Blood lipid levels, statin therapy and risk of intracerebral hemorrhage versus ischemic vascular events: a prospective case control study from tertiary care center of south India

Sandhya Manorenj; Imran Ahmed Siddiqui; Snehalatha Inturi; Sudhaker Barla

doi:10.18203/2320-6012.ijrms20163780

Authors

Sandhya Manorenj Department of Neurology, Superspeciality Hospital, Sanath Nagar, Hyderabad, Telangana, India
Imran Ahmed Siddiqui Department of Biochemistry Employees State Insurance Corporations, Superspeciality Hospital, Sanath Nagar, Hyderabad, Telangana, India
Snehalatha Inturi Department of Neurology, Superspeciality Hospital, Sanath Nagar, Hyderabad, Telangana, India
Sudhaker Barla Department of Neurology, Superspeciality Hospital, Sanath Nagar, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20163780

Keywords:

Lipids, ICH, Risk, Statins

Abstract

Background: Intracerebral hemorrhage (ICH) is characterized by high mortality and morbidity. A little is known about the association between blood lipids, statin use and risk of ICH. Objective of the study was to investigate the relation between blood lipid levels and risk of hemorrhagic stroke.

Methods: Prospectively compared the lipid levels of primary ICH patients (case) with ischemic group (control) patients, i.e. age and sex matched individuals admitted from January 2014 to January 2015 and outcome analyzed.

Results: Of the 678 acute stroke patients, 78 (11.5%) had ICH who was enrolled. Mean age was 53±14.4. ICH was frequent in older age (57.6%) with male gender predominance (73%). Most frequent location of bleed was in thalamus (30.7%). Low density lipoprotein (LDL), triglyceride (TG) and very low density lipoprotein (VLDL) cholesterol were significantly low in ICH patients compared to controls. There was no significant difference in the high density lipoprotein (HDL) levels in both groups. Mean total cholesterol was significantly low in a subset of study group that included male gender, younger onset stroke (<50 years) and with prior history of hypertension. Subgroup analysis in ICH group showed significantly low mean total cholesterol, LDL and TG cholesterol in statin group compared to non-statin group.

Conclusions: Lower blood lipid levels are associated with an increased risk of ICH. The reduction of blood lipids due to statin therapy might increase the risk of ICH, especially in hypertensive individuals and those with alcohol use; hence there should be a cautious use of statins.

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References

Ikram MA, Wieberdink RG, Koudstaal PJ.International epidemiology of intracerebral hemorrhage.Curr Atheroscler Rep. 2012;14(4):300-6.

Yingxu Ma, Zhaokai Li, Liang Chen, Xiangping Li. Blood lipid levels, statin therapy and the risk of intracerebral haemorrhage. Lipids Health Dis. 2016;15:43.

Tsai CF, Anderson N, Thomas B, Sudlow CL. Risk factors for ischemic stroke and its subtypes in Chinese vs. Caucasians: Systematic review and meta-analysis. Int J Stroke. 2015;10(4):485-93.

Bonaventure A, Kurth T, Pico F, Barberger-Gateau P, Ritchie K, Stapf C, et al. Triglycerides and risk of hemorrhagic stroke vs. ischemic vascular events: the three-city study. Atherosclerosis. 2010;210(1):243-8.

Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Total and high-density lipoprotein cholesterol and stroke risk. Stroke. 2012;43(7):1768-74.

O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case–control study. Lancet. 2010;376(9735):112-23.

Konishi M, Iso H, Komachi Y, Iida M, Shimamoto T, Jacobs DR, et al. Associations of serum cholesterol, different types of stroke and stenosis distribution of cerebral arteries.The Akita Pathology Study. Stroke. 1993;24:954-62.

Suzuki K, Izumi M, Sakamoto T, Hayashi M. Blood pressure and total cholesterol level are critical risks especially for hemorrhagic stroke in Akita, Japan. Cerebrovasc Dis. 2011;31(1):100-6.

Nakanishi N, Yoshida H, Nakamura K, Kawashimo and H, Tatara K. Influence of alcohol intake on risk for increased low-density lipoprotein cholesterol in middle-aged Japanese men. Alcohol Clin Exp Res. 2001;25(7):1046-50.

Amarenco P, Bogousslavsky J, Callahan AR, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549-59.

Goldstein LB, Amarenco P, Szarek M, Callahan AR, Hennerici M, Sillesen H, et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology. 2008;70(24 Pt 2):2364-70.