Zhao Wenjuan, An Zhongping, Hong Yan, Zhou Guanen, Guo Jingjing, Zhang Yongli, Yang Yuanju, Ning Xianjia, Wang Jinghua
Department of Neurology, Tianjin Huanhu Hospital, 122 Qixiangtai Road, Hexi District, Tianjin, 300060, China.
Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China.
BMC Neurol. 2016 Mar 15;16:36. doi: 10.1186/s12883-016-0561-z.
Total cholesterol is a well-documented risk factor for coronary disease. Previous studies have shown that high total cholesterol level is associated with better stroke outcomes, but the association of low total cholesterol levels and ischemic stroke outcomes is rare. Therefore, we aimed to assess the association of low total cholesterol levels and stroke outcomes among acute ischemic stroke patients in China.
This study recruited 6407 atherothrombotic infarction patients from Tianjin, China, between May 2005 and September 2014. All patients were categorized into five groups according to TC level quintiles at admission. Differences in subtypes, severity, risk factors, and outcomes at 3, 12, and 36 months after stroke were compared between these groups.
In total, 1256 (19.6%) patients had low cholesterol levels, with a higher prevalence in men than in women (23.7% vs. 11.2%, P < 0.001). Compared with higher cholesterol levels, the lowest cholesterol level quintile (TC, <4.07 mmol/L) was associated with older age (64.7 years, P = 0.033), anterior circulation infarct (22.8%), atrial fibrillation (4.9%), current smoking (41.1%), and alcohol consumption (21.1%) and lower frequencies of hypertension (72.9%), diabetes (30.7%), and obesity (9.9%). Dependency and recurrence rates were significantly higher at 36 months in patients in the lowest TC level quintile than in those with higher cholesterol levels (dependency rates, 51.2% vs 45.2%; P = 0.007 and recurrence rates, 46.3% vs 37.3%, P = 0.001). Moreover, these differences remained after adjustment for age, sex, stroke severity, and Oxfordshire Community Stroke Project classification (odds ratios [ORs] for dependency rate, 1.41; 95% confidence interval [CI], 1.11, 1.79; P = 0.005 and recurrence rate, 1.50; 95% CI, 1.19, 1.89; P = 0.001). However, mortality rates after stroke were not significantly different between the groups.
These findings suggest that statin treatment for patients with atherothrombotic infarction and low cholesterol levels increase long-term dependency and recurrence rates, but do not increase mortality rates. It is crucial to highlight the different impact of statin treatment on patients with atherothrombotic infarction and lower cholesterol levels for secondary stroke prevention in China.
总胆固醇是冠心病的一个有充分文献记载的危险因素。既往研究表明，高总胆固醇水平与更好的卒中预后相关，但低总胆固醇水平与缺血性卒中预后的关联较为少见。因此，我们旨在评估中国急性缺血性卒中患者中低总胆固醇水平与卒中预后的关联。
本研究于2005年5月至2014年9月在中国天津招募了6407例动脉粥样硬化性血栓形成性梗死患者。所有患者根据入院时总胆固醇（TC）水平五分位数分为五组。比较这些组之间卒中后3个月、12个月和36个月时的亚型、严重程度、危险因素及预后的差异。
总共1256例（19.6%）患者胆固醇水平较低，男性患病率高于女性（23.7%对11.2%，P<0.001）。与较高胆固醇水平相比，最低胆固醇水平五分位数（TC<4.07 mmol/L）与年龄较大（64.7岁，P=0.033）、前循环梗死（22.8%）、心房颤动（4.9%）、当前吸烟（41.1%）及饮酒（21.1%）相关，而高血压（72.9%）、糖尿病（30.7%）及肥胖（9.9%）的发生率较低。最低TC水平五分位数组患者在36个月时的依赖率和复发率显著高于胆固醇水平较高组（依赖率：51.2%对45.2%；P=0.007；复发率：46.3%对37.3%，P=0.001）。此外，在对年龄、性别、卒中严重程度及牛津郡社区卒中项目分类进行校正后，这些差异仍然存在（依赖率的比值比[OR]为1.41；95%置信区间[CI]为1.11, 1.79；P=0.005；复发率的OR为1.50；95%CI为1.19, 1.89；P=0.001）。然而，各组间卒中后的死亡率无显著差异。
这些发现提示，对动脉粥样硬化性血栓形成性梗死且胆固醇水平较低的患者进行他汀类药物治疗会增加长期依赖率和复发率，但不会增加死亡率。在中国，强调他汀类药物治疗对动脉粥样硬化性血栓形成性梗死且胆固醇水平较低患者在二级卒中预防中的不同影响至关重要。
