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We read the article by Ma et al.1 with great interest. Despite the observed significant association between lower low-density lipoprotein cholesterol (LDL-C) levels and higher intracranial hemorrhage (ICH) risk when LDL-C was <70 mg/dL, we must consider a result that there were only 768 events in a follow-up of 9 years on a cohort of 96,043 participants, representing only 0.0008 events per person-year. Even considering the increased risk of 65% in the lower LDL group, we assessed only a risk of 0.0015 events per person-year (there were only 179 cases in 13,050 participants). Then, despite being statistically significant, it can be considered clinically insignificant, facing an extremely low individual risk of ICH, especially considering the potential benefits that low LDL can bring in patients at high cardiovascular risk, which is more prevalent. Further studies must be conducted, but we do not believe that these findings will reflect future changes in current practice.
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Author disclosures are available upon request (journal{at}neurology.org).
- © 2020 American Academy of Neurology
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