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Low Cholesterol Levels Are Associated With Short-Term Mortality in Older Patients With Ischemic Stroke

¹ 2nd Department of Internal Medicine, University of Ferrara, Italy.
² Institute of Gerontology and Geriatrics, University of Perugia, Italy.

Address correspondence to Giovanni Zuliani, MD, PhD, Istituto di Medicina Interna II, Universitá degli Studi, via Savonarola n° 9, 44100 Ferrara, Italy. E-mail: gzuliani{at}hotmail.com

Background. The possible relationship between serum total cholesterol (TC) levels and outcome following ischemic stroke is still controversial. We evaluated the association between TC levels and 30-day mortality in a sample of older patients with acute ischemic stroke.

Methods. We enrolled 490 older patients with severe ischemic stroke consecutively admitted to University Hospital's Internal Medicine or Geriatrics Department. Stroke type was classified according to the Oxfordshire Community Stroke Project. The data recorded included clinical features, medical history, electrocardiogram, and blood analyses. Patients were divided into three groups by TC levels: group I (TC < 4.1 mmol/L), group II (TC 4.1–5.2 mmol/L), and group III (TC > 5.2 mmol/L).

Results. The overall mortality was 27.7%. Mortality was higher in patients with low TC levels (47.4%) compared with those with normal and high TC levels (23.0% and 24.1%, respectively). The odds ratio (OR) for short-term death was 2.17 (95% confidence interval [CI] 1.22–3.85) in group I compared with group III, after adjustment for age and gender. This result did not change after adjustment for possible confounders (OR 2.87; 95% CI 1.23–6.68). A similar trend was observed after adjustment for the Oxfordshire classification, age, and gender (OR 1.67; 95% CI 0.83–3.33).

Conclusions. Short-term mortality following ischemic stroke is higher in older participants with low TC levels, independent of a large number of factors. Low TC levels might be useful in identifying frail older participants at high risk of stroke short-term mortality.