The Relationship of Low Density Lipoprotein (LDL) Cholesterol Level with Haemorrhagic Transformation of Acute Cerebral Infarct
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 5
Abstract
Background: Acute ischemic stroke (AIS) is characterized by the sudden loss of blood circulation to an area of the brain, typically in a vascular territory, resulting in a corresponding loss of neurologic function. Although stroke often is considered a disease of elderly persons, one third of strokes occur in persons younger than 65 years. Risk of stroke increases with age, especially in patients older than 64 years, in whom 75% of all strokes occur. The system of categorizing stroke developed in the multicenter Trial of ORG 10172 in Acute Stroke Treatment (TOAST) divides ischemic strokes into the following 3 major subtypes: • Large-artery • Small-vessel, or lacunar • Cardioembolic infarction Large-artery infarctions often involve thrombotic insitu occlusions on atherosclerotic lesions in the carotid, vertebrobasilar, and cerebral arteries, typically proximal to major branches; however, large-artery infarctions may also be cardioembolic. Cardiogenic emboli are a common source of recurrent stroke. They may account for up to 20% of acute strokes and have been reported to have the highest 1-month mortality. Small vessel or lacunar strokes are associated with small focal areas of ischemia due to obstruction of single small vessels. Ischemic and hemorrhagic stroke cannot be reliably differentiated on the basis of clinical examination findings alone. Further evaluation, especially with brain imaging tests (ie, computed tomography [CT] scanning or magnetic resonance imaging [MRI]), is required. The prevalence of hemorrhagic transformation (HT) after acute ischemic infarction varies greatly. Risk factors of HT include ageing, severity of stroke, baseline hypertension, hyperglycemia and cardioembolic infarction and low levels of low-density lipoprotein (LDL). We investigated the relationship between LDL, lipid profile and HT after acute ischemic infarction and suggested precautions for HT management. Methods: Fifty-four patients with acute infarction were included in the study. Fasting lipid profile was examined on the next morning following hospitalization. Either MRI brain or CT was performed, in follow up to detect any cerebral microbleed (CMB) and hemorrhagic transformation. The lipid profiles examined included total cholesterol (TCH), triglyceride (TG), LDL and high-density lipoprotein (HDL). Results : Among all the patients, HT was noted in 20 patients and non-HT in 34. As compared with non-HT group, HT group had lower levels of LDL, but higher scores of NIHSS, higher rates of diabetes mellitus, higher BP and the older age group(>65years). The study showed that cardioembolic infarction, infarction with undetermined etiology, high scores of NIHSS, diabetes, hypertension and dyslipidemia were the risk factors of HT. Conclusion : Low level of LDL is likely associated with increased HT after acute ischemic infarct. So for those patients who are having low level of LDL, higher blood sugar, high HbA1c, and hypertension at the time of admission, aggressive lipid- lowering treatment should be prescribed cautiously to prevent the incidence of haemorrhagic transformation.
Authors and Affiliations
Dr. Arvind Kumar
Keywords
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