ABSTRACT NUMBER: ESOC2026YS117 JOINT ASSOCIATION OF LOW-DENSITY LIPOPROTEIN CHOLESTEROL AND SYSTOLIC BLOOD PRESSURE WITH HEMORRHAGIC STROKE DEATH

Abstract Background and aims Lowering low-density lipoprotein cholesterol (LDL-C) is the key strategy for prevention of atherosclerotic cardiovascular disease. However, recent evidences suggested the possible intracerebral hemorrhagic risk resulted from low LDL-C. Comprehensive understanding on the combined effects of LDL-C and systolic blood pressure (SBP) on the risk of hemorrhagic stroke events is lacking. We aimed to examine the joint association of LDL-C and SBP with hemorrhagic stroke death. Methods We performed a prospective cohort study among 3,449,305 participants enrolled in the ChinaHEART project. Hemorrhagic stroke death data was ascertained from the National Mortality Surveillance System and Vital Registration. We used Cox proportional hazard model and Fine & Gray model to analyze the joint association. Results During the 4-year follow-up, 7,173 participants (0.21%) died due to hemorrhagic stroke. Participants with LDL-C <70mg/dL and SBP ≥120mmHg had higher risks of hemorrhagic stroke death than those with LDL-C ≥70mg/dL and SBP of 120–140mmHg; HRs were 1.36 (1.24–1.50) for LDL-C <70 mg/dL and 120 mmHg ≤SBP <140mmHg, and 2.53 (2.34–2.74) for LDL-C <70mg/dL and SBP ≥140mmHg, whereas the risk was not pronounced among individuals with LDL-C <70mg/dL and SBP <120mmHg [HR=0.93 (0.79–1.09)]. Considerable excess risk of hemorrhagic stroke death was observed in participants with LDL-C <70mg/dL and SBP ≥120mmHg, particularly among those with SBP ≥140mmHg, whereas the association became nonsignificant among individuals with SBP <120mmHg. These findings emphasis the importance of management of SBP to reduce risk of hemorrhagic stroke death among individuals with low LDL-C. Conflict of interest Guoliang Hu. nothing to disclose. Shujuan Li. nothing to disclose.