Background:
Intensive Lipid-lowering therapy (ILLT) is a crucial strategy for secondary prevention of ischemic stroke. While current evidence of the risks of intracerebral hemorrhage (ICH) after ILLT were contradictory; morever, insights into the associations between ILLT and the outcomes of ICH were also limited.
Methods:
Data of consecutive patients with acute ICH and histories of ischemic stroke at an academic stroke center from 2017 to 2019 were retrospectively collected. The study patients were classifed according to their baseline low-density lipoprotein cholesterol (LDL-c) levels: <1.8 mmol/L vs. LDL-c≥1.8 mmol/L.
Results:
A total of 197 patients were included in the study, 31 of them had LDL-c <1.8 mmol/L and 166 had LDL-c≥1.8 mmol/L. We did not tested any significant differences regarding the demographic characteristics or the medical histories (Table 1). Medians of baseline National Institutes of Health Stroke Scale (NIHSS) scores (8 vs. 9, p=0.79) and ICH scores (1 vs.1 , p=0.26) were similar. But patients with LDL-c<1.8 mmol/L had higher bleeding volume (11 (19) vs. 10 (52), p=0.03) and higher risks of secondary intraventricular hemorrhage (13% vs. 4%, p=0.03) (Table 2).Outcomes of the ICH events at discharge were generally similar (Table 3), except that patients with LDL-c≥1.8 mmol/L had significant improvements in their NIHSS scores at discharge (estimated change in means: -2.4, 95% [-3.9, -0.9] ), than patients with LDL-c<1.8 mmol/L (estimated change in means: -1.4, 95% CI [-4.7, 0.5]).
Conclusions:
Achieving LDL-c<1.8 mmol/L was associated with bigger bleeding volume, higher risks of secondary intraventricular hemorrhage, and worse neurological improvements.
Review of the book: Fonyakin A.V., Geraskina L.A. Prevention of ischemic stroke. Guidelines for lipid-lowering therapy. Moscow: IMA-PRESS, 2015. – 72 p.