LOW LDL CHOLESTEROL INCREASE HEMORRHAGIG STROKE RISK

More evidence supports the link between low-density lipoprotein (LDL) cholesterol levels and an increased risk of intracerebral hemorrhage (ICH).

Results from a large, prospective longitudinal study show individuals with LDL below 70 mg/dL had a 65% increased likelihood of ICH over 9 years.

Furthermore, the participants with LDL below 50 mg/dL had 169% greater risk compared with their counterparts who had levels in the 70 to 99 mg/dL range.

"Consistently, previous population-based studies already reported that low LDL cholesterol level could be associated with high ICH risk. However, LDL cholesterol level was only assessed once in these studies — and it remains unclear whether long-term LDL status is associated with altered ICH risk," study investigator Xiang Gao, MD, PhD, associate professor and director of the Nutritional Epidemiology Lab at Penn State University in University Park, Pennsylvania, told Medscape Medical News.

“For our study, we wanted to expand the scope of knowledge in this area by investigating the issue prospectively in a large cohort with multiple LDL cholesterol measurements to capture variation over time,” first author Chaoran Ma, a nutritional sciences graduate student at Penn State, added in a news release.

The findings were published online July 2 in Neurology.

Less Rigid Targets Warranted?

The investigators assessed 101,510 participants in the Kailuan study in China.

At baseline between June 2006 and October 2007, enrollees completed a standardized questionnaire and underwent physical exams and laboratory testing, including LDL values. Assessments were repeated in 2008, 2010, and 2012.

The researchers excluded individuals without full LDL cholesterol results, as well as those diagnosed with stroke, myocardial infarction, or cancer at baseline.

Almost 14% of the 96,043 remaining participants had an LDL cholesterol value below 70 mg/dL.

During the 9 years of follow-up, 753 participants developed a hemorrhagic stroke. Within this group, 179 participants (24%) had LDL cholesterol below 70 mg/dL before the onset of disease.

The researchers controlled for age, sex, education, occupation, physical activity, smoking, alcohol intake, and relevant medical history.

Results showed an adjusted hazard ratio (HR) of 1.65 (95% confidence interval [CI], 1.32 – 2.05) for risk of developing ICH in the below 70 mg/dL group compared with those who had LDL concentrations of 70 to 99 mg/dL.

For participants with even lower LDL cholesterol concentrations (between 50 and 69 mg/dL), the risk was even more pronounced (HR, 2.69; 95% CI, 2.03 – 3.57).

Interestingly, the results did not change significantly when the investigators excluded those who were taking cholesterol-lowering medications or anticoagulants.  More evidence supports the link between low-density lipoprotein (LDL) cholesterol levels and an increased risk of intracerebral hemorrhage (ICH).

Results from a large, prospective longitudinal study show individuals with LDL below 70 mg/dL had a 65% increased likelihood of ICH over 9 years.

Furthermore, the participants with LDL below 50 mg/dL had 169% greater risk compared with their counterparts who had levels in the 70 to 99 mg/dL range.

"Consistently, previous population-based studies already reported that low LDL cholesterol level could be associated with high ICH risk. However, LDL cholesterol level was only assessed once in these studies — and it remains unclear whether long-term LDL status is associated with altered ICH risk," study investigator Xiang Gao, MD, PhD, associate professor and director of the Nutritional Epidemiology Lab at Penn State University in University Park, Pennsylvania, told Medscape Medical News.

“For our study, we wanted to expand the scope of knowledge in this area by investigating the issue prospectively in a large cohort with multiple LDL cholesterol measurements to capture variation over time,” first author Chaoran Ma, a nutritional sciences graduate student at Penn State, added in a news release.

The findings were published online July 2 in Neurology.

Less Rigid Targets Warranted?

The investigators assessed 101,510 participants in the Kailuan study in China.

At baseline between June 2006 and October 2007, enrollees completed a standardized questionnaire and underwent physical exams and laboratory testing, including LDL values. Assessments were repeated in 2008, 2010, and 2012.

The researchers excluded individuals without full LDL cholesterol results, as well as those diagnosed with stroke, myocardial infarction, or cancer at baseline.

Almost 14% of the 96,043 remaining participants had an LDL cholesterol value below 70 mg/dL.

During the 9 years of follow-up, 753 participants developed a hemorrhagic stroke. Within this group, 179 participants (24%) had LDL cholesterol below 70 mg/dL before the onset of disease.

The researchers controlled for age, sex, education, occupation, physical activity, smoking, alcohol intake, and relevant medical history.

Results showed an adjusted hazard ratio (HR) of 1.65 (95% confidence interval [CI], 1.32 – 2.05) for risk of developing ICH in the below 70 mg/dL group compared with those who had LDL concentrations of 70 to 99 mg/dL.

For participants with even lower LDL cholesterol concentrations (between 50 and 69 mg/dL), the risk was even more pronounced (HR, 2.69; 95% CI, 2.03 – 3.57).

Interestingly, the results did not change significantly when the investigators excluded those who were taking cholesterol-lowering medications or anticoagulants.