The Korean journal of internal medicine

  • 제27권3호
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  • Pages.317-326
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  • 2012
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Characteristics of Subjects with Very Low Serum Low-Density Lipoprotein Cholesterol and the Risk for Intracerebral Hemorrhage

  • Lee, Jae-Geun (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Koh, Sung-Joo (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Yoo, So-Yeon (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Yu, Jung-Re (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Lee, Sang-Ah (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Koh, Gwan-Pyo (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Lee, Dae-Ho (Department of Internal Medicine, Jeju National University School of Medicine)
  • 발행 : 2012.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: The clinical implications of hypocholesterolemia have not been well studied, although some studies have revealed an association between hypocholesterolemia and intracerebral hemorrhage (ICH). We evaluated the clinical characteristics of subjects with very low-density lipoprotein cholesterol (LDL-C) and compared the risk for ICH using various clinical parameters. Methods: Using hospital records, we evaluated the clinical characteristics of subjects with LDL-C levels ${\leq}$ 40 mg/dL (very low LDL-C group). We also evaluated the risk for ICH in this very low LDL-C group and in subjects with low LDL-C ${\leq}$ 70 mg/dL (low LDL-C group). Results: Among 34,415 subjects who presented at the laboratory for serum LDL-C measurements, 250 subjects had a very low serum LDL-C level (${\leq}$ 40 mg/dL). About half of the subjects were statin users; the very low LDL levels in the other subjects were likely attributable to alcohol consumption or a various chronic illness such as liver disease or end-stage renal disease (ESRD). ICH occurred in three subjects with very low LDL-C, all of whom had no history of statin use. ESRD tended to be associated with ICH in subjects with serum LDL-C ${\leq}$ 70 mg/dL. Conclusions: About 1% of the subjects whose LDL-C was measured in the hospital had a LDL-C level ${\leq}$ 40 mg/dL, and about half of these subjects had no history of hypolipidemic therapy. ICH incidence was not related to LDL-C level or statin use.

키워드

참고문헌

  1. Cziraky MJ, Watson KE, Talbert RL. Targeting low HDLcholesterol to decrease residual cardiovascular risk in the managed care setting. J Manag Care Pharm 2008;14(8 Suppl):S3-S28.
  2. Brunzell JD, Davidson M, Furberg CD, et al. Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care 2008;31:811-822. https://doi.org/10.2337/dc08-9018
  3. O'Keefe JH Jr, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dL: lower is better and physiologically normal. J Am Coll Cardiol 2004;43:2142-2146. https://doi.org/10.1016/j.jacc.2004.03.046
  4. Stemmermann GN, Chyou PH, Kagan A, Nomura AM, Yano K. Serum cholesterol and mortality among Japanese-American men: the Honolulu (Hawaii) Heart Program. Arch Intern Med 1991;151:969-972. https://doi.org/10.1001/archinte.1991.00400050113021
  5. Iribarren C, Reed DM, Burchfiel CM, Dwyer JH. Serum total cholesterol and mortality: confounding factors and risk modification in Japanese-American men. JAMA 1995;273:1926-1932. https://doi.org/10.1001/jama.1995.03520480046038
  6. Frank JW, Reed DM, Grove JS, Benfante R. Will lowering population levels of serum cholesterol affect total mortality? Expectations from the Honolulu Heart Program. J Clin Epidemiol 1992;45:333-346. https://doi.org/10.1016/0895-4356(92)90034-K
  7. Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level and mortality findings for men screened in the multiple risk factor intervention trial: multiple risk factor intervention trial research group. Arch Intern Med 1992;152:1490-1500. https://doi.org/10.1001/archinte.1992.00400190110021
  8. Noda H, Iso H, Irie F, et al. Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study. Circulation 2009;119:2136-2145. https://doi.org/10.1161/CIRCULATIONAHA.108.795666
  9. Stone NJ, Bilek S, Rosenbaum S. Recent National Cholesterol Education Program Adult Treatment Panel III update: adjustments and options. Am J Cardiol 2005;96(4A):53E-59E.
  10. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005;352:1425-1435. https://doi.org/10.1056/NEJMoa050461
  11. Johnson C, Waters DD, DeMicco DA, et al. Comparison of effectiveness of atorvastatin 10 mg versus 80 mg in reducing major cardiovascular events and repeat revascularization in patients with previous percutaneous coronary intervention (post hoc analysis of the Treating to New Targets [TNT] Study). Am J Cardiol 2008;102:1312-1317. https://doi.org/10.1016/j.amjcard.2008.07.023
  12. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-1278. https://doi.org/10.1016/S0140-6736(05)67394-1
  13. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350:1495-1504. https://doi.org/10.1056/NEJMoa040583
  14. Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol 2009;8:453-463. https://doi.org/10.1016/S1474-4422(09)70058-4
  15. Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. Highdose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006;355:549-559. https://doi.org/10.1056/NEJMoa061894
  16. Goldstein LB, Amarenco P, Szarek M, et al. Hemorrhagic stroke in the stroke prevention by aggressive reduction in cholesterol levels study. Neurology 2008;70(14 Pt 2):2364-2370. https://doi.org/10.1212/01.wnl.0000296277.63350.77
  17. Song JX, Ren JY, Chen H. Primary and secondary hypocholesterolemia. Beijing Da Xue Xue Bao 2010;42:612-615.
  18. Moutzouri E, Elisaf M, Liberopoulos EN. Hypocholesterolemia. Curr Vasc Pharmacol 2011;9:200-212. https://doi.org/10.2174/157016111794519354
  19. Levesque H, Gancel A, Pertuet S, Czernichow P, Courtois H. Hypocholesterolemia: prevalence, diagnostic and prognostic value: study in a department of internal medicine. Presse Med 1991;20:1935-1938.
  20. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2012;35 Suppl 1:S64-S71. https://doi.org/10.2337/dc12-s064
  21. Iribarren C, Jacobs DR, Sadler M, Claxton AJ, Sidney S. Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program. Stroke 1996;27:1993-1998. https://doi.org/10.1161/01.STR.27.11.1993
  22. Yang X, So WY, Ma RC, et al. Low LDL cholesterol, albuminuria, and statins for the risk of cancer in type 2 diabetes: the Hong Kong diabetes registry. Diabetes Care 2009;32:1826-1832. https://doi.org/10.2337/dc09-0725
  23. Suh I, Jee SH, Kim HC, Nam CM, Kim IS, Appel LJ. Low serum cholesterol and haemorrhagic stroke in men: Korea Medical Insurance Corporation Study. Lancet 2001;357:922-925. https://doi.org/10.1016/S0140-6736(00)04213-6
  24. Segal AZ, Chiu RI, Eggleston-Sexton PM, Beiser A, Greenberg SM. Low cholesterol as a risk factor for primary intracerebral hemorrhage: a case-control study. Neuroepidemiology 1999;18:185-193. https://doi.org/10.1159/000026210
  25. Benn M, Tybjaerg-Hansen A, Stender S, Frikke-Schmidt R, Nordestgaard BG. Low-density lipoprotein cholesterol and the risk of cancer: a mendelian randomization study. J Natl Cancer Inst 2011;103:508-519. https://doi.org/10.1093/jnci/djr008
  26. Elmehdawi R. Hypolipidemia: a word of caution. Libyan J Med 2008;3:84-90. https://doi.org/10.4176/071221
  27. Vyroubal P, Chiarla C, Giovannini I, et al. Hypocholesterolemia in clinically serious conditions: review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008;152:181-189. https://doi.org/10.5507/bp.2008.029
  28. Barter P, Gotto AM, LaRosa JC, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007;357:1301-1310. https://doi.org/10.1056/NEJMoa064278
  29. Woo D, Kissela BM, Khoury JC, et al. Hypercholesterolemia, HMG-CoA reductase inhibitors, and risk of intracerebral hemorrhage: a case-control study. Stroke 2004;35:1360-1364. https://doi.org/10.1161/01.STR.0000127786.16612.A4
  30. Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebocontrolled trial. Lancet 2002;360:7-22. https://doi.org/10.1016/S0140-6736(02)09327-3
  31. White HD, Simes RJ, Anderson NE, et al. Pravastatin therapy and the risk of stroke. N Engl J Med 2000;343:317-326. https://doi.org/10.1056/NEJM200008033430502
  32. Byington RP, Davis BR, Plehn JF, et al. Reduction of stroke events with pravastatin: the Prospective Pravastatin Pooling (PPP) project. Circulation 2001;103:387-392. https://doi.org/10.1161/01.CIR.103.3.387
  33. Wanner C, Krane V, Marz W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005;353:238-248. https://doi.org/10.1056/NEJMoa043545

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