Low level of low-density lipoprotein cholesterol is related with increased hemorrhagic transformation after acute ischemic cerebral infarction

OBJECTIVE: The prevalence of hemorrhagic transformation (HT) after acute ischemic infarction varies greatly. Risk factors of HT include ageing, severity of stroke, baseline hypertension, high NIH Stroke Scale (NIHSS) scores, hyperglycemia and cardioembolic infarction and low levels of low-density lipoprotein (LDL). We investigated the relationship between LDL, lipid profile and HT after acute ischemic infarction and suggested precautions for HT management.

PATIENTS AND METHODS: Three hundred and forty-eight patients with acute infarction were included in the study. Fasting lipid profile was examined on the next morning following hospitalization. Either MRI GRE-T2*WI or CT was performed, one week after hospitalization to detect any cerebral microbleed (CMB) and hemorrhagic transformation. The lipid profiles examined included total cholesterol (TCH), triglyceride (TG), LDL and high-density lipoprotein (HDL).

RESULTS: Among all the patients, HT was noted in 35 patients and non-HT in 313. As compared with non-HT group, HT group had lower levels of TCH, HDL and LDL, lower rates of leukoaraiosis and CMB, but higher scores of NIHSS, higher rates of diabetes mellitus, atrial fibrillation and urokinase thrombolysis. The multivariate binary logistic regression showed that cardioembolic infarction, infarction with undetermined etiology, high scores of NIHSS and diabetes  were the risk factors of HT, while the protective factor was LDL (OR=0.654, 95% CI: 0.430-0.996, p=0.048).

CONCLUSIONS: Low level of LDL is likely associated with increased HT after acute ischemic infarct, so for those patients with low level of LDL, high scores of NIHSS and cardioembolic infarction at admission, aggressive lipid- lowering treatment should be prescribed cautiously to prevent the incidence of HT.

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