Serum Low-Density Lipoprotein Cholesterol Levels are Associated with Relapse in Neuromyelitis Optica Spectrum Disorder

Background: The relationship between serum low-density lipoprotein cholesterol (LDL-C) and the risk of relapse in neuromyelitis optica spectrum disorder (NMOSD) remains uncertain. We aimed to examine the association between serum LDL-C level and relapse in NMOSD patients. Methods: We conducted an analysis of the prospective observational NMOSD cohort study with consecutive 184 hospitalized NMOSD patients from department of neurology. Blood samples were collected to measure LDL-C level upon admission. Primary and relapse were evaluated during hospitalization. The relationship between serum LDL-C level and relapse were analyzed by linear curve fitting analyses. Crude and adjusted odds ratios (OR) of LDL-C for relapse with 95% confidence intervals were analyzed using multiple logistic regression models. ROC curve analysis was used to identify the target lipid-lowering value of LDL-C and the probability of relapse was evaluated by the Kaplan–Meier Plot. Results: Over a mean disease course of 100± 87 days, 59.24% (n=109) participants developed relapse with higher LDL-C than the primary group (n=75) ( p < 0.001). Adjusted smoothed plots suggested that there were linear relationships between serum LDL-C level and relapse ( p < 0.001). The OR (95% CI) between serum LDL-C level and relapse were 2.67 (1.76– 4.04, p < 0.001), and 2.38 (1.48– 3.83, p < 0.001) respectively in NMOSD patients before and after adjusting for potential confounders. The target LDL-C lowering values were 2.795 mmol/L with potential benefits to prevent relapse in NMOSD. Conclusion: In this sample of NMOSD patients, we found that the elevated serum LDL-C was independently and positively associated with the relapse, and serum LDL-C should be well-controlled to prevent the relapse of NMOSD. Keywords: neuromyelitis optica spectrum disorder, NMOSD, low-density lipoprotein cholesterol, relapse, multivariate analysis