Lower admission LDL-C was independently associated with early haematoma expansion after spontaneous ICH, but its incremental predictive value beyond established clinical and imaging factors was limited.
Early haematoma expansion occurred in 11.5% of patients with spontaneous intracerebral haemorrhage.
Median LDL-C was significantly lower in patients who experienced haematoma expansion compared to those who did not.
Each 1 mmol/L lower admission LDL-C was independently associated with a 70% increased risk of early haematoma expansion.
Patients in the lowest LDL-C quartile had more than four times the haematoma expansion risk compared to those in the highest quartile.
Adding LDL-C to prediction models provided limited incremental predictive value beyond established clinical and imaging factors.
This research suggests that patients admitted to hospital with a type of brain bleed called spontaneous intracerebral haemorrhage (ICH) who have lower levels of LDL cholesterol (often called 'bad' cholesterol) at the time of admission are more likely to experience haematoma expansion — a dangerous worsening of the bleed in the hours following the initial event. In a study of 541 patients, about 1 in 9 experienced early haematoma expansion, and those who did had notably lower LDL cholesterol levels on average. For every 1 mmol/L drop in LDL cholesterol, the risk of haematoma expansion increased by 70%, and patients in the lowest quarter of LDL levels had over four times the risk compared to those in the highest quarter. However, while the association between low LDL cholesterol and haematoma expansion was statistically robust, adding LDL cholesterol measurements to existing prediction tools — which already use clinical information and brain scan findings — did not meaningfully improve the ability to predict which patients would experience haematoma expansion. This means that, on its own, LDL cholesterol is unlikely to change clinical decision-making in the short term. This research suggests that LDL cholesterol may play a role in blood vessel integrity or clotting processes relevant to brain bleeding, but further studies in different patient populations are needed to confirm these findings before they could be applied in clinical practice. The results also raise questions about whether cholesterol-lowering medications (such as statins, which are widely prescribed) might influence outcomes in this setting — a question that warrants careful future investigation.
Wang G, Bai R, Zhao W, Li G, Wang D, Hou B. (2026). Admission low-density lipoprotein cholesterol and early haematoma expansion after spontaneous intracerebral haemorrhage.. Annals of medicine. https://doi.org/10.1080/07853890.2026.2730555