Low Cholesterol Levels Increase Symptomatic Intracranial Hemorrhage Rates After Intravenous Thrombolysis: A Multicenter Cohort Validation Study

Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

AIM: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. METHODS: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24-36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. RESULTS: For enrolled 1845 patients, SICH rates were ≥2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281-0.846], p=0.0106), the ECASS II (adjusted RR: 0.318 [0.130-0.776], p=0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048-0.957], p=0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of <130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24-36 h. CONCLUSIONS: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of <130 mg/dL is supposed to a candidate marker for predicting SICH within 24-36 h.

Original languageEnglish
Pages (from-to)513-527
Number of pages15
JournalJournal of Atherosclerosis and Thrombosis
Volume26
Issue number6
DOIs
Publication statusPublished - Jun 1 2019

Fingerprint

Intracranial Hemorrhages
Validation Studies
Cohort Studies
Cholesterol
Hyperlipidemias
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid
Stroke
National Institute of Neurological Disorders and Stroke
Multicenter Studies
Lipids
oxidized low density lipoprotein

Keywords

  • Cholesterol
  • Intracranial hemorrhage
  • Low-density lipoprotein cholesterol (LDL-C)
  • Stroke
  • Thrombolysis

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Biochemistry, medical

Cite this

Low Cholesterol Levels Increase Symptomatic Intracranial Hemorrhage Rates After Intravenous Thrombolysis : A Multicenter Cohort Validation Study. / Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group.

In: Journal of Atherosclerosis and Thrombosis, Vol. 26, No. 6, 01.06.2019, p. 513-527.

Research output: Contribution to journalArticle

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title = "Low Cholesterol Levels Increase Symptomatic Intracranial Hemorrhage Rates After Intravenous Thrombolysis: A Multicenter Cohort Validation Study",
abstract = "AIM: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. METHODS: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24-36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. RESULTS: For enrolled 1845 patients, SICH rates were ≥2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281-0.846], p=0.0106), the ECASS II (adjusted RR: 0.318 [0.130-0.776], p=0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048-0.957], p=0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of <130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24-36 h. CONCLUSIONS: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of <130 mg/dL is supposed to a candidate marker for predicting SICH within 24-36 h.",
keywords = "Cholesterol, Intracranial hemorrhage, Low-density lipoprotein cholesterol (LDL-C), Stroke, Thrombolysis",
author = "{Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group} and Lin, {Sheng Feng} and Chao, {A. Ching} and Hu, {Han Hwa} and Lin, {Ruey Tay} and Chen, {Chih Hung} and Lung Chan and Lin, {Huey Juan} and Yu Sun and Lin, {Yung Yang} and Chen, {Po Lin} and Lin, {Shinn Kuang} and Wei, {Cheng Yu} and Lin, {Yu Te} and Lee, {Jiunn Tay} and Bai, {Chyi Huey}",
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T1 - Low Cholesterol Levels Increase Symptomatic Intracranial Hemorrhage Rates After Intravenous Thrombolysis

T2 - A Multicenter Cohort Validation Study

AU - Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

AU - Lin, Sheng Feng

AU - Chao, A. Ching

AU - Hu, Han Hwa

AU - Lin, Ruey Tay

AU - Chen, Chih Hung

AU - Chan, Lung

AU - Lin, Huey Juan

AU - Sun, Yu

AU - Lin, Yung Yang

AU - Chen, Po Lin

AU - Lin, Shinn Kuang

AU - Wei, Cheng Yu

AU - Lin, Yu Te

AU - Lee, Jiunn Tay

AU - Bai, Chyi Huey

PY - 2019/6/1

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N2 - AIM: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. METHODS: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24-36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. RESULTS: For enrolled 1845 patients, SICH rates were ≥2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281-0.846], p=0.0106), the ECASS II (adjusted RR: 0.318 [0.130-0.776], p=0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048-0.957], p=0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of <130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24-36 h. CONCLUSIONS: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of <130 mg/dL is supposed to a candidate marker for predicting SICH within 24-36 h.

AB - AIM: Although a lower level of non-high-density lipoprotein cholesterol (HDL-C) was reported to be inversely associated with spontaneous intracranial hemorrhage (ICH), no enough evidence has verified whether lipid profiles modify hemorrhagic transformation and functional outcomes in patients with acute ischemic treated with thrombolysis. METHODS: This multicenter cohort study included 2373 patients with acute ischemic stroke treated with intravenous thrombolysis between December 2004 and December 2016. Of these, 1845 patients were categorized into either the hyperlipidemia or non-hyperlipidemia group. Symptomatic ICH (SICH) rates within 24-36 h of thrombolytic onset and functional outcomes at 30 and 90 days were longitudinally surveyed. Models of predicting hemorrhagic transformation were used to validate our findings. RESULTS: For enrolled 1845 patients, SICH rates were ≥2-fold reduced for the hyperlipidemia group by the NINDS (adjusted RR: 0.488 [0.281-0.846], p=0.0106), the ECASS II (adjusted RR: 0.318 [0.130-0.776], p=0.0119), and SITS-MOST standards (adjusted RR: 0.214 [0.048-0.957], p=0.0437). The favorable functional rates between the two groups were not significantly different. Lower levels of LDL-C were showed in robust association with SICH. With a cut-off LDL-C value of <130 mg/dL, new models are more robust and significant in predicting hemorrhagic transformation within 24-36 h. CONCLUSIONS: This study supports the strong association between reduced LDL-C and increased SICH, but not for functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. LDL-C level of <130 mg/dL is supposed to a candidate marker for predicting SICH within 24-36 h.

KW - Cholesterol

KW - Intracranial hemorrhage

KW - Low-density lipoprotein cholesterol (LDL-C)

KW - Stroke

KW - Thrombolysis

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