BACKGROUND: Multiple studies suggested an immunomodulatory role of cholesterol. We investigated whether cholesterol levels are associated with the risk of infectious complications (IC) in patients with acute ischemic stroke.
METHODS: A single center prospective cohort was analyzed. Total (TOTc), Low Density Lipoprotein (LDLc) and High Density Lipoprotein (HDLc) cholesterol levels were measured within 24 hours from admission. The outcome of interest was the occurrence of any IC (pneumonia, urinary tract infection, sepsis, other infection) during hospitalization. Predictors of IC were investigated with multivariable logistic regression.
RESULTS: A total of 603 patients were included (median age 78, 49.3% males), of whom 134 (22.2%) developed an IC. Subjects with IC had lower TOTc compared to patients without IC (median 157 vs 173 mg/dl, p<0.001). When TOTc was stratified in quartiles, we observed a linear decrease in the prevalence of IC with higher TOTc levels (Q1<144 mg/dl, 32.7%; Q2 145-168 mg/dl, 24.7%; Q3 169-197 mg/dl, 17.8%; Q4>197 mg/dl, 13.3% p<0.001). The inverse relationship between TOTc and IC remained significant after adjustment for confounders in logistic regression [odds ratio (OR) for 10 mg/dL increase 0.92, 95% confidence interval (CI) 0.87-0,97, p=0.001]. This association was confirmed also for LDLc (OR 0.93, 95% CI 0.88-0.99, p=0.013) and HDLc (OR 0.85, 95% CI 0.73-0.98, p=0.026) and was not mediated by statin treatment.
CONCLUSION: Higher cholesterol levels are independently associated with lower risk of IC in patients with ischemic stroke. Further studies are needed to confirm our findings and characterize the biological mechanisms underlying this association.