Lower cholesterol tied to increased mortality in ischaemic stroke patients with carotid artery stenosis

  • Lung YJ & al.
  • J Stroke Cerebrovasc Dis
  • 11 Jan 2019

  • curated by Antara Ghosh
  • UK Clinical Digest
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Takeaway

  • In patients with acute, first-ever ischaemic stroke with high-grade internal carotid artery (ICA) stenosis and post-stroke functional dependence, lower total cholesterol level was associated with increased risk for 5-year mortality.

Why this matters

  • Recent treatment guidelines of hyperlipidaemia suggest more aggressive treatment for reducing risk for atherosclerotic cardiovascular diseases and ischaemic stroke.
  • However, these findings suggest a careful consideration of aggressive treatment of hyperlipidaemia in patients with acute, first-ever ischaemic stroke with high-grade ICA stenosis and post-stroke functional dependence.

Study design

  • Study prospectively evaluated 196 patients with acute ischaemic stroke with high-grade ICA stenosis and modified Rankin Scale score ≥3.
  • Patients were divided into 2 groups based on total cholesterol level at admission : ≥200 or
  • Patients were followed-up for 5 years after initial assessment.
  • Funding: None.

Key results

  • After adjusting for established clinical predictors of adverse outcomes, lower total cholesterol level (aHR, 1.88; 95% CI, 1.09-3.23; P=.023) was a significant risk factor for 5-year all-cause mortality.
  • The prevalence of diabetes mellitus (P=.013) was significantly higher and that of atrial fibrillation (P=.011) was significantly lower in patients with high vs low total cholesterol level.
  • Patients with lower cholesterol level had significantly lower value of haemoglobin (P=.001), whereas glycohaemoglobin was significantly higher in patients with higher total cholesterol level (P=.001).

Limitations

  • Small study population.
  • Nutritional status of patients not evaluated.