Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups

Tirschwell, David; Smith, Nicholas L.; Heckbert, S.R.; Lemaître, Rozenn N.; Longstreth, W. T.; Psaty, Bruce M.

doi:10.1212/01.wnl.0000144282.42222.da

Cited by 283 publications

(255 citation statements)

References 52 publications

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“…Okumara et al [17], Irribarren [18], Tirschwell [19], in their studies observed that hypercholesterolemia is a protective factor against ICH and that low blood cholesterol increases risk for ICH with an inverse relationship existing between serum cholesterol and incidence of ICH. Bang et al [20], postulated that Cholesterol is known to have effects on the vasculature and is essential for normal membrane fluidity, and adequate cholesterol levels may be important for maintaining the integrity of vessels and their resistance to rupture.…”

Section: Discussionmentioning

confidence: 98%

Effect of Lipid Profile Upon Prognosis in Ischemic and Haemorrhagic Cerebrovascular Stroke

Bharosay

Bandyopadhyay

et al. 2013

Ind J Clin Biochem

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Stroke is the third major cause of death worldwide. Elevated plasma concentration of low density lipoproteins and low plasma concentration of high density lipoprotein concentration are associated with an increased risk of atherosclerosis and coronary heart disease but the relation between serum lipids, and cerebrovascular disease is less clear. The aim of this study was to investigate the reliability and accuracy of serum lipid profile in assessing the prognosis/neurological worsening in patients with ischemic and hemorrhagic cerebrovascular stroke. The subjects in the present study comprised of 101 healthy controls and 150 cerebrovascular stroke patients (including 90 with ischemic stroke and 60 with intracerebral hemorrhagic stroke). In both the groups fasting lipid profile was determined within 72 h of the stroke. A statistically significant association was observed (p \ 0.001) between the parameters of lipid profile of cases and healthy controls, and also with the prognosis of the stroke.

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Section: Discussionmentioning

confidence: 98%

Effect of Lipid Profile Upon Prognosis in Ischemic and Haemorrhagic Cerebrovascular Stroke

Bharosay

Bandyopadhyay

et al. 2013

Ind J Clin Biochem

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“…Numerous studies have thus reported a beneficial effect of LA on blood lipids and blood pressure 23, 24. Since hypercholesterolemia and hypertension have a different impact on the large precerebral arteries and the small cerebral arteries,9, 25, 26 this could partly explain the observed differences in risk between subtypes of ischemic stroke. We found a lower risk of large artery atherosclerosis and indications of a negative association between LA content in adipose tissue and small‐vessel occlusion.…”

Section: Discussionmentioning

confidence: 99%

Linoleic Acid in Adipose Tissue and Development of Ischemic Stroke: A Danish Case‐Cohort Study

Venø

Bork

Jakobsen

et al. 2018

JAHA

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BackgroundWe investigated the association between the content of linoleic acid in adipose tissue, a biomarker of long‐term intake of linoleic acid, and the risk of ischemic stroke and its subtypes.Methods and ResultsThe Danish cohort study Diet, Cancer and Health included 57 053 patients aged 50 to 65 years at enrollment. All participants had an adipose tissue biopsy performed at enrollment, while information on ischemic stroke during follow‐up was obtained from the Danish National Patient Register. Stroke diagnoses were all validated and classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Cases and a randomly drawn subcohort of 3500 patients had their fatty acid composition in adipose tissue determined by gas chromatography. Hazard ratios with 95% confidence intervals were calculated using weighted Cox proportional hazard regression. During 13.5 years of follow‐up, 1879 ischemic stroke cases were identified, for which 1755 adipose biopsies were available, while adipose biopsies were available for 3203 participants in the subcohort. When comparing the highest and the lowest quartiles of adipose tissue content of linoleic acid there was a negative association with the rate of total ischemic stroke (hazard ratio, 0.78; 95% confidence interval, 0.65–0.93) and large artery atherosclerosis (hazard ratio, 0.61; 95% confidence interval, 0.43–0.88), while there was an indication of a negative association with small‐vessel occlusion (hazard ratio, 0.87; 95% confidence interval, 0.69–1.11). There was no clear association with the rate of cardioembolism.ConclusionsThe content of linoleic acid in adipose tissue was inversely associated with the risk of total ischemic stroke and stroke caused by large artery atherosclerosis.

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“…Recent studies that have addressed the limitations of prior studies generally have shown an association of elevated serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, and nonhigh-density lipoprotein cholesterol with ischemic stroke risk, especially atherosclerotic and lacunar stroke subtypes. For instance, in 1 study the highest total cholesterol quintile was related to greater ischemic stroke risk vs the lowest quintile (odds ratio, 1.6; 95% confidence interval, 1.3 to 2.0), and the most robust subtype associations were for atherosclerotic stroke (OR, 3.2) and lacunar stroke (OR, 2.4) [34]. Elevated high-density lipoprotein cholesterol was shown to be protective for stroke in NOMASS [4].…”

Section: Modifiable Medical Risk Factorsmentioning

confidence: 93%

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

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Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

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Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups

Abstract: Higher total and lower HDL cholesterol levels were associated with increased risk of ischemic stroke, especially certain stroke subtypes and patient subgroups. The lowest levels of total cholesterol were associated with an increased risk of all hemorrhagic strokes.

Cited by 283 publications

References 52 publications

Effect of Lipid Profile Upon Prognosis in Ischemic and Haemorrhagic Cerebrovascular Stroke

Effect of Lipid Profile Upon Prognosis in Ischemic and Haemorrhagic Cerebrovascular Stroke

Linoleic Acid in Adipose Tissue and Development of Ischemic Stroke: A Danish Case‐Cohort Study

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

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