Yan Tao, Li Lehui, Zhang Ziying, Cao Ning, Xia Yuan, Shen Yuan, Ju Haitao, Zhang Xingguang, Zhang Nan
School of Public Health, Inner Mongolia Medical University, 010110 Hohhot, Inner Mongolia, China.
School of Basic Medicine, Inner Mongolia Medical University, 010110 Hohhot, Inner Mongolia, China.
Rev Cardiovasc Med. 2025 May 27;26(5):36363. doi: 10.31083/RCM36363. eCollection 2025 May.
The association between low-density lipoprotein cholesterol (LDL-C) levels and the risk of hemorrhagic stroke (HS) detected through different blood pressure statuses remains unclear. Hence, we systematically evaluated the association between LDL-C and HS in populations with and without hypertension.
We searched PubMed, Cochrane Library, and Embase databases for articles written in English. Only prospective design or randomized controlled trials (RCTs) reporting effect estimates with 95% confidence intervals (CIs) for the relationship between LDL-C and HS were included. We pooled risk ratios (RRs) stratified by blood pressure status and dose-response analyses with a two-stage generalized least squares for trend estimation (GLST) model. Finally, we compared the lower and optimal groups to find the effect of very low LDL-C levels on the risk of HS.
We included seven randomized controlled trials and 9 prospective cohort studies involving 304,763 participants with 2125 (0.70%) HS events. The non-linear trend suggested that LDL-C levels of approximately 80 mg/dL among hypertensive patients and 115 mg/dL among non-hypertensive patients had the lowest risk of HS. Meanwhile, continually lowering LDL-C levels under the optimal (80 mg/dL for hypertensive patients and 115 mg/dL for non- hypertensive patients) LDL-C level would increase the risk of HS in the hypertensive population (RR = 1.84, 95% CI: 1.36-2.50) but not in the non-hypertensive population (RR = 1.15, 95% CI: 0.97-1.36).
The risk of HS can be effectively reduced by controlling LDL-C levels to 60-80 mg/dL in the hypertensive population and 115 mg/dL in the non-hypertensive population. The safety range of controlling LDL-C levels to protect against HS among hypertensive patients is narrower than that among the non-hypertensive population. Additionally, controlling blood pressure might play a positive role in safeguarding against HS by lowering LDL-C levels.
低密度脂蛋白胆固醇（LDL-C）水平与通过不同血压状态检测出的出血性卒中（HS）风险之间的关联尚不清楚。因此，我们系统评估了高血压患者和非高血压患者中LDL-C与HS之间的关联。
我们在PubMed、Cochrane图书馆和Embase数据库中检索英文撰写的文章。仅纳入报告LDL-C与HS之间关系的效应估计值及95%置信区间（CI）的前瞻性设计或随机对照试验（RCT）。我们汇总按血压状态分层的风险比（RR），并使用两阶段广义最小二乘法趋势估计（GLST）模型进行剂量反应分析。最后，我们比较较低和最佳组，以发现极低LDL-C水平对HS风险的影响。
我们纳入了7项随机对照试验和9项前瞻性队列研究，涉及304,763名参与者，其中有2125例（0.70%）HS事件。非线性趋势表明，高血压患者中LDL-C水平约为80mg/dL，非高血压患者中约为115mg/dL时，HS风险最低。同时，在最佳LDL-C水平（高血压患者为80mg/dL，非高血压患者为115mg/dL）以下持续降低LDL-C水平，会增加高血压人群中HS的风险（RR = 1.84，95%CI：1.36 - 2.50），但不会增加非高血压人群中的风险（RR = 1.15，95%CI：0.97 - 1.36）。
将高血压人群的LDL-C水平控制在60 - 80mg/dL，非高血压人群控制在115mg/dL，可有效降低HS风险。高血压患者中控制LDL-C水平以预防HS的安全范围比非高血压人群更窄。此外，控制血压可能通过降低LDL-C水平对预防HS起到积极作用。
