AI Article Synopsis
- The study examines the complex relationship between low LDL cholesterol (LDL-C) levels and early vascular outcomes in acute ischemic stroke patients, noting that lower LDL-C levels might lead to worse outcomes at first glance.
- Researchers analyzed over 32,500 patients and found a U-shaped relationship between LDL-C levels and three-month outcomes, with the highest events occurring in those with low LDL-C, but this trend wasn’t significant after adjustments were made.
- The findings suggest that statin pretreatment may mitigate the negative effects associated with low LDL-C levels, indicating the need for further research on this paradoxical relationship.
Article Abstract
Background: Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission.
Objective: This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes.
Patients And Methods: This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored.
Results: A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (P<0.001), with substantial relationships in the no pretreatment subgroup.
Conclusions: The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted.
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| http://dx.doi.org/10.1016/j.jacl.2023.08.002 | DOI Listing |
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