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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Association between low-density cholesterol change and outcomes in acute ischemic stroke patients who underwent
Ting Cui1, Changyi Wang1,2, Qiange Zhu3
1Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Sichuan, 610041, Chengdu, China.
Insights
A drop in low-density lipoprotein cholesterol (LDL-C) during hospitalization is linked to worse outcomes for acute ischemic stroke (AIS) patients receiving reperfusion therapy. This finding highlights the importance of monitoring LDL-C changes post-stroke.
Area of Science:
- Cardiology
- Neurology
- Biochemistry
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) is a known cardiovascular risk factor.
- The relationship between LDL-C fluctuations and functional recovery in acute ischemic stroke (AIS) patients undergoing reperfusion therapy requires further investigation.
Purpose of the Study:
- To investigate the association between changes in LDL-C levels during hospitalization and functional outcomes at 90 days in AIS patients treated with reperfusion therapy.
Main Methods:
- Consecutive enrollment of patients receiving reperfusion therapy.
- LDL-C measurements taken at admission and during hospitalization.
- Calculation of LDL-C change (ΔLDL-C) from admission to lowest inpatient level.
- Assessment of functional outcome using modified Rankin Scale (mRS) at 90 days.
Main Results:
- A total of 432 patients were analyzed.
- No significant association was found between admission LDL-C and functional outcome.
- A positive association was observed between ΔLDL-C and poor functional outcome (OR 1.80, 95% CI 1.12-2.91, p=0.016).
- Patients in the highest tertile of ΔLDL-C showed significantly higher odds of poor functional outcomes (OR 2.56, 95% CI 1.22-5.36, p=0.013).
Conclusions:
- A decrease in LDL-C levels during hospitalization is significantly associated with poor functional outcomes at 90 days in AIS patients who received reperfusion therapy.
- Monitoring LDL-C dynamics may be crucial for predicting stroke recovery.
Background:
Low-density lipoprotein cholesterol (LDL-C) can increase cardiovascular risk. However, the association between LDL-C change and functional outcomes in acute ischemic stroke (AIS) patients who underwent reperfusion therapy remains unclear.
Methods:
Patients who received reperfusion therapy were consecutively enrolled. LDL-C measurement was conducted at the emergency department immediately after admission and during hospitalization. The change of LDL-C level (ΔLDL-C) was calculated by subtracting the lowest LDL-C among all measurements during hospitalization from the admission LDL-C. Poor functional outcome was defined as modified Rankin Scale (mRS) > 2 at 90 days.
Results:
A total of 432 patients were enrolled (mean age 69.2 ± 13.5 years, 54.6 % males). The mean LDL-C level at admission was 2.55 ± 0.93 mmol/L. The median ΔLDL-C level was 0.43 mmol/L (IQR 0.08-0.94 mmol/L). A total of 263 (60.9 %) patients had poor functional outcomes at 90 days. There was no significant association between admission LDL-C level and functional outcome (OR 0.99, 95 % CI 0.77-1.27, p = 0.904). ΔLDL-C level was positively associated with poor functional outcome (OR 1.80, 95 % CI 1,12-2.91, p = 0.016). When patients were divided into tertiles according to ΔLDL-C, those in the upper tertile (T3, 0.80-3.98 mmol/L) were positively associated with poor functional outcomes compared to patients in the lower tertile (T1, -0.91-0.13 mmol/L) (OR 2.56, 95 % CI 1.22-5.36, p = 0.013). The risk of poor functional outcome increased significantly with ΔLDL-C tertile (P-trend = 0.010).
Conclusions:
In AIS patients who underwent reperfusion therapy, the decrease in LDL-C level during hospitalization was significantly associated with poor functional outcomes at 90 days.
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