Background
Prior statin treatment and high admission cholesterol have been associated with favorable
outcome after ischemic stroke (IS), a paradox not completely explained. The aim of
this study was to investigate the effect of admission cholesterol levels and the impact
of statin treatment on short- and long-term survival after IS.
Methods
Consecutive patients admitted in 2006 and 2010 were included in the study. Total cholesterol
of 4.6 mmol/L or more was defined as high. Logistic regression analysis was performed
to assess predictors of 1-month mortality, and Cox proportional hazard regression
analysis was applied to investigate predictors of long-term mortality.
Results
Of 190 patients included in the final analysis, 21 (11%) died within 1 month and 61
(32%) died during 7 years of observation. Low cholesterol was associated with older
age, lower blood pressure (BP), presence of angina, and higher risk of death. Three-month,
1-year, and 5-year survival rates were 100%, 98%, and 84%, respectively, in high cholesterol
patients, compared with 92%, 87%, and 57% in low cholesterol group (P = .0001 with the log-rank test). Mortality risk was increased for patients with low
cholesterol (hazard ratio: 1.97; 95% confidence interval [CI]: 1.05-3.69), after adjustment
for age and admission National Institutes of Health Stroke Scale score. After further
adjustment for angina and admission BP, the effect of cholesterol on mortality risk
was still obvious, yet attenuated (hazard ratio: 1.87; 95% CI: .94-3.32).
Conclusions
High admission cholesterol may be associated with increased long-term survival after
IS. Future studies on the temporal profile of cholesterol levels and stroke outcome
would be of interest.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010.Lancet. 2012; 380: 2095-2128
- Variations in stroke incidence and survival in 3 areas of Europe. European Registries of Stroke (EROS) Collaboration.Stroke. 2000; 31: 2074-2079
- Long-term outcome after ischaemic stroke/transient ischaemic attack.Cerebrovasc Dis. 2003; 16: 14-19
- Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke study.Stroke. 2000; 31: 2080-2086
- Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.Lancet Neurol. 2009; 8: 355-369
- High-dose atorvastatin after stroke or transient ischemic attack.N Engl J Med. 2006; 355: 549-559
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial.Lancet. 2002; 360: 7-22
- Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: The North Dublin Population Stroke Study.Stroke. 2011; 42: 1021-1029
- Low cholesterol, statins and outcomes in patients with first-ever acute ischemic stroke.Cerebrovasc Dis. 2012; 34: 213-220
- Effects of clinical and laboratory variables at admission and of in-hospital treatment with cardiovascular drugs on short term prognosis of ischemic stroke. The GIFA Study.Nutr Metab Cardiovasc Dis. 2013; 23: 642-649
- Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study.Stroke. 2007; 38: 2646-2651
- Sex differences in the prognostic value of the lipid profile after the first ischemic stroke.J Neurol. 2009; 256: 989-995
- International Expert Committee Report on the role of the A1C assay in the diagnosis of diabetes.Diabetes Care. 2009; 32: 1327-1334
- A computerized algorithm for etiologic classification of ischemic stroke: the causative classification of stroke system.Stroke. 2007; 38: 2979-2984
- New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke.Cerebrovasc Dis. 2009; 27: 502-508
- Better outcome after stroke with higher serum cholesterol levels.Neurology. 2000; 54: 1944-1949
- Serum cholesterol levels do not influence outcome or recovery in acute ischemic stroke.Neurol Res. 2008; 30: 82-84
- LDL and HDL subclasses in acute ischemic stroke: prediction of risk and short-term mortality.Atherosclerosis. 2010; 210: 548-554
- Body weight after stroke: lessons from the obesity paradox.Stroke. 2011; 42: 3646-3650
- The obesity paradox in chronic disease: facts and numbers.J Cachexia Sarcopenia Muscle. 2012; 3: 1-4
Andersen KK, Olsen TS. The obesity paradox in stroke: lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients. Int J Stroke 2013 Mar 12. http://dx.doi.org/10.1111/ijs.12016. [Epub ahead of print].
- 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines writing group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina.J Am Coll Cardiol. 2007; 50: 2264-2274
- Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events.Eur Heart J. 2012; 33: 734-744
- Reduction in blood pressure with statins: results from the UCSD Statin Study, a randomized trial.Arch Intern Med. 2008; 168: 721-727
- Characteristics of first ever ischemic stroke in the very elderly: profile of vascular risk factors and clinical outcome.Clin Neurol Neurosurg. 2011; 113: 654-657
- Statins in ischemic stroke: just low-density lipoprotein lowering or more?.J Stroke Cerebrovasc Dis. 2009; 18: 124-127
- Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke: a pleiotropic effect of statins or a beneficial effect of hypercholesterolemia?.BMC Neurol. 2010; 10: 47
- Effect of previous statin therapy on severity and outcome in ischemic stroke patients: a population-based study.J Neurol. 2013; 260: 30-37
- Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials.Stroke. 2013; 44: 448-456
Article info
Publication history
Published online: October 07, 2013
Accepted:
August 13,
2013
Received in revised form:
August 9,
2013
Received:
July 27,
2013
Footnotes
This study was supported by funds from Karolinska Institutet and the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet (ALF).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.08.009
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
