Low-density lipoprotein cholesterol and severity of intracerebral hemorrhage: Insights from the SIREN study

Background: We investigated the link between LDL-C and markers of ICH severity among Indigenous West Africans in the Stroke Investigative Research and Education Network study. Methods: ICH severity was evaluated using the Glasgow Coma Scale (GCS), Stroke Levity Scale (SLS), and the National Institutes of Health Stroke Scale (NIHSS). The serum LDL-c of the study population was dichotomized into <133 mg/dl and ≥ 133 mg/dl using the optimum threshold by the Youden Index after assessing the linear relationship between the serum LDL-c measured at admission and ICH severity markers. A multivariate-adjusted logistic regression was performed to identify the independent association of serum LDL-C with ICH severity. Results: Overall, 959 subjects were investigated, with a mean age of 53.9 ± 13.24 years; 62.7 % were men with GCS median (IQR) of 8.0 (12.0,15.0), SLS of 5.0 (2.0,8.0) and NIHSS of 15.0 (8.0,23.0). The mean ± SD LDL-C was 124.78 ± 51.8 mg/dl and the baseline serum LDL-C showed a positive linear relationship with admitting GCS and SLS scores and a negative relationship with the NIHSS score. Patients with LDL < 133 mg/dl had more severe stroke [SLS median (IQR): 5.0(2.0,8.0] and GCS median (IQR):11.0(7.0,15.0] compared to patients with LDL-C ≥ 133 mg/dl. Systolic BP ≥ 140 mmHg [1.720 (1.168,2.532)], ICH volume ≥ 30mls [2.774(1.990,3.865)], presence of intraventricular extension [1.564 (1.158, 2.113)] and serum LDL-C < 133 mg/dl [1.502 (1.110, 2.032)] were independently associated with severe ICH. In the subgroup analysis, the independent association between serum LDL-C < 133 mg/dl and severe ICH was stronger for subjects <50 years [1.690 (1.017, 2.808)] and males [1.621 (1.092, 2.406)]. Conclusion: Low serum LDL-C is independently associated with severe ICH among West Africans.