# Low Cholesterol Concentrations and the Risk of Peptic Ulcer Bleeding: A Retrospective Cohort Study

## TL;DR

Low cholesterol levels, especially LDL and HDL, are linked to a higher risk of peptic ulcer bleeding, suggesting cholesterol monitoring could help prevent severe outcomes.

## Contribution

This study identifies specific cholesterol thresholds and their association with increased peptic ulcer bleeding risk.

## Key findings

- Patients with peptic ulcer bleeding had significantly lower TC, LDL-C, and HDL-C levels compared to non-bleeding patients.
- An LDL cut-off of 91.50 and HDL cut-off of 42.50 were associated with increased PUB risk with notable sensitivity.
- Each unit increase in LDL and HDL reduced PUB risk by 0.95-fold and 0.97-fold, respectively.

## Abstract

Background: Hypolipidemia has been shown to be a factor that elevates the risk of bleeding. This study aimed to investigate the relationship between cholesterol levels and the risk of peptic ulcer bleeding (PUB). Methods: A total of 15,547 patients who underwent esophagogastroduodenoscopy (EGD) between May 2017 and December 2020 were screened. Of these, 317 were included in this retrospective cohort study. PUB was diagnosed by EGD. Serum cholesterol levels were measured at six-month intervals, and cumulative mean cholesterol concentrations were calculated using all available data during the observation period. Results: Ulcer bleeding was detected in 173 (45.6%) patients with peptic ulcer. Patients with bleeding peptic ulcer exhibited significantly lower TC, LDL-C, and HDL-C levels compared to non-bleeding peptic ulcer patients and controls (p < 0.001). The optimal LDL cut-off was 91.50 (p < 0.001), with 75.1% sensitivity and 24.1% specificity. For HDL, the cut-off was 42.50 (p < 0.001), yielding 72.3% sensitivity and 30.1% specificity. A one-unit increase in LDL and HDL reduced the risk of PUB by 0.95-fold and 0.97-fold, respectively. Conclusions: Our findings suggest that reduced cholesterol levels, particularly LDL-C and HDL-C, may elevate the risk of PUB. Therefore, monitoring cholesterol levels in peptic ulcer patients, especially those at higher bleeding risk, could be beneficial.