High-Density Lipoprotein Cholesterol and Risk of Stroke in Japanese Men and Women

Abstract

Background and Purpose-Evidence of an inverse relationship between serum high-density lipoprotein cholesterol (HDL-C) and the risk of stroke is sparse in Asians and in women. The purpose of this investigation was to examine the relationship in a long-term cohort study of Japanese men and women among whom stroke occurrence is higher than in Western countries. Methods-A prospective cohort study was performed involving 4989 participants (1523 men, 3466 women) 35 to 79 years of age at baseline with Ϸ10 years of follow-up in a rural area of Japan. End points included all stroke incidence and ischemic stroke incidence. Results-During follow-up, 132 participants developed stroke, including 81 ischemic stroke cases. Age-adjusted incidence rates per 10 000 person-years for all stroke in subjects with low HDL-C (Ͻ30 mg/dL [0.78 mmol/L]) were 103.4 in men and 49.3 in women, which were remarkably higher than in subjects with high HDL-C (Ն60 mg/dL [1.56 mmol/L]) (26.4 in men and 15.5 in women). A similar relationship was observed for ischemic stroke. Multivariate-adjusted relative risks for all stroke incidence and ischemic stroke incidence were 2.89 (95% CI, 1.35 to 6.20) and 2.92 (95% CI, 1.17 to 7.32), respectively, for low versus high HDL-C participants. The relationships were independent of sex, age, body mass index, blood pressure, serum total cholesterol, alcohol consumption, and smoking. Conclusions-This 10-year follow-up study of Japanese men and women demonstrated that lower HDL-C levels were related significantly and independently to increased risk of all stroke incidence and ischemic stroke incidence.

The Relationship between Very High Levels of Serum High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in a 20-Year Follow-Up Study of Japanese General Population

“…Thus, it is not surprising that there is no association between low HDL-C and cerebral infarction in a population where there is no relationship between high LDL-C and cerebral infarction. A previous study in Japan showed a significant association between low HDL-C and risk of cerebral infarction; however, the definition of low HDL-C was too low [ 0.78 mmol/ L (30 mg/dl)], which suggested other metabolic background such as diabetes or visceral obesity 27) .…”

Serum Low-Density Lipoprotein to High-Density Lipoprotein Ratio as a Predictor of Future Acute Myocardial Infarction Among Men in a 2.7-Year Cohort Study of a Japanese Northern Rural Population

“…Furthermore, there were mostly non-significant associations between other lipid profiles or their indices and ischemic stroke. The Cardiovascular Health study 23) reported a positive association between LDL-C and the risk of ischemic stroke, and the Oyabe study 24) demonstrated an inverse relationship between HDL-C levels and ischemic stroke incidence; however, the Framingham study 25) and Hisayama study 26) did not report a clear association between the LDL-C level and the risk of ischemic stroke, and HDL-C levels were not associated with the risk of ischemic stroke in the Women's Health study 27) . Furthermore, LDL-C and HDL-C were not associated with ischemic stroke in the Atherosclerosis Risk in Community study 28) .…”

Comparison of Four Blood Pressure Indexes for the Prediction of 10-Year Stroke Risk in Middle-Aged and Older Asians

“…21,22 Briefly, the city of Oyabe is located in Toyama Prefecture in the central part of Japan. Participants of this population-based cohort study, which was performed as a part of the Oyabe Study, consisted of 5074 residents (1569 men and 3505 women) aged 35 to 79 years who received medical check-ups for the population of Oyabe from May 1988 through November 1988.…”

“…Details of this registration system were described previously. 21,22 In brief, this registration system of stroke has been continuously active for prevention of stroke and rehabilitation since 1967. Information regarding stroke was documented mainly for cases of hospitalization and outpatients by physicians of all general hospitals and general practitioners in Oyabe and general hospitals in neighboring cities.…”