HDL cholesterol and stroke risk: The Multi-Ethnic Study of Atherosclerosis

Abstract

Background and Purpose Accurate identification of risk factors for stroke is important for public health promotion and disease prevention. HDL cholesterol is a potential risk factor, yet its role in stroke risk is unclear, as is whether HDL cholesterol content or particle number might be a better indicator of stroke risk. Furthermore, the degree to which ethnicity moderates the risk is unknown. As such, the current study examines the associations between incident stroke and both HDL cholesterol concentration and particle number, and assesses the moderating role of race and ethnicity. Methods The sample is a racially diverse cohort of US adults between the ages of 45 - 84 years enrolled in the Multi-Ethnic Study of Atherosclerosis between 2000 - 2002 and followed until December 2011. The associations among cholesterol content and stroke risk, particle number and stroke risk, and the interaction with race were explored. Results The incidence of stroke was 2.6%. HDL cholesterol concentration (mmol/L) (Hazard Ratio (HR) = 0.56; 95% Confidence Interval (CI): 0.312 - 0.988) and number of large HDL particles (μmol/L) (HR = 0.52, CI: 0.278 - 0.956) were associated with lower stroke risk. When interactions with race were evaluated, the relationship between both HDL variables and stroke were significant in Blacks, but not other races. Conclusions Higher HDL cholesterol and a higher concentration of large particles are associated with lower risk of stroke in Blacks. Further research is needed to elucidate the mechanisms by which HDL subfractions may differentially affect stroke outcome in different races/ethnicities.

Prevalence and Clinical Characteristics of Dyslipidemia in Koreans

“…Diabetes was the sixth most common cause of death. Atherosclerosis is a preceding pathologic condition in the development of both heart and cerebrovascular diseases [45], and dyslipidemia is the greatest risk factor for atherosclerosis. Therefore, there is no doubt that dyslipidemia is a major risk factor for cardiovascular disease and mortality in Koreans.…”

The Changing Face of HDL and the Best Way to Measure It

“…The Framingham study expanded on this observation, identifying an association between low serum HDL-C and both the incidence of coronary heart disease (CHD) and overall mortality (18,19 ). Since the Framingham study, several large-scale population observational studies have provided additional support for the relationship between low concentrations of HDL-C (often quantified as between 15-40 mg/dL in serum) and an increased risk for ischemic heart disease (20 -22 ), coronary artery disease (CAD) (23,24 ), , and stroke (28 ). These early landmark findings directed the next several decades of research into the specific contributions of HDL to cardiovascular health.…”

Incorporating sampling weights into robust estimation of Cox proportional hazards regression model, with illustration in the Multi-Ethnic Study of Atherosclerosis

“…Specifically, baseline age, gender, and race/ethnicity (White, Black, Hispanic, Chinese American) were included as adjustment variables in the regression models. Based on previous analyses of stroke in the MESA data [24], we ran sensitivity analyses that included additional covariates such as season of blood draw, systolic blood pressure, cardiovascular medications (anti-hypertensives and statins), smoking, education (via an indicator of having attained a bachelor's degree or higher), low-density lipoprotein cholesterol, total cholesterol, diabetes, and body mass index.…”