Beyond low-density lipoprotein cholesterol levels:Impact of prior statin treatment on ischemic stroke outcomes

Although essential for cardiovascular therapy,the pleiotropic effects of statins on ischemic stroke lack clinical evidence.This study examined the effects of statins beyond low-density lipoprotein cholesterol(LDL-C)levels on mortality and stroke severity.A total of 825,874 patients with ischemic stroke were included in this study,of whom 125,650 statin users were 1:1 matched with non-users based on their LDL-C levels(±0.05 mmol/L),forming the LDL-C-matched cohort.Associations between preceding statin treatment,in-hospital mortality,and stroke severity(National Institutes of Health Stroke Scale scoreR16)were estimated by multivariate and conditional logistic regression models in overall cohort and LDL-C-matched cohort,respectively.

缺血性卒中后感染介导了低密度脂蛋白胆固醇与全因死亡风险之间的U形曲线关系

在缺血性卒中急性期,尚不清楚低水平的低密度脂蛋白胆固醇(LDL-C)的病理生理意义,本研究旨在评估LDL-C水平、卒中后感染和全因死亡间的关系.研究共纳入804,855名缺血性卒中患者.通过多元logistic回归模型分析LDL-C水平、感染和死亡之间的关系,采用基于反事实框架的中介分析,以阐明卒中后感染的中介效应,研究发现LDL-C与死亡风险之间呈U形曲线关系,死亡风险最低的LDL-C水平为2.67mmol/L.经多因素校正后,与LDL-C=2.50~2.99mmol/L相比,LDL-C<1.0mmol/L患者的死亡风险比值比(OR)为2.22(95%置信区间(CI):1.77~2.79),LDL-C5.0mmol/L患者的OR为1.22(95%CI:0.98~1.50).LDL-C与死亡之间关联的38.20%(95%CI:5.96~70.45,P=0.020)由感染介导:在逐步剔除存在心血管危险因素的患者后,LDL-C与全因死亡间的U形曲线关系及感染的中介效应与主要分析一致,而死亡风险最低时的LDL-C水平逐渐升高.在缺血性卒中急性期,LDL-C水平与全因死亡之间存在U形曲线关系,其被卒中后感染介导。