Frontiers in Neurology (Jan 2022)

Low-Density Lipoprotein Cholesterol and Mortality in Patients With Intracerebral Hemorrhage in Taiwan

  • Chi-Pang Wen,
  • Chi-Pang Wen,
  • Chi-Pang Wen,
  • Yi-Che Lee,
  • Yi-Che Lee,
  • Yuan-Ting Sun,
  • Chih-Yuan Huang,
  • Chon-Haw Tsai,
  • Po-Lin Chen,
  • Wei-Lun Chang,
  • Po-Yen Yeh,
  • Cheng-Yu Wei,
  • Ming-Jun Tsai,
  • Yu Sun,
  • Chih-Hao Lin,
  • Jiunn-Tay Lee,
  • Ta-Chang Lai,
  • Li-Ming Lien,
  • Mei-Chen Lin,
  • Mei-Chen Lin,
  • Cheng-Li Lin,
  • Cheng-Li Lin,
  • June-Han Lee,
  • Hao-Kuang Wang,
  • Hao-Kuang Wang,
  • Chung Y. Hsu,
  • Chung Y. Hsu,
  • Taiwan Stroke Registry Investigators,
  • Chung-Hsiang Liu,
  • Wei-Shih Huang,
  • Chung-Ta Lu,
  • Tzung-Chang Tsai,
  • Chun-Hung Tseng,
  • Kang-Hsu Lin,
  • Woei-Cherng Shyn,
  • Yu-Wan Yang,
  • Yen-Liang Liu,
  • Der-Yang Cho,
  • Chun-Chung Chen,
  • Shih-Pin Hsu,
  • Han-Jung Chen,
  • Cheng-Sen Chang,
  • Hung-Chang Kuo,
  • Lian-Hui Lee,
  • Huan-Wen Tsui,
  • Jung-Chi Tsou,
  • Yan-Tang Wang,
  • Yi-Cheng Tai,
  • Kun-Chang Tsai,
  • Yen-Wen Chen,
  • Kang Lu,
  • Po-Chao Liliang,
  • Yu-Tun Tsai,
  • Cheng-Loong Liang,
  • Kuo-Wei Wang,
  • Jui-Sheng Chen,
  • Po-Yuan Chen,
  • Cien-Leong Chye,
  • Wei-Jie Tzeng,
  • Pei-Hua Wu,
  • Chih-Hung Chen,
  • Han-Chieh Hsieh,
  • Hui-Chen Su,
  • Yu-Shan Lee,
  • Hsin-Yi Chi,
  • Chou-Hsiung Pan,
  • Po-Chi Chan,
  • Min-Hsien Hsu,
  • Ya-Ying Wu,
  • Zhi-Zang Huang,
  • Hai-Ming Shoung,
  • Yi-Chen Lo,
  • Fu-Hwa Wang,
  • Chien-Chung Chen,
  • Yu-Tai Tsai,
  • Ko-Yi Wang,
  • Tzu-Hsuan Huang,
  • Chao-Nan Yang,
  • Chao-Hsien Hung,
  • Ian Shih,
  • Hsin-Yi Kao,
  • Chien-Jung Lu,
  • Cheng-Huai Lin,
  • Chieh-Cheng Huang,
  • Chang-Hsiu Liu,
  • Hoi-Fong Chan,
  • Ping-Kun Chen,
  • Pai-Yi Chiu,
  • Jiann-Chyun Lin,
  • Yaw-Don Hsu,
  • Jong-Chyou Denq,
  • Giia-Sheun Peng,
  • Chang-Hung Hsu,
  • Chun-Chieh Lin,
  • Che-Hung Yen,
  • Chun-An Cheng,
  • Yueh-Feng Sung,
  • Yuan-Liang Chen,
  • Ming-Tung Lien,
  • Chung-Hsing Chou,
  • Chia-Chen Liu,
  • Fu-Chi Yang,
  • Yi-Chung Wu,
  • An-Chen Tso,
  • Yu-Hua Lai,
  • Chun-I Chiang,
  • Chia-Kuang Tsai,
  • Meng-Ta Liu,
  • Ying-Che Lin,
  • Yu-Chuan Hsu,
  • Jiu-Haw Yin,
  • Chung-JenWang,
  • Kai-ChenWang,
  • Li-Mei Chen,
  • Jong-Chyou Denq,
  • Hou-Chang Chiu,
  • Wei-Hung Chen,
  • Chyi-Huey Bai,
  • Tzu-Hsuan Huang,
  • Chi-Ieong Lau,
  • Ya-Ying Wu,
  • Hsu-Ling Yeh,
  • Anna Chang,
  • Jiann-Shing Jeng,
  • Sung-Chun Tang,
  • Li-Kai Tsai,
  • Shin-Joe Yeh,
  • Ching-Huang Lin,
  • Cheng-Chang Yen,
  • Ruey-Tay Lin,
  • Chun-Hung Chen,
  • Gim-Thean Khor,
  • A-Ching Chao,
  • Hsiu-Fen Lin,
  • Poyin Huang,
  • Huey-Juan Lin,
  • Der-Shin Ke,
  • Chia-Yu Chang,
  • Poh-Shiow Yeh,
  • Kao-Chang Lin,
  • Tain-Junn Cheng,
  • Chih-Ho Chou,
  • Chun-Ming Yang,
  • Hsiu-Chu Shen,
  • An-Chih Chen,
  • Shih-Jei Tsai,
  • Tsong-Ming Lu,
  • Sheng-Ling Kung,
  • Mei-Ju Lee,
  • Hsi-Hsien Chou,
  • Siu-Pak Lee,
  • Ming-Hui Sun,
  • Li-Ying Ke,
  • Sheng-Feng Sung,
  • Cheung-Ter Ong,
  • Chi-Shun Wu,
  • Yu-Hsiang Su,
  • Ling-Chien Hung,
  • Tsuey-Ru Chiang,
  • Mei-Ching Lee,
  • Pai-Hao Huang,
  • Sian-King Lie,
  • Pin-Wen Liao,
  • Jen-Tse Chen,
  • Mu-Chien Sun,
  • Tien-Pao Lai,
  • Wei-Liang Chen,
  • Yen-Chun Chen,
  • Ta-Cheng Chen,
  • Wen-Fu Wang,
  • Kwo-Whei Lee,
  • Chen-Shu Chang,
  • Chien-Hsu Lai,
  • Siao-Ya Shih,
  • Chieh-Sen Chuang,
  • Yen-Yu Chen,
  • Chien-Min Chen,
  • Shinn-Kuang Lin,
  • Yu-Chin Su,
  • Cheng-Lun Hsiao,
  • Fu-Yi Yang,
  • Chih-Yang Liu,
  • Han-Lin Chiang,
  • Ser-Chen Fu,
  • Chun-Yuan Chang,
  • I-sheng Lin,
  • Chung-Hsien Chien,
  • Yang-Chuang Chang,
  • Yu-Jen Hsiao,
  • Chen-Wen Fang,
  • Yu-Wei Chen,
  • Kuo-Ying Lee,
  • Yun-Yu Lin,
  • Chen-Hua Li,
  • Hui-Fen Tsai,
  • Chuan-Fa Hsieh,
  • Chih-Dong Yang,
  • Shiumn-Jen Liaw,
  • How-Chin Liao,
  • Shoou-Jeng Yeh,
  • Liang-Po Hsieh,
  • Yong-Hui Lee,
  • Chung-Wen Chen,
  • Chih-Shan Hsu,
  • Ye-Jian-Jhih,
  • Hao-Yu Zhuang,
  • Yan-Hong Pan,
  • Shin-An Shih,
  • Chin-I Chen,
  • Jia-Ying Sung,
  • Hsing-Yu Weng,
  • Hao-Wen Teng,
  • Jing-Er Lee,
  • Chih-Shan Huang,
  • Shu-Ping Chao,
  • Rey-Yue Yuan,
  • Jau-Jiuan Sheu,
  • Jia-Ming Yu,
  • Chun-Sum Ho,
  • Ting-Chun Lin,
  • Shih-Chieh Yu,
  • Jiunn-Rong Chen,
  • Song-Yen Tsai,
  • Hung-Pin Tseng,
  • Chin-Hsiung Liu,
  • Chun-Liang Lin,
  • Hung-Chih Lin,
  • Pi-Tzu Chen,
  • Chaur-Jong Hu,
  • Nai-Fang Chi,
  • Lung Chan,
  • Chang-Ming Chern,
  • Chun-Jen Lin,
  • Shuu-Jiun Wang,
  • Li-Chi Hsu,
  • Wen-Jang Wong,
  • I-Hui Lee,
  • Der-Jen Yen,
  • Ching-Piao Tsai,
  • Shang-Yeong Kwan,
  • Bing-Wen Soong,
  • Shih-Pin Chen,
  • Kwong-Kum Liao,
  • Kung-Ping Lin,
  • Chien Chen,
  • Din-E Shan,
  • Jong-Ling Fuh,
  • Pei-Ning Wang,
  • Yi-Chung Lee,
  • Yu-Hsiang Yu,
  • Hui-Chi Huang,
  • Jui-Yao Tsai,
  • Ming-Hsiu Wu,
  • Shi-Cheng Chen,
  • Chiung-Yao Wang,
  • Ming-Chin Hsu,
  • Tsang-Shan Chen,
  • Ping-Keung Yip,
  • Vinchi Wang,
  • Kaw-ChenWang,
  • Chung-Fen Tsai,
  • Chao-Ching Chen,
  • Chih-Hao Chen,
  • Yi-Chien Liu,
  • Shao-Yuan Chen,
  • Zi-Hao Zhao,
  • Zhi-Peng Wei,
  • Shey-Lin Wu,
  • Ching-Kuan Liu,
  • Ryh-Huei Lin,
  • Ching-Hua Chu,
  • Sui-Hing Yan,
  • Yi-Chun Lin,
  • Pei-Yun Chen,
  • Sheng-Huang Hsiao,
  • Bak-Sau Yip,
  • Pei-Chun Tsai,
  • Ping-Chen Chou,
  • Tsam-Ming Kuo,
  • Yi-Chen Lee,
  • Yi-Pin Chiu,
  • Kun-Chang Tsai,
  • Yi-Sheng Liao

DOI
https://doi.org/10.3389/fneur.2021.793471
Journal volume & issue
Vol. 12

Abstract

Read online

Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts.Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality.Results: Low cholesterol (LDL-C <100 mg/dL), found in 1/4 of the MJ cohort, was highly prevalent (36%) among young adults (age 20–39). There was a graded relationship between cholesterol and mortality for ICH [Hazard ratio, 1.56; 95% confidence interval (CI), 1.13–2.16]. Compared with patients with an LDL-C of 110–129 mg/dL in TSR, the risk for mortality was 1.84 (95% CI, 1.28–2.63) with an LDL-C of <100 mg/dL.Conclusion: Lower serum LDL-C level independently predicts higher mortality after acute ICH. While its causative role may vary, low cholesterol may pose potential harms in Taiwan.

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