Association of LDL-C with stroke and all-cause mortality in hypertensive patients with high risk of ASCVD

The aim of this study was to determine the association between low density lipoprotein cholesterol (LDL-C) and risks of stroke and mortality in the hypertensive patients with high risk of atherosclerotic cardiovascular disease (ASCVD). A total of 19,507 hypertensive patients with high risk of ASCVD from the Kailuan cohort study were included in the present study. Patients were categorized into 5 groups by the levels of LDL-C: < 1.40 mmol/L (55 mg/dL), 1.40-1.79 mmol/L (55-69 mg/dL), 1.80-2.59 mmol/L (70-99 mg/dL), 2.60-3.39 mmol/L (100-130 mg/dL), and ≥ 3.40 mmol/L (131 mg/dL). The primary outcomes of this study included hemorrhagic stroke (HS), ischemic stroke (IS), and all-cause mortality. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HS, IS, and all-cause mortality among hypertensive patients with high risk of ASCVD across LDL-C groups. During a median follow-up of 15.81 years, 3,055 cases of stroke (including 500 cases of HS and 2,555 cases of IS) and 5,340 cases of all-cause mortality were documented. Patients with LDL-C < 1.40 mmol/L had the highest incidences of HS and all-cause mortality among the 5 LDL-C groups. After adjusting for potential confounders, the HRs of HS, IS, and all-cause mortality were 1.34 (95% CI, 1.01-1.80), 1.08 (95% CI, 0.94-1.24), and 1.10 (95% CI, 1.01-1.21) for patients with LDL-C < 1.40 mmol/L compared with those with LDL-C 1.80-2.59 mmol/L. Similar results were generated across LDL-C groups with several sensitivity analyses. LDL-C < 1.40 mmol/L was associated with increased risk of HS and all-cause mortality in hypertensive patients with high-risk of ASCVD.