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High-density lipoprotein cholesterol (HDL-C) has been shown to be a neuroprotective agent and decreases ischemic stroke (IS) severity in animal models. We evaluated the influence of baseline HDL-C on IS severity and clinical outcomes in patients (pts) with IS.
From August 2006 to December 2011, acute IS pts fulfilling the following criteria were recruited: (1) age ≥18 years, (2) no lipid-lowering drugs use prior to admission, and (3) IS due to large artery atherosclerosis and small vessel occlusion. Cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), HDL-C and National Institutes of Health Stroke Scale (NIHSS) scores were checked at admission. The primary outcomes were a composite end point of all-cause mortality, recurrent stroke, or occurrence of ischemic heart disease during follow-up.
Overall, 3,093 pts (mean age 67 years) were included and 675 pts (22%) had low HDL-C (≤ 35 mg/dL) at admission. Multivariate logistic analysis showed that low HDL-C (OR, 1.79, 95% CI, 1.40-2.29) was associated with higher IS severity (NIHSS score > 6). The mean follow-up period was 32.7 ± 19.4 months. Kaplan-Meier analysis showed a worse clinical outcome in the pts with low HDL-C (log-rank test, p = 0.017). In multivariate Cox regression analysis, low HDL-C (HR, 1.41, 95% CI, 1.02-1.95) was an independent predictor of the composite end point. In all pts with low HDL-C, 441 pts (65%) had isolated low HDL-C (HDL-C ≤ 35 mg/dL and LDL-C < 160 mg/dL and TG < 200mg/dL) and 234 (35%) had non-isolated low HDL-C (HDL-C ≤ 35 mg/dL combined with LDL-C ≥ 160 mg/dL and/or TG ≥ 200mg/dL). Kaplan-Meier analysis showed a similar clinical outcome (log-rank test, p = 0.347) in pts with isolated and non-isolated low HDL-C. However, a lower percentage of pts with isolated low HDL-C were treated with lipid lowering drugs at discharge (27% vs. 69%, p < 0.001).
A lower baseline HDL-C (≤ 35 mg/dL) at admission was associated with higher stroke severity and poor clinical outcome in pts with atherosclerotic stroke. Isolated low HDL-C was a common lipid phenotype and as strongly associated with the risk of adverse clinical outcome as non-isolated low HDL-C in our patients.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Coronary Risk Factors and Management
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1115-97
- 2013 American College of Cardiology Foundation