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

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d3254142e274">Background and Purpose</h5> <p id="P1">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, LDL, and lipid-lowering agent use are lacking. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d3254142e279">Methods</h5> <p id="P2">The medical records of 4,701 patients with 6,411 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 non-ruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the effects of lipids (total cholesterol, LDL, 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. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d3254142e284">Results</h5> <p id="P3">Lipid-lowering agent use was significantly inversely associated with rupture status (OR 0.58, 95% CI 0.47–0.71). In a subgroup analysis of complete cases that includes both lipid-lowering agent use and lipid values, higher HDL levels (OR 0.95, 95% CI 0.93–0.98) and lipid-lowering agent use (OR 0.41, 95% CI 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. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d3254142e289">Conclusions</h5> <p id="P4">Higher HDL values and the use of lipid-lowering agents are significantly inversely associated with ruptured intracranial aneurysms. </p> </div>