Low-density lipoprotein cholesterol and severity of intracerebral hemorrhage: Insights from the SIREN study

We investigated the link between LDL-C and markers of ICH severity among Indigenous West Africans in the Stroke Investigative Research and Education Network study.

ICH severity was evaluated using the Glasgow Coma Scale (GCS), Stroke Levity Scale (SLS), and the National Institutes of Health Stroke Scale (NIHSS). The serum LDL-c of the study population was dichotomized into <133 mg/dl and ≥ 133 mg/dl using the optimum threshold by the Youden Index after assessing the linear relationship between the serum LDL-c measured at admission and ICH severity markers. A multivariate-adjusted logistic regression was performed to identify the independent association of serum LDL-C with ICH severity.

Overall, 959 subjects were investigated, with a mean age of 53.9 ± 13.24 years; 62.7 % were men with GCS median (IQR) of 8.0 (12.0,15.0), SLS of 5.0 (2.0,8.0) and NIHSS of 15.0 (8.0,23.0). The mean ± SD LDL-C was 124.78 ± 51.8 mg/dl and the baseline serum LDL-C showed a positive linear relationship with admitting GCS and SLS scores and a negative relationship with the NIHSS score. Patients with LDL < 133 mg/dl had more severe stroke [SLS median (IQR): 5.0(2.0,8.0] and GCS median (IQR):11.0(7.0,15.0] compared to patients with LDL-C ≥ 133 mg/dl. Systolic BP ≥ 140 mmHg [1.720 (1.168,2.532)], ICH volume ≥ 30mls [2.774(1.990,3.865)], presence of intraventricular extension [1.564 (1.158, 2.113)] and serum LDL-C < 133 mg/dl [1.502 (1.110, 2.032)] were independently associated with severe ICH. In the subgroup analysis, the independent association between serum LDL-C < 133 mg/dl and severe ICH was stronger for subjects <50 years [1.690 (1.017, 2.808)] and males [1.621 (1.092, 2.406)].

Low serum LDL-C is independently associated with severe ICH among West Africans.