Associations between Intensive Lipid-lowering Therapy and Outcomes of Intracerebral Hemorrhage

T. Tang
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Abstract

Background: The intensive lipid-lowering therapy (ILLT), targeting an low-density lipoprotein cholesterol (LDL-C) < 1.80 mmol/L, was a crucial strategy for the secondary prevention of cerebrovascular diseases. But the associations between ILLT and the outcomes after intracerebral hemorrhage (ICH) were unclear. Materials and Methods: Data of the consecutive patients with acute ICH and past medical histories of ischemic stroke from 2017 to 2019 at an academic stroke center in China were analyzed. The study patients were classified according to their baseline LDL-C levels: < 1.80 mmol/Lvs. ≥ 1.80 mmol/L. The outcomes of ICH were compared between the two groups. Multivariate linear mixed effect model with repeated measures adjusting for ICH scores were used to determine the associations between LDL-C levels and the change in NIHSS scores; baseline ICH scores were adjusted in the multi-variable models Results: A total of 197 patients were included in the study, 31 of them had LDL-C < 1.80 mmol/L and 166 had LDL-C ≥ 1.80 mmol/L. We did not test any significant differences regarding the demographic characteristics or vascular risk factors. Medians of the baseline National Institutes of Health Stroke Scale (NIHSS) scores (8 vs. 9, P = 0.79) and ICH scores (1 vs.1, P = 0.26) were similar. But the patients with LDL-C < 1.80 mmol/L had higher risks of secondary intraventricular hemorrhage (13% vs. 4%, P = 0.03). Outcomes of the hemorrhagic stroke at discharge were similar, except the patients with LDL-C ≥ 1.80 mmol/L had significant improvements in their NIHSS scores at discharge (estimated change in means: -2.4, 95% CI: [-4.3, -0.5]), while patients with LDL-C < 1.80 mmol/L did not (estimated change in means: -1.4, 95% CI: [-5.9, 3.0]). Conclusion: ILLT achieved LDL-C < 1.80 mmol/L was associated with limited improvements in the neurological deficits in the patients with ICH.
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强化降脂治疗与脑出血预后的关系
背景:以低密度脂蛋白胆固醇(LDL-C) < 1.80 mmol/L为靶点的强化降脂治疗(ILLT)是脑血管疾病二级预防的重要策略。但ILLT与脑出血(ICH)后预后之间的关系尚不清楚。材料与方法:分析2017 - 2019年中国某脑卒中学术中心连续急性脑出血患者及缺血性脑卒中病史资料。研究患者根据基线LDL-C水平进行分类:< 1.80 mmol/ lv。≥1.80 mmol/L。比较两组脑出血的预后。采用重复测量的多变量线性混合效应模型调整ICH评分,以确定LDL-C水平与NIHSS评分变化之间的关系;结果:共纳入197例患者,其中LDL-C < 1.80 mmol/L 31例,LDL-C≥1.80 mmol/L 166例。我们没有测试任何关于人口统计学特征或血管危险因素的显著差异。基线美国国立卫生研究院卒中量表(NIHSS)评分中位数(8比9,P = 0.79)和ICH评分中位数(1比1,P = 0.26)相似。但LDL-C < 1.80 mmol/L的患者继发性脑室内出血的风险更高(13% vs. 4%, P = 0.03)。出血性卒中出院时的结局相似,但LDL-C≥1.80 mmol/L的患者出院时的NIHSS评分有显著改善(估计平均值变化:-2.4,95% CI:[-4.3, -0.5]),而LDL-C < 1.80 mmol/L的患者则没有(估计平均值变化:-1.4,95% CI:[-5.9, 3.0])。结论:ILLT达到LDL-C < 1.80 mmol/L与脑出血患者神经功能障碍改善有限相关。
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