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. 2018 May;49(5):1148-1154.
doi: 10.1161/STROKEAHA.117.019972. Epub 2018 Apr 5.

Lipid-Lowering Agents and High HDL (High-Density Lipoprotein) Are Inversely Associated With Intracranial Aneurysm Rupture

Anil Can  1 , Victor M Castro  2 , Dmitriy Dligach  3   4 , Sean Finan  3 , Sheng Yu  5   6 , Vivian Gainer  2 , Nancy A Shadick  7 , Guergana Savova  3 , Shawn Murphy  2   8 , Tianxi Cai  9 , Scott T Weiss  5   10 , Rose Du  11   10
Affiliations

Lipid-Lowering Agents and High HDL (High-Density Lipoprotein) Are Inversely Associated With Intracranial Aneurysm Rupture

Anil Can et al. Stroke. 2018 May.

Abstract

Background and purpose: Growing evidence from experimental animal models and clinical studies suggests the protective effect of statin use against rupture of intracranial aneurysms; however, results from large studies detailing the relationship between intracranial aneurysm rupture and total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and lipid-lowering agent use are lacking.

Methods: The medical records of 4701 patients with 6411 intracranial aneurysms diagnosed at the Massachusetts General Hospital and the Brigham and Women's Hospital between 1990 and 2016 were reviewed and analyzed. Patients were separated into ruptured and nonruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the effects of lipids (total cholesterol, LDL, and HDL) and lipid-lowering medications on intracranial aneurysm rupture risk. Propensity score weighting was used to account for differences in baseline characteristics of the cohorts.

Results: Lipid-lowering agent use was significantly inversely associated with rupture status (odds ratio, 0.58; 95% confidence interval, 0.47-0.71). In a subgroup analysis of complete cases that includes both lipid-lowering agent use and lipid values, higher HDL levels (odds ratio, 0.95; 95% confidence interval, 0.93-0.98) and lipid-lowering agent use (odds ratio, 0.41; 95% confidence interval, 0.23-0.73) were both significantly and inversely associated with rupture status, whereas total cholesterol and LDL levels were not significant. A monotonic exposure-response curve between HDL levels and risk of aneurysmal rupture was obtained.

Conclusions: Higher HDL values and the use of lipid-lowering agents are significantly inversely associated with ruptured intracranial aneurysms.

Keywords: aneurysm; cholesterol; intracranial aneurysms; lipids; subarachnoid hemorrhage.

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Figures

Figure 1
Figure 1
Proportion of ruptured aneurysms stratified according to lipid lowering agents and dose.
Figure 2
Figure 2
Proportion of ruptured aneurysms stratified by HDL levels. Error bars are standard errors.
See this image and copyright information in PMC

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