Response to Letter by Paciaroni et al
We thank Paciaroni et al for their comments and agree with their general points. The retrospective nature of our single-center study performed in South Korea was one of the major caveats limiting the applicability of our results to general population. However, Paciaroni et al reported largely similar results with our work in their own prospectively collected Italian population1 so that the dubious association between low low-density lipoprotein cholesterol and hemorrhagic transformation may become evident.
For easier comparison, we would like to present the results of our multivariate analysis in metric units. Lower low-density lipoprotein cholesterol levels were associated with an increased risk of hemorrhagic transformation after ischemic stroke due to large artery atherothrombosis by 2% for each 1-mg/dL decrease in the low-density lipoprotein cholesterol level (adjusted OR, 0.98; 95% CI, 0.96 to 1.00; P=0.03). The association between low-density lipoprotein cholesterol levels and the risk of hemorrhagic transformation in ischemic stroke due to cardioembolism was not evident (adjusted OR, 1.01; 95% CI, 0.99 to 1.02; P=0.38), as we previously reported.2
Paciaroni M, Agnelli G, Corea F, Ageno W, Alberti A, Lanari A, Caso V, Micheli S, Bertolani L, Venti M, Palmerini F, Biagini B, Comi G, Previdi P, Silvestrelli G. Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome results of a prospective multicenter study. Stroke. 2008; 39: 2249–2256.
Kim BJ, Lee S-H, Ryu W-S, Kang BS, Kim CK, Yoon B-W. Low level of low-density lipoprotein cholesterol increases hemorrhagic transformation in large artery atherothrombosis but not in cardioembolism. Stroke. 2009; 40: 1627–1632.