A Low LDL-C Level but not Statin Use is Associated with In-hospital Mortality in Spontaneous Intracerebral Hemorrhage; The J-ICH Registry

2026-03-01

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Kazo Kanazawa

Miyamoto, Nobukazu *

Hideaki Ueno

Tsutsumi, Satoshi

Rikizo Saito

Joji Tokugawa

Yuji Ueno

Yamashiro, Kazuo

Munetaka Yamamoto

Yukimasa Yasumoto

Makoto Hishii

Takuji Yamamoto

Chikashi Maruki

Takao Urabe

Kondo, Akihide

Hajime Arai

Nobutaka Hattori

Ryota Tanaka *

DOI：10.5551/jat.65992

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Aim: A reduction in low-density lipoprotein cholesterol (LDL-C) is beneficial for vascular diseases; however, lower LDL-C levels may be associated with an increased risk of spontaneous intracerebral hemorrhage (sICH). The present study investigated the relationship between the LDL-C levels and in-hospital mortality after sICH using data from the Juntendo Registry of Spontaneous Intra-Cerebral Hemorrhage (J-ICH registry). Methods: Patients aged >= 20 years with non-traumatic sICH admitted to five Juntendo-affiliated hospitals between September 2016 and December 2019 were enrolled in this study. The relationships between the LDL-C levels and in-hospital mortality, statin therapy, and antithrombotic therapy were analyzed. Results: Among the 1,017 patients with sICH, lower LDL-C levels were associated with older age, a lower BMI, a larger hematoma volume, more severe neurological deficits, and a higher in-hospital mortality. A logistic regression analysis confirmed that LDL-C < 100 mg/dL independently increased the risk of in-hospital death, along with age, the NIHSS score, hematoma volume, and intraventricular hemorrhage. Subgroup analyses showed that the association between low LDL-C levels and mortality was particularly evident in patients with deep/infratentorial intracerebral hemorrhage, those managed without surgery, and those without prior statin use. Prior statin use was associated with a potential protective effect against in-hospital mortality and hematoma volume. Conclusion: This study demonstrated that lower LDL-C levels were associated with a higher in-hospital mortality after sICH, whereas prior statin use was not associated with poorer outcomes and may instead offer a protective effect.

Keywords:

Low-density lipoprotein cholesterol

Intracerebral hemorrhage

In-hospital mortality

Statins

J-ICH registry

A Low LDL-C Level but not Statin Use is Associated with In-hospital Mortality in Spontaneous Intracerebral Hemorrhage; The J-ICH Registry

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