What causes heart disease part 62

19th January 2019

I suppose it is gratifying to find things I write strongly supported a couple of days later. After telling everybody that a high cholesterol level is not a risk for stroke, out comes a study almost immediately, demonstrating a low cholesterol level increases mortality in patients who have already had a stroke.

This was in a people who have high grade carotid artery stenosis — and I would highlight this reality — in a population. Which mean a high level of atherosclerosis on the carotid arteries (supplying blood to the brain). The paper is called:

‘Lower cholesterol tied to increased mortality in ischaemic stroke patients with carotid artery stenosis.

Takeaway

In patients with acute, first-ever ischaemic stroke with high-grade internal carotid artery (ICA) stenosis and post-stroke functional dependence, lower total cholesterol level was associated with greater risk for 5-year mortality.

Why this matters:

For reducing risk for atherosclerotic cardiovascular diseases and stroke treatment guidelines of hyperlipidaemia suggest more aggressive treatment.

However, these findings suggest a cautious consideration of aggressive treatment of hyperlipidaemia in patients with acute, first-ever ischaemic stroke using high-grade ICA stenosis and post-stroke functional dependence.

Study design:

Study prospectively evaluated 196 patients with acute ischaemic stroke with high-grade ICA stenosis and modified Rankin Scale score ≥3.

Patients were divided into two groups based on total cholesterol level at entrance: ≥200 or <200 mg/dL.

Patients were followed-up for 5 years following initial assessment.

Key results:

After adjusting for established clinical predictors of adverse outcomes, lower overall cholesterol level (aHR, 1.88; 95% CI, 1.09-3.23; P=.023) was a significant risk factor for 5-year all-cause mortality.

The prevalence of diabetes mellitus (P=.013) was significantly greater and that of atrial fibrillation (P=.011) was significantly lower in patients with high versus low overall cholesterol level.

Patients with reduced cholesterol level had significantly lower value of haemoglobin (P=.001), whereas glycohaemoglobin was significantly greater in patients with higher total cholesterol level (P=.001).

Funding: None.

Four words in the English language. ‘I told you so.’

Of course, this study will be dismissed out of hand. “We should still be prescribing statins to those who’ve had ischaemic strokes” we will be told. “Studies such as this are purely observational” we’ll be told. “A high cholesterol level still needs to be lowered” we will be told. Nothing to see here, please move along!

I absolutely contradicts the cholesterol hypothesis and do become increasingly tired of finding evidence. It never makes the difference. Hopefully there are a few individuals out there listening, whose heads aren’t made of reinforced concrete.

1: https://www.univadis.co.uk/viewarticle/lower-cholesterol-tied-to-increased-mortality-in-ischaemic-stroke-patients-with-carotid-artery-stenosis-651463

Lung YJ, Weng WC, Wu CL, Huang WY. Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional D ependence. J Stroke Cerebrovasc Dis. 2019 Jan 11 [Epub ahead of print]. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.030. PMID: 30642665

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