individual patient informed consent under the common rule or a waiver of authorization and exemption from their Institutional Review Board.

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The original online version of this article was revised: Affiliation 1 should be revised to: China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Wang, Y., Wu, J., Gu, H. et al. Lower low-density lipoprotein cholesterol levels are associated with an increased risk of hematoma expansion and ensuing mortality in acute ICH patients. Neurol Sci 43, 3121–3129 (2022). https://doi.org/10.1007/s10072-021-05742-w

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