Differential impacts of admission LDL-cholesterol on early vascular outcomes by ischemic stroke subtypes

Abstract

BACKGROUND: Because ischemic stroke is heterogeneous, the associations between low -density lipoprotein (LDL)-cholesterol levels and early vascular outcomes might be different according to the stroke subtype in acute ischemic stroke patients. METHODS: This study was an analysis of a prospective, multicenter, stroke registry. Acute ischemic stroke patients previously not treated with statins were included. Admission LDL-cholesterol levels were divided into 7 groups at 20 mg/dl intervals for comparison. The primary early vascular outcome was a composite of stroke, myocardial infarction (MI) and all -cause mortality within 3 months. RESULTS: A total of 38,531 patients (age, 68.5 +/- 12.8 yrs; male, 59.6%) were analyzed for this study. The 3 -month cumulative incidences of the composite of stroke, MI, and all -cause mortality significantly differed among the LDL-cholesterol level groups, with the highest event rate (11.11%) in the lowest LDL-cholesterol group ( < 70 mg/dl). After adjustment, the U-shaped associations of LDL-cholesterol levels with primary outcome and all -cause mortality were observed. For the stroke subtypes, there were substantial interactions between the LDL-cholesterol groups and stroke subtype and all -cause mortality (P (interaction) = 0.07). Different patterns, with higher risks of all -cause mortality in the lower LDL-cholesterol in the large artery atherosclerosis subtype (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 0.98-1.69), but in the higher LDL-cholesterol in the cardioembolism subtype (aHR 1.71 95% CI [1.28-2.29]), were observed among stroke subtypes. CONCLUSION: We found that there were differential associations of admission LDL-cholesterol levels with all -cause mortality within 3 months among stroke subtypes. These results suggest that admission LDL-cholesterol and early vascular outcomes had complex relationships in patients with ischemic stroke according to the stroke subtypes. (c) 2023 National Lipid Association. Published by Elsevier Inc. All rights reserved.