Association of low serum cholesterol levels with increased risk of primary intracerebral hemorrhage
Keywords:
risk factors, primary intracerebral hemorrhage, cholesterol, ThaiAbstract
Objective Several of the risk factors that increase the risk of primary intracerebral hemorrhage (PICH) are well documented. However, the association between serum cholesterol levels and PICH is still controversial. The objective of this study was to evaluate the correlation between serum cholesterol levels and PICH in Thai people.
Methods In this retrospective case-control study, the serum cholesterol levels in PICH patients were compared to an independent control group in a primary care practice hospital in patients having yearly health check ups during the study. Participants were matched for age, gender, and race. The lowest quartile of the pooled blood lipid distribution was designated as the low cholesterol threshold.
Results From 2015 to 2016, 55 cases of PICH and 112 control cases were enrolled. The mean total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) level in the PICH group was significantly lower than the control group (TC 176 mg/dL vs 211 mg/dL, p<0.001; LDL-C 107.2 mg/dL vs 145 mg/dL, p<0.001, respectively). A low LDL-C also increases the odds of hemorrhage by 11.78-fold (3.78-36.67, p< 0.001) after adjustment for covariates.
Conclusions Low serum TC and LDL-C levels are associated with an increased risk of PICH in Thai people.
References
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10. Amarenco P, Benavente O, Goldstein LB, Callahan A 3rd, Sillesen H, Hennerici MG, et al. Results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial by stroke subtypes. Stroke. 2009;40:1405-9.
11. Tanaka H, Ueda Y, Hayashi M, Date C, Baba T, Yamashita H, et al. Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community. Stroke. 1982;13:62-73.
12. Lin CH, Shimizu Y, Kato H, Robertson TL, Furonaka H, Kodama K, et al. Cerebrovascular diseases in a fixed population of Hiroshima and Nagasaki, with special reference to relationship between type and risk factors. Stroke. 1984;15:653-60.
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14. Goldstein LB, Amarenco P, Szarek M, Callahan A 3rd, Hennerici M, Sillesen H, et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology. 2008;70:2364-70.
15. Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke. 2013; 44:1833-9.
16. Suh I, Jee SH, Kim HC, Nam CM, Kim IS, Appel LJ. Low serum cholesterol and haemorrhagic stroke in men: Korea Medical Insurance Corporation Study. Lancet. 2001;357:922-5.
17. McKinney JS, Kostis WJ. Statin therapy and the risk of intracerebral hemorrhage: a meta-analysis of 31 randomized controlled trials. Stroke. 2012; 43:2149-56.
18. Sturgeon JD1, Folsom AR, Longstreth WT Jr, Shahar E, Rosamond WD, Cushman M. Risk factors for intracerebral hemorrhage in a pooled prospective study. Stroke. 2007;38:2718-25.
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20. Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke. 2003;34:2060-5.
21. Ma Y, Li Z, Chen L, Li X. Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage. Lipids Health Dis. 2016;15:43.
22. Yano K, Reed DM, MacLean CJ. Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program. Stroke. 1989;20:1460-5.
23. Psaty BM, Anderson M, Kronmal RA, Tracy RP, Orchard T, Fried LP, et al. The association between lipid levels and the risks of incident myocardial infarction, stroke, and total mortality: The Cardiovascular Health Study. J Am Geriatr Soc. 2004;52:1639-47.
24. Woodward M, Huxley H, Lam TH, Barzi F, Lawes CM, Ueshima H, et al. A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia. Eur J Cardiovasc Prev Rehabil. 2005;12:484-91.
25. Konishi M, Iso H, Komachi Y, Iida M, Shimamoto T, Jacobs DR Jr, et al. Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries. The Akita Pathology Study. Stroke. 1993;24:954-64.
26. Molina CA, Selim MH. Continued statin treatment after acute intracranial hemorrhage: fighting fire with fire. Stroke. 2013;44:2062-3.
27. Westover MB, Bianchi MT, Eckman MH, Greenberg SM. Statin use following intracerebral hemorrhage: a decision analysis. Arch Neurol. 2011;68: 573-9.
28. Hackam DG, Austin PC, Huang A, Juurlink DN, Mamdani MM, Paterson JM, et al. Statins and intracerebral hemorrhage: a retrospective cohort study. Arch Neurol. 2012; 69:39-45.
29. Scheitz JF, Seiffge DJ, Tütüncü S, Gensicke H, Audebert HJ, Bonati LH, et al. Dose-related effects of statins on symptomatic intracerebral hemorrhage and outcome after thrombolysis for ischemic stroke. Stroke. 2014;45:509-14.
30. Flint AC, Conell C, Rao VA, Klingman JG, Sidney S, Johnston SC, et al. Effect of statin use during hospitalization for intracerebral hemorrhage on mortality and discharge disposition. JAMA Neurol. 2014;71:1364-71.
31. Priglinger M, Arima H, Anderson C, Krause M. INTERACT Investigators. No relationship of lipid-lowering agents to hematoma growth: pooled analysis of the intensive blood pressure reduction in acute cerebral hemorrhage trials studies. Stroke. 2015;46:857-9.
32. Rubiés-Prat J, Joven J. How soon after myocardial infarction should plasma lipid values be assessed? Br Med J. (Clin Res Ed) 1985;290:470-1.
33. Hollanders FD, Shafar J, Burton P. Serum lipid changes following the completed stroke syndrome. Postgrad Med J. 1975;51:386-9.
2. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007;116:391-413.
3. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF.Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344:1450-60.
4. Woo D1, Deka R, Falcone GJ, Flaherty ML, Haverbusch M, Martini SR, et al. Apolipoprotein E, statins, and risk of intracerebral hemorrhage. Stroke. 2013;44:3013-7.
5. Inagawa T. What are the actual incidence and mortality rates of intracerebral hemorrhage? Neurosurg Rev. 2002;25:237-46.
7. Kurth T, Everett BM, Buring JE, Kase CS, Ridker PM, Gaziano JM. Lipid levels and the risk of ischemic stroke in women. Neurology. 2007;68:556-62.
8. Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549-59.
9. Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group, Armitage J, Bowman L, Wallendszus K, Bulbulia R, Rahimi K, et al. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial. Lancet. 2010;376:1658-69.
10. Amarenco P, Benavente O, Goldstein LB, Callahan A 3rd, Sillesen H, Hennerici MG, et al. Results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial by stroke subtypes. Stroke. 2009;40:1405-9.
11. Tanaka H, Ueda Y, Hayashi M, Date C, Baba T, Yamashita H, et al. Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community. Stroke. 1982;13:62-73.
12. Lin CH, Shimizu Y, Kato H, Robertson TL, Furonaka H, Kodama K, et al. Cerebrovascular diseases in a fixed population of Hiroshima and Nagasaki, with special reference to relationship between type and risk factors. Stroke. 1984;15:653-60.
13. Szatrowski TP, Peterson AV Jr, Shimizu Y, Prentice RL, Mason MW, Fukunaga Y, et al. Serum cholesterol, other risk factors, and cardiovascular disease in a Japanese cohort. J Chronic Dis. 1984;37:569-84.
14. Goldstein LB, Amarenco P, Szarek M, Callahan A 3rd, Hennerici M, Sillesen H, et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology. 2008;70:2364-70.
15. Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke. 2013; 44:1833-9.
16. Suh I, Jee SH, Kim HC, Nam CM, Kim IS, Appel LJ. Low serum cholesterol and haemorrhagic stroke in men: Korea Medical Insurance Corporation Study. Lancet. 2001;357:922-5.
17. McKinney JS, Kostis WJ. Statin therapy and the risk of intracerebral hemorrhage: a meta-analysis of 31 randomized controlled trials. Stroke. 2012; 43:2149-56.
18. Sturgeon JD1, Folsom AR, Longstreth WT Jr, Shahar E, Rosamond WD, Cushman M. Risk factors for intracerebral hemorrhage in a pooled prospective study. Stroke. 2007;38:2718-25.
19. Amarenco P, Tonkin AM. Statins for stroke prevention: disappointment and hope. Circulation. 2004; 109:44-9.
20. Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke. 2003;34:2060-5.
21. Ma Y, Li Z, Chen L, Li X. Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage. Lipids Health Dis. 2016;15:43.
22. Yano K, Reed DM, MacLean CJ. Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program. Stroke. 1989;20:1460-5.
23. Psaty BM, Anderson M, Kronmal RA, Tracy RP, Orchard T, Fried LP, et al. The association between lipid levels and the risks of incident myocardial infarction, stroke, and total mortality: The Cardiovascular Health Study. J Am Geriatr Soc. 2004;52:1639-47.
24. Woodward M, Huxley H, Lam TH, Barzi F, Lawes CM, Ueshima H, et al. A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia. Eur J Cardiovasc Prev Rehabil. 2005;12:484-91.
25. Konishi M, Iso H, Komachi Y, Iida M, Shimamoto T, Jacobs DR Jr, et al. Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries. The Akita Pathology Study. Stroke. 1993;24:954-64.
26. Molina CA, Selim MH. Continued statin treatment after acute intracranial hemorrhage: fighting fire with fire. Stroke. 2013;44:2062-3.
27. Westover MB, Bianchi MT, Eckman MH, Greenberg SM. Statin use following intracerebral hemorrhage: a decision analysis. Arch Neurol. 2011;68: 573-9.
28. Hackam DG, Austin PC, Huang A, Juurlink DN, Mamdani MM, Paterson JM, et al. Statins and intracerebral hemorrhage: a retrospective cohort study. Arch Neurol. 2012; 69:39-45.
29. Scheitz JF, Seiffge DJ, Tütüncü S, Gensicke H, Audebert HJ, Bonati LH, et al. Dose-related effects of statins on symptomatic intracerebral hemorrhage and outcome after thrombolysis for ischemic stroke. Stroke. 2014;45:509-14.
30. Flint AC, Conell C, Rao VA, Klingman JG, Sidney S, Johnston SC, et al. Effect of statin use during hospitalization for intracerebral hemorrhage on mortality and discharge disposition. JAMA Neurol. 2014;71:1364-71.
31. Priglinger M, Arima H, Anderson C, Krause M. INTERACT Investigators. No relationship of lipid-lowering agents to hematoma growth: pooled analysis of the intensive blood pressure reduction in acute cerebral hemorrhage trials studies. Stroke. 2015;46:857-9.
32. Rubiés-Prat J, Joven J. How soon after myocardial infarction should plasma lipid values be assessed? Br Med J. (Clin Res Ed) 1985;290:470-1.
33. Hollanders FD, Shafar J, Burton P. Serum lipid changes following the completed stroke syndrome. Postgrad Med J. 1975;51:386-9.
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2018-10-01
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Champawong K, Jetjumnong C. Association of low serum cholesterol levels with increased risk of primary intracerebral hemorrhage. BSCM [Internet]. 2018 Oct. 1 [cited 2024 Jul. 18];57(4):165-71. Available from: https://he01.tci-thaijo.org/index.php/CMMJ-MedCMJ/article/view/101481
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