News | Stroke | June 28, 2023

U-shaped Association Between Low-density Lipoprotein Cholesterol Levels and Risk of All-cause Mortality Mediated by Post-stroke Infection in Acute Ischemic Stroke

This study aimed to evaluate the association between LDL-C levels, post-stroke infection and all-cause mortality. 804,855 ischemic stroke patients were enrolled.

The U-shaped association between LDL-C level and all-cause mortality during hospitalization, and the mediation effect of infection in patients with acute ischemic stroke in the CSCA program. 804,855 patients were included. Abbreviations: LDL-C: low-density lipoprotein cholesterol; CSCA: Chinese Stroke Center Alliance. Image courtesy of Science China Press 


June 28, 2023 — The general perception supports the mantra of “lower is better” for low-density lipoprotein cholesterol (LDL-C) levels in cardiovascular disease. However, during the acute stage of ischemic stroke, it is unclear how to interpret different LDL-C levels accurately. The evidence on clinical implication of LDL-C levels was mainly derived from long-term follow-up studies. The pathophysiological features of patients under the acute stage of ischemic stroke are different from the chronic stage. Concerns exist over whether low LDL-C levels may lead to adverse outcomes, such as increased mortality risk due to infection. The crosstalk between LDL-C and infection is also garnering increasing amounts of interest. 

This study aimed to evaluate the association between LDL-C levels, post-stroke infection and all-cause mortality. 804,855 ischemic stroke patients were enrolled. Associations between LDL-C levels, infection, and mortality risk were estimated by multivariate logistic regression models. Mediation analysis was performed under counterfactual framework to elucidate the mediation effect of post-stroke infection. 

The study found a U-shaped association between LDL-C and mortality risk in acute ischemic stroke patients. The lowest mortality risk was at an LDL-C level of 2.67 mmol/L. The association between LDL-C and all-cause mortality was 38.20% mediated by infection. Sensitivity analysis showed that after excluding patients with increasing numbers of cardiovascular risk factors, the U-shaped association remained consistent but the LDL-C interval with the lowest mortality risk increased progressively, where infection maintained prominent mediation effects. Subgroup analysis showed a consistent U-shaped association between LDL-C levels and mortality risk. The mediation effects of infection were largely consistent in subgroups of age ≥65 years, female, body mass index <25 kg/m2, and National Institutes of Health Stroke Scale ≥16. 

Despite the known adverse effects of high LDL-C levels, in ischemic stroke patients, this study revealed that low LDL-C levels also indicate an increased risk of all-cause mortality during hospitalization, where post-stroke infection is an important mediating mechanism, indicating a potential causal chain of low LDL-C-infection-mortality in the acute stage of ischemic stroke. Further research is warranted to explore the risk-benefit relationship of approaches for rapid and substantial LDL-C reduction during the acute stage of ischemic stroke. 

For more information: https://www.scichina.com/


Related Content

News | Stroke

July 9, 2025 — InspireMD, Inc., developer of the CGuard Prime carotid stent system for the prevention of stroke ...

Home July 09, 2025
Home
News | Stroke

May 28, 2025 — Siemens Healthineers has introduced the first mobile stroke unit (MSU) featuring the Somatom On.site head ...

Home May 28, 2025
Home
News | Stroke

May 21, 2025 — RapidAI recently announced new study findings that show RapidAI’s clinically deep algorithms deliver ...

Home May 21, 2025
Home
News | Stroke

April 17, 2025 — Adults younger than 50 years of age had more than double the risk of having a stroke from migraine or ...

Home April 17, 2025
Home
News | Stroke

On April 9, 2025, the world’s first multisector advocacy movement dedicated to stroke — the Global Stroke Action ...

Home April 15, 2025
Home
News | Stroke

March 3, 2025 — Genentech, a member of the Roche Group, recently announced that the U.S. Food and Drug Administration ...

Home March 04, 2025
Home
News | Stroke

Feb. 6, 2025 — New findings from the DiVERT Stroke clinical study showed women spent less time in the hospital, saw ...

Home February 07, 2025
Home
News | Stroke

Feb. 5, 2025 — Removing a clot blocking a medium- or small-sized artery in the brain mechanically is a safe treatment ...

Home February 07, 2025
Home
News | Stroke

Jan. 29, 2025 — Researchers at Ochsner Health, led by Hernan Bazan, MD, DFSVS, FACS, have developed a predictive model ...

Home January 30, 2025
Home
News | Stroke

Nov. 16, 2024 Anthos Therapeutics, Inc.recently presented new data at the American Heart Association (AHA) Scientific ...

Home November 18, 2024
Home
Subscribe Now