Study of cholesterol levels in patients with ischaemic stroke and their outcome

Background: Stroke is a major health problem in India. Stroke burden has been rising in India as compared to the developed countries. Recent studies have shown that high serum cholesterol is associated with clinically less severe ischaemic strokes and better outcome. Aim: The primary objective of the study was to compare the outcome of patients with ischaemic stroke to their cholesterol levels and to correlate the cholesterol levels to the stroke outcome. Materials and methods: This hospital based prospective follow-up study was conducted in 140 patients admitted with ischaemic stroke in the medical wards of Medical College hospital, Trivandrum. Patients were divided into 2 groups based on cholesterol levels as <160 mg/dl and >160 mg/dl. Their clinical severity at presentation was calculated by Scandinavian stroke scale (0=worst, 58=best) and outcome of these patients at the end of 1 year was measured by Modified Rankin scale (0=best, 6=worst).Serum cholesterol was measured using enzymatic method. Results: Mean age of 140 patients of at presentation was 63.4±11.9 years of which 53.5% (n=75) males, the mean Scandinavian stroke scale (SSS) being 28.3±12.5. The mean SSS score of high cholesterol group was 39.6 whereas 17 in the low cholesterol group (p<0.001). Similarly, the size of infarct in CT brain, outcome variables of modified Rankin scale and mortality were statistically significant between these groups (p<0.001). Bivariate correlation analysis showed that increased serum cholesterol level is associated with increased SSS score (positive correlation) with high statistical significance (p<0.001). Logistic regression adjustedwith other risk factors showed high cholesterol levels are associated with better outcome and decreased mortality, which is supported by Kaplan-Meier survival analysis. Conclusion: Hypercholesterolemia is associated with clinically minor strokes and better outcome, whereas major strokes are commonly seen in patients in the low cholesterol group. Hence post stroke outcome is inversely related to serum cholesterol levels in ischaemic stroke patients.