Low level of low-density lipoprotein cholesterol increases hemorrhagic transformation in large artery atherothrombosis but not in cardioembolism.
OBJECTIVE
Low cholesterol level is known to be associated with increased cerebral hemorrhage. However, the associations of hemorrhagic transformation (HTf) after acute ischemic stroke and the low levels of total cholesterol (TC) or low-density lipoprotein cholesterol (LDLC) are largely undiscovered.


METHODS
Of the 1034 patients with acute ischemic stroke who were consecutively admitted to our hospital, 377 patients with stroke attributable to large artery atherothrombosis (LAA; n=210) or cardioembolism (n=167) were selected for this study. Demographic and clinical information was collected and HTf was evaluated through follow-up T2*-weighted gradient-echo MRI performed usually within 1 week after stroke. Measurement of lipid parameters included TC, LDLC, high-density lipoprotein cholesterol, and triglyceride.


RESULTS
Of the 377 patients, HTf was noted in 74 patients (19.6%). When patients were divided into 4 groups according to their TC and LDLC levels, the incidence of HTf was significantly elevated in the lowest quartile of each TC (P<0.01) and LDLC (P<0.01) level in LAA subgroup, but not in cardioembolism. After adjusting covariates, a low level of LDLC (OR, 0.46 per 1 mmol/L-increase; 95% CI, 0.22-0.98) was independently associated with HTf in LAA, but not in cardioembolism. There was no significant association between low levels of TC (OR, 0.63 per 1 mmol/L-increase; 95% CI, 0.35-1.15) and HTf in LAA.


CONCLUSIONS
Low levels of LDLC, and possibly TC, are associated with greater risk of hemorrhagic transformation after acute ischemic stroke attributable to LAA.
Kim
Beom Joon
BJ
Department of Neurology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea.
Lee
Seung-Hoon
SH
Ryu
Wi-Sun
WS
Kang
Bong Su
BS
Kim
Chi Kyung
CK
Yoon
Byung-Woo
BW
D000368:Aged; D050197:Atherosclerosis / Q000097:blood* / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000473:pathology*; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000097:blood* / Q000473:pathology; D020767:Intracranial Thrombosis / Q000097:blood* / Q000473:pathology*; D008077:Lipoproteins, LDL / Q000097:blood*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000097:blood* / Q000209:etiology / Q000473:pathology*; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; D002784:Cholesterol