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Admission LDL-cholesterol, statin pretreatment and early outcomes in acute ischemic stroke

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Author(s)
Joon-Tae KimJi Sung LeeBeom Joon KimJihoon KangKeon-Joo LeeJong-Moo ParkKyusik KangSoo Joo LeeJae Guk KimJae-Kwan ChaDae-Hyun KimTai Hwan ParkKyungbok LeeJun LeeKeun-Sik HongYong-Jin ChoHong-Kyun ParkByung-Chul LeeKyung-Ho YuMi Sun OhDong-Eog KimWi-Sun RyuJay Chol ChoiJee-Hyun KwonWook-Joo KimDong-Ick ShinKyu Sun YumSung Il SohnJeong-Ho HongSang-Hwa LeeMan-Seok ParkKang-Ho ChoiJuneyoung LeeKwang-Yeol ParkHee-Joon Bae
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
J Clin Lipidol
Issued Date
2023
Volume
17
Issue
6
Keyword
Acute ischemic strokeEarly vascular outcomeLDL-cholesterolLipid paradoxStatin pretreatment
Abstract
Background:
Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission.

Objective:
This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes.

Patients and methods:
This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored.

Results:
A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (Pnon-linearity<0.001), with substantial relationships in the no pretreatment subgroup.

Conclusions:
The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1876-4789
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1933287423002489
DOI
10.1016/j.jacl.2023.08.002
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45236
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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