title: Serum cholesterol levels and survival after rtPA treatment in acute stroke.
abstract: BACKGROUND
  According to the reverse epidemiology hypothesis, high cholesterol levels might be protective and associated with greater survival rates under certain conditions. In stroke patients, a clear correlation between lipid levels and mortality after ischaemic and hemorrhagic strokes has been demonstrated. The aim of this study was to analyze the impact of lipid levels on 3-month mortality in patients with ischaemic stroke (IS) homogeneously treated with intravenous rtPA and admitted to a monitored acute stroke unit.
  
  
  METHODS
  Retrospective analysis of a prospective cohort of 220 patients with an IS treated with rtPA within the first 4.5 h in a single tertiary hospital from January 2005 to August 2010.
  
  
  RESULTS
  Mortality at 3 months was 15.0%. Univariate analysis showed that age, NIHSS at admission, heart failure, and atrial fibrillation were directly related to 3-month mortality; cholesterol, triglycerides, and low density lipoprotein were inversely associated. The death rate by cholesterol level was 5.5% for the highest tertile (>192 mg/dl), 13.7% for the middle (192-155 mg/dl), and 25.7% for the lowest (<155 mg/dl), P = 0.003. Multivariate analysis showed that amongst the lipid determinations, only cholesterol [OR: 0.985 (95% CI: 0.972-0.998), P = 0.021] was inversely associated with 3-month mortality. The 'protective' effect of cholesterol was independent of stroke severity and remained significant in non-lacunar strokes.
  
  
  CONCLUSIONS
  Survival of stroke patients receiving current, most effective medical treatment is related to blood cholesterol levels, with an inverse relationship between cholesterol and mortality. The mechanism of this apparently paradoxical situation remains unexplained but merits further research.
authors.affiliation: Servei de Neurologia, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain. jroquer@hospitaldelmar.cat
authors.forename: J
authors.initials: J
authors.lastname: Roquer
authors.forename: E
authors.initials: E
authors.lastname: Cuadrado-Godia
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Campello
authors.forename: J
authors.initials: J
authors.lastname: Jiménez-Conde
authors.forename: J E
authors.initials: JE
authors.lastname: Martínez-Rodríguez
authors.forename: E
authors.initials: E
authors.lastname: Giralt
authors.forename: A
authors.initials: A
authors.lastname: Ois
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000097:blood / Q000209:etiology; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D005163:Factor Analysis, Statistical; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D005343:Fibrinolytic Agents; D002784:Cholesterol; D010959:Tissue Plasminogen Activator