Skip to main content

Advertisement

SpringerLink
Log in

Lipid profile, statin use, and outcome after intravenous thrombolysis for acute ischaemic stroke

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

Low cholesterol levels have been associated with an increased risk of haemorrhagic stroke. This study investigated whether lipid levels or prior statin use influence outcome in patients with acute ischaemic stroke treated with IV thrombolysis.

Methods

The relation between admission lipid levels or statin use and both the development of symptomatic intracerebral haemorrhage (sICH) and 3-months functional outcome was assessed in a prospective hospital-based stroke registry comprising 252 patients treated with IV tissue plasminogen activator (tPA). The fasting status of the patients was unknown. Favourable outcome at 3 months was defined as a modified Rankin scale score ≤ 2. Logistic regression analysis was performed with adjustment for possible confounders.

Results

Low density lipoprotein (LDL), total cholesterol levels, and statin use were not associated with sICH. Mean triglyceride levels were significantly higher (2.5 mmol/L vs 1.8 mmol/L, p = 0.02) and high density lipoprotein (HDL) was significantly lower (1.0 mmol/L vs 1.2 mmol/L, p = 0.03) in patients with sICH than in patients without sICH. Multivariable analysis showed that higher triglyceride levels were independently associated with sICH (OR 2.16 per mmol/ L increase, 95 % CI 1.20–3.91, p = 0.01). There was no relation between any of the lipid levels or statin use and functional outcome at 3 months.

Conclusions

High admission triglyceride levels were independently associated with a higher risk of sICH, but were not associated with a reduced chance of a favourable functional outcome at 3 months. Total cholesterol levels, LDL levels and statin use had no influence on both the occurrence of sICH or functional outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. (1995) N Engl J Med 333(24):1581–1587

    Google Scholar 

  2. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group (1997) Stroke 28(11):2109–2118

    Google Scholar 

  3. Blood pressure, cholesterol, and stroke in eastern Asia. Eastern Stroke and Coronary Heart Disease Collaborative Research Group (1998) Lancet 352 (9143):1801–1807

    Google Scholar 

  4. Adams H, Adams R, del Zoppo G, Goldstein LB (2005) Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke 36(4):916–923

    Article  PubMed  Google Scholar 

  5. Alvarez-Sabin J, Huertas R, Quintana M, Rubiera M, Delgado P, Ribo M, Molina CA, Montaner J (2007) Prior statin use may be associated with improved stroke outcome after tissue plasminogen activator. Stroke 38(3):1076–1078

    Article  PubMed  CAS  Google Scholar 

  6. Alvarez-Sabin J, Molina CA, Montaner J, Arenillas JF, Huertas R, Ribo M, Codina A, Quintana M (2003) Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator-treated patients. Stroke 34(5):1235–1240

    Article  PubMed  Google Scholar 

  7. Amarenco P, Bogousslavsky J, Callahan A, III, Goldstein LB, Hennerici M, Rudolph AE, Sillesen H, Simunovic L, Szarek M, Welch KM, Zivin JA (2006) High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 355(6):549–559

    Article  PubMed  CAS  Google Scholar 

  8. Ariesen MJ, Claus SP, Rinkel GJ, Algra A (2003) Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34(8):2060–2065

    Article  PubMed  CAS  Google Scholar 

  9. Bamford J, Sandercock P, Dennis M, Warlow C, Burn J (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337(8756):1521–1526

    Article  PubMed  CAS  Google Scholar 

  10. Bang OY, Saver JL, Liebeskind DS, Starkman S, Villablanca P, Salamon N, Buck B, Ali L, Restrepo L, Vinuela F, Duckwiler G, Jahan R, Razinia T, Ovbiagele B (2007) Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis. Neurology 68(10):737–742

    Article  PubMed  CAS  Google Scholar 

  11. Butterworth RJ, Marshall WJ, Bath PMW (1997) Changes in Serum Lipid Measurements following Acute Ischaemic Stroke. Cerebrovasc Dis 7:10–13

    Article  Google Scholar 

  12. Castellanos M, Leira R, Serena J, Pumar JM, Lizasoain I, Castillo J, Davalos A (2003) Plasma metalloproteinase-9 concentration predicts hemorrhagic transformation in acute ischemic stroke. Stroke 34(1):40–46

    Article  PubMed  CAS  Google Scholar 

  13. Demchuk AM, Tanne D, Hill MD, Kasner SE, Hanson S, Grond M, Levine SR (2001) Predictors of good outcome after intravenous tPA for acute ischemic stroke. Neurology 57(3):474–480

    PubMed  CAS  Google Scholar 

  14. Ebrahim S, Sung J, Song YM, Ferrer RL, Lawlor DA, Davey SG (2006) Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study. BMJ 333(7557):22

    Article  PubMed  Google Scholar 

  15. Ferreira AC, Peter AA, Mendez AJ, Jimenez JJ, Mauro LM, Chirinos JA, Ghany R, Virani S, Garcia S, Horstman LL, Purow J, Jy W, Ahn YS, de ME (2004) Postprandial hypertriglyceridemia increases circulating levels of endothelial cell microparticles. Circulation 110(23):3599–3603

    Article  PubMed  Google Scholar 

  16. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 352(9136):1245–1251

    Article  PubMed  CAS  Google Scholar 

  17. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK (1990) Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 263(21):2893–2898

    Article  PubMed  CAS  Google Scholar 

  18. Heuschmann PU, Kolominsky-Rabas PL, Roether J, Misselwitz B, Lowitzsch K, Heidrich J, Hermanek P, Leffmann C, Sitzer M, Biegler M, Buecker-Nott HJ, Berger K (2004) Predictors of inhospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy. JAMA 292(15):1831–1838

    Article  PubMed  CAS  Google Scholar 

  19. Lapchak PA, Chapman DF, Zivin JA (2000) Metalloproteinase inhibition reduces thrombolytic (tissue plasminogen activator)-induced hemorrhage after thromboembolic stroke. Stroke 31(12):3034–3040

    PubMed  CAS  Google Scholar 

  20. Montaner J, Molina CA, Monasterio J, Abilleira S, Arenillas JF, Ribo M, Quintana M, Alvarez-Sabin J (2003) Matrix metalloproteinase-9 pretreatment level predicts intracranial hemorrhagic complications after thrombolysis in human stroke. Circulation 107(4):598–603

    Article  PubMed  CAS  Google Scholar 

  21. Paciaroni M, Agnelli G, Caso V, Venti M, Alberti A, Milia P, Silvestrelli G, Biagini S (2006) Prior use of antithrombotic agents and neurological functional outcome at discharge in patients with ischemic stroke. J Thromb Haemost 4(9):1957–1961

    Article  PubMed  CAS  Google Scholar 

  22. Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, Tress BM, Davis SM (2002) Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol 52(1):20–28

    Article  PubMed  Google Scholar 

  23. Tanne D, Kasner SE, Demchuk AM, Koren-Morag N, Hanson S, Grond M, Levine SR (2002) Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice. The multicenter rt-PA acute stroke survey. Circulation 105(14):1679–1685

    Article  PubMed  CAS  Google Scholar 

  24. Tirschwell DL, Smith NL, Heckbert SR, Lemaitre RN, Longstreth WT Jr, Psaty BM (2004) Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups. Neurology 63(10):1868–1875

    PubMed  CAS  Google Scholar 

  25. Uyttenboogaart M, Koch MW, Stewart RE, Vroomen PC, Luijckx GJ, De Keyser J (2007) Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke. Brain 130(Pt 6):1626–1630

    Article  PubMed  Google Scholar 

  26. Uyttenboogaart M, Vroomen PC, Stewart RE, De Keyser J, Luijckx GJ (2007) Safety of routine IV thrombolysis between 3 and 4. 5 h after ischemic stroke. J Neurol Sci 254(1–2):28–32

    Article  PubMed  CAS  Google Scholar 

  27. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5):604–607

    PubMed  CAS  Google Scholar 

  28. Wang S, Lee SR, Guo SZ, Kim WJ, Montaner J, Wang X, Lo EH (2006) Reduction of tissue plasminogen activator-induced matrix metalloproteinase- 9 by simvastatin in astrocytes. Stroke 37(7):1910–1912

    Article  PubMed  CAS  Google Scholar 

  29. Wardlaw JM, del Zoppo G, Yamaguchi T, Berge E (2003) Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev(3):CD000213

  30. Zia E, Pessah-Rasmussen H, Khan FA, Norrving B, Janzon L, Berglund G, Engstrom G (2006) Risk factors for primary intracerebral hemorrhage: a population-based nested case-control study. Cerebrovasc Dis 21(1–2):18–25

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurology, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    M. Uyttenboogaart MD, M. W. Koch, K. Koopman, P. C. Vroomen, G. J. Luijckx & J. De Keyser

Authors
  1. M. Uyttenboogaart MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. W. Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Koopman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. C. Vroomen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. J. Luijckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. De Keyser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Uyttenboogaart MD.

Additional information

We declare we have no conflicts of interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uyttenboogaart, M., Koch, M.W., Koopman, K. et al. Lipid profile, statin use, and outcome after intravenous thrombolysis for acute ischaemic stroke. J Neurol 255, 875–880 (2008). https://doi.org/10.1007/s00415-008-0797-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-008-0797-7

Key words

Search

Navigation