Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry

Yu Wei Chen, Chen Hua Li, Chih Dong Yang, Chung Hsiang Liu, Chih Hung Chen, Jau Jiuan Sheu, Shinn Kuang Lin, An Chih Chen, Ping Kun Chen, Po Lin Chen, Chung Hsin Yeh, Jiunn Rong Chen, Yu Jen Hsiao, Ching Huang Lin, Shih Pin Hsu, Tsang Shan Chen, Sheng Feng Sung, Shih Chieh Yu, Chih Hsin Muo, Chi Pang WenFung Chang Sung, Jiann Shing Jeng, Chung Y. Hsu

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The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160±200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41±2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11±1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76±8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.

Original languageEnglish
Article numbere0171379
JournalPloS one
Issue number4
Publication statusPublished - 2017 Apr


All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Chen, Y. W., Li, C. H., Yang, C. D., Liu, C. H., Chen, C. H., Sheu, J. J., Lin, S. K., Chen, A. C., Chen, P. K., Chen, P. L., Yeh, C. H., Chen, J. R., Hsiao, Y. J., Lin, C. H., Hsu, S. P., Chen, T. S., Sung, S. F., Yu, S. C., Muo, C. H., ... Hsu, C. Y. (2017). Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry. PloS one, 12(4), [e0171379]. https://doi.org/10.1371/journal.pone.0171379