Lee Kang-Po, Hsu Li-Chi
Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
BMJ Neurol Open. 2025 Jun 1;7(1):e000850. doi: 10.1136/bmjno-2024-000850. eCollection 2025.
The relationship between dyslipidaemia and ischaemic stroke is well known. However, its relationship towards intracranial haemorrhage (ICH) remains controversial. Additionally, it remains uncertain whether the relationship between dyslipidaemia, deep and lobar ICH differs. The study aimed to uncover the interplay between low-density lipoprotein cholesterol (LDL-C) level, ICH pattern, severity, short-term and long-term outcomes.
In this retrospective observational cohort study using the Taipei Veterans General Hospital Stroke Registry, we enrolled patients who had experienced an ICH and were receiving LDL-C tests on admission. Baseline characteristics, ICH severity, discharge functional outcome and mortality were compared and analysed according to patients' LDL-C levels (LDL-C<1.423 mmol/L, 1.423 mmol/L ≤LDL-C<1.811 mmol/L, 1.811 mmol/L ≤LDL-C<2.586 mmol/L, 2.586 mmol/L ≤LDL-C<3.363 mmol/L, 3.363 mmol/L ≤LDL-C<4.144 mmol/L and LDL-C>4.144 mmol/L). Our results confirmed that LDL-C is independently correlated with more severe ICH, poorer discharge functional status and higher short-term and long-term mortality in ICH patients. However, this correlation is only significant for patients with deep ICH, not in those with lobar haemorrhage. Moreover, statin use is associated with better long-term outcome and may attenuate the effects of initial LDL-C in ICH patients.
In patients with ICH, particularly those with deep ICH, lower LDL-C levels are associated with more severe ICH and higher short-term and long-term mortality rates. Further randomised controlled trials are warranted to determine the optimal LDL-C levels in patients with ICH and dyslipidaemia.
血脂异常与缺血性卒中之间的关系已广为人知。然而，其与颅内出血（ICH）的关系仍存在争议。此外，血脂异常与深部和脑叶ICH之间的关系是否存在差异也尚不明确。本研究旨在揭示低密度脂蛋白胆固醇（LDL-C）水平、ICH类型、严重程度、短期和长期预后之间的相互作用。
在这项使用台北荣民总医院卒中登记处数据的回顾性观察队列研究中，我们纳入了发生ICH且入院时接受LDL-C检测的患者。根据患者的LDL-C水平（LDL-C<1.423 mmol/L、1.423 mmol/L≤LDL-C<1.811 mmol/L、1.811 mmol/L≤LDL-C<2.586 mmol/L、2.586 mmol/L≤LDL-C<3.363 mmol/L、3.363 mmol/L≤LDL-C<4.144 mmol/L以及LDL-C>4.144 mmol/L）比较并分析了基线特征、ICH严重程度、出院时的功能结局和死亡率。我们的结果证实，LDL-C与ICH患者更严重的ICH、更差的出院功能状态以及更高的短期和长期死亡率独立相关。然而，这种相关性仅在深部ICH患者中显著，在脑叶出血患者中并不显著。此外，使用他汀类药物与更好的长期结局相关，并且可能减轻ICH患者初始LDL-C的影响。
在ICH患者中，尤其是深部ICH患者，较低的LDL-C水平与更严重的ICH以及更高的短期和长期死亡率相关。有必要进行进一步的随机对照试验，以确定ICH和血脂异常患者的最佳LDL-C水平。
