作者
Joon‐Tae Kim,Ji Sung Lee,Beom Joon Kim,Jihoon Kang,Keon‐Joo Lee,Jong‐Moo Park,Kyusik Kang,Soo Joo Lee,Jae Guk Kim,Jae‐Kwan Cha,Dae Hyun Kim,Tai Hwan Park,Kyungbok Lee,Jun Lee,Keun‐Sik Hong,Yong Jin Cho,Hong‐Kyun Park,Byung‐Chul Lee,Kyung‐Ho Yu,Mi Sun Oh,Dong‐Eog Kim,Wi‐Sun Ryu,Jay Chol Choi,Jee‐Hyun Kwon,Wook‐Joo Kim,Dong‐Ick Shin,Kyu Sun Yum,Sung Il Sohn,Jeong Ho Hong,Sang Hwa Lee,Man‐Seok Park,Kang Ho Choi,Jun-Young Lee,Kwang‐Yeol Park,Hee Joon Bae
摘要
Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission.This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes.This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored.A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (Pnon-linearity<0.001), with substantial relationships in the no pretreatment subgroup.The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted.