Low-density lipoprotein cholesterol and severity of intracerebral hemorrhage: Insights from the SIREN study

Authors

• Oladotun V. Olalusi, University College Hospital, Ibadan
• Osahon J. Asowata, College of Medicine, University of Ibadan
• Fred Stephen Sarfo, Kwame Nkrumah University of Science & Technology
• Onoja Matthew Akpa, College of Medicine, University of Ibadan
• Joshua Akinyemi, College of Medicine, University of Ibadan
• Joseph Yaria, University College Hospital, Ibadan
• Akintomiwa Makanjuola, University College Hospital, Ibadan
• Akinkunmi Paul Okekunle, Seoul National University
• Feyisayo Alabi, University College Hospital, Ibadan
• Paul Olowoyo, Afe Babalola University
• Adekunle Fakunle, University College Hospital, Ibadan
• Oladimeji Adebayo, College of Medicine, University of Ibadan
• Okechukwu Ogah, College of Medicine, University of Ibadan
• Oyedunni Arulogun, College of Medicine, University of Ibadan
• Ijezie Chukwuonye, Federal Medical Centre, Umuahia
• Ugochukwu Onyeonoro, Federal Medical Centre Nigeria
• Benedict Calys-Tagoe, University of Ghana
• Lambert Appiah, Kwame Nkrumah University of Science & Technology
• Arti Singh, Kwame Nkrumah University of Science & Technology
• Samuel Diala, University College Hospital, Ibadan
• Ayomide Owolabi, University College Hospital, Ibadan
• Hemant K. Tiwari, The University of Alabama at Birmingham
• Ruth Y. Larea, University of Ghana
• Carolyn Jenkins, MUSC College of Nursing
• Godwin Ogbole, College of Medicine, University of Ibadan
• Albert Akpalu, University of Ghana
• Reginald Obiako, Ahmadu Bello University
• Morenikeji Komolafe, Obafemi Awolowo University

Abstract

Background: We investigated the link between LDL-C and markers of ICH severity among Indigenous West Africans in the Stroke Investigative Research and Education Network study. Methods: ICH severity was evaluated using the Glasgow Coma Scale (GCS), Stroke Levity Scale (SLS), and the National Institutes of Health Stroke Scale (NIHSS). The serum LDL-c of the study population was dichotomized into <133 mg/dl and ≥ 133 mg/dl using the optimum threshold by the Youden Index after assessing the linear relationship between the serum LDL-c measured at admission and ICH severity markers. A multivariate-adjusted logistic regression was performed to identify the independent association of serum LDL-C with ICH severity. Results: Overall, 959 subjects were investigated, with a mean age of 53.9 ± 13.24 years; 62.7 % were men with GCS median (IQR) of 8.0 (12.0,15.0), SLS of 5.0 (2.0,8.0) and NIHSS of 15.0 (8.0,23.0). The mean ± SD LDL-C was 124.78 ± 51.8 mg/dl and the baseline serum LDL-C showed a positive linear relationship with admitting GCS and SLS scores and a negative relationship with the NIHSS score. Patients with LDL < 133 mg/dl had more severe stroke [SLS median (IQR): 5.0(2.0,8.0] and GCS median (IQR):11.0(7.0,15.0] compared to patients with LDL-C ≥ 133 mg/dl. Systolic BP ≥ 140 mmHg [1.720 (1.168,2.532)], ICH volume ≥ 30mls [2.774(1.990,3.865)], presence of intraventricular extension [1.564 (1.158, 2.113)] and serum LDL-C < 133 mg/dl [1.502 (1.110, 2.032)] were independently associated with severe ICH. In the subgroup analysis, the independent association between serum LDL-C < 133 mg/dl and severe ICH was stronger for subjects <50 years [1.690 (1.017, 2.808)] and males [1.621 (1.092, 2.406)]. Conclusion: Low serum LDL-C is independently associated with severe ICH among West Africans.

Publication Title

Journal of the Neurological Sciences

Recommended Citation

Olalusi, O., Asowata, O., Sarfo, F., Akpa, O., Akinyemi, J., Yaria, J., Makanjuola, A., Okekunle, A., Alabi, F., Olowoyo, P., Fakunle, A., Adebayo, O., Ogah, O., Arulogun, O., Chukwuonye, I., Onyeonoro, U., Calys-Tagoe, B., Appiah, L., Singh, A., Diala, S., Owolabi, A., Tiwari, H., Larea, R., Jenkins, C., Ogbole, G., Akpalu, A., Obiako, R., & Komolafe, M. (2025). Low-density lipoprotein cholesterol and severity of intracerebral hemorrhage: Insights from the SIREN study. Journal of the Neurological Sciences, 474 https://doi.org/10.1016/j.jns.2025.123555