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Abstract
Objective: To determine whether low low-density lipoprotein cholesterol (LDL-C) but not high-density lipoprotein cholesterol (HDL-C) and triglyceride concentrations are associated with worse outcome in a large cohort of ischemic stroke patients treated with IV thrombolysis.
Methods: Observational multicenter post hoc analysis of prospectively collected data in stroke thrombolysis registries. Because of collinearity between total cholesterol (TC) and LDL-C, we used 2 different models with TC (model 1) and with LDL-C (model 2).
Results: Of the 2,485 consecutive patients, 1,847 (74%) had detailed lipid profiles available. Independent predictors of 3-month mortality were lower serum HDL-C (adjusted odds ratio [adjOR] 0.531, 95% confidence interval [CI] 0.321–0.877 in model 1; adjOR 0.570, 95% CI 0.348–0.933 in model 2), lower serum triglyceride levels (adjOR 0.549, 95% CI 0.341–0.883 in model 1; adjOR 0.560, 95% CI 0.353–0.888 in model 2), symptomatic ICH, and increasing NIH Stroke Scale score, age, C-reactive protein, and serum creatinine. TC, LDL-C, HDL-C, and triglycerides were not independently associated with symptomatic ICH. Increased HDL-C was associated with an excellent outcome (modified Rankin Scale score 0–1) in model 1 (adjOR 1.390, 95% CI 1.040–1.860).
Conclusion: Lower HDL-C and triglycerides were independently associated with mortality. These findings were not due to an association of lipid concentrations with symptomatic ICH and may reflect differences in baseline comorbidities, nutritional state, or a protective effect of triglycerides and HDL-C on mortality following acute ischemic stroke.
GLOSSARY
- adjOR=
- adjusted odds ratio;
- CI=
- confidence interval;
- HDL-C=
- high-density lipoprotein cholesterol;
- IQR=
- interquartile range;
- LDL-C=
- low-density lipoprotein cholesterol;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- rtPA=
- recombinant tissue plasminogen activator;
- sICH=
- symptomatic intracerebral hemorrhage;
- TC=
- total cholesterol;
- TG=
- triglyceride
Footnotes
Lipid Profile in Thrombolysis Study Group coinvestigators are listed on the Neurology® Web site at www.neurology.org.
Study funding: This study was an unfunded investigator-initiated academic research project. Katiuscia Nardi was supported by a grant from the European Federation of Neurological Societies.
Editorial, page 1076
Supplemental data at www.neurology.org
- Received December 3, 2011.
- Accepted March 8, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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