Low Serum Cholesterol as a Risk Factor for Hemorrhagic Stroke in Men

Okumura, Koichiro; Iseki, Kunitoshi; Wakugami, Kiyoshi; Kimura, Yorio; Muratani, Hiromi; Ikemiya, Yoshiharu; Fukiyama, Koshiro

doi:10.1253/jcj.63.53

Cited by 68 publications

(45 citation statements)

References 31 publications

(34 reference statements)

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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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“…Serum total cholesterol is not a risk factor for stroke, either cerebral hemorrhage or cerebral infarction, in Japan 29,[33][34][35][36][37] because most incidents of cerebral infarction in Japan are caused by hypertension and smoking 11,[21][22][23][24][25][26][27][28][29][30]33) . Although atherosclerosis of large vessels in the brain is caused by hypercholesterolemia 38) , the proportion caused by hypercholesterolemia is quite low in Japan 33) .…”

Section: Risk Factors For Stroke and Chd In Japanmentioning

confidence: 99%

“…Hypertension and smoking are potent risk factors for CHD and stroke 11,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . The higher the population blood pressure, the higher the risk of CHD and stroke [21][22][23][24]29) .…”

Section: Possible Explanation For the Decline In Stroke And Coronary mentioning

confidence: 99%

“…It is true in Japanese populations that serum total cholesterol is a risk factor for CHD 21,29,35,36) ; therefore, the increase in population serum total cholesterol level directly contributes to increasing CHD in the Japanese population. However, the increase in serum total cholesterol appears mainly in young to middleaged populations 5) (Fig.…”

Section: Possible Explanation For the Decline In Stroke And Coronary mentioning

confidence: 99%

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Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Ueshima

2007

JAT

250

225

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Japan's age-adjusted rate for mortality from stroke increased after the Second World War until 1965 and then showed a significant decline until 1990; however, the age-adjusted rate for mortality from all heart disease and coronary heart disease (CHD) increased until 1970 and then declined slowly. A puzzling question is why the rate of mortality from CHD declined in spite of an increase in serum total cholesterol level following an increase in fat consumption. It was confirmed that CHD incidence was far lower in several Japanese populations compared to Western countries in the "Monitoring Trends and Determinants in Cardiovascular Disease" (MONICA) project; therefore, the lower CHD mortality in Japan stems from the lower CHD incidence. CHD risk factors based on epidemiologic cohort studies in Japan were no different from those of other industrialized countries: hypertension, hypercholesterolemia, smoking and diabetes mellitus (DM). So, how can we explain this phenomenon ? There are three possible explanations. One is the decline in population blood pressure level and the prevalence of hypertension during the years 1965-1990; the second is the decline in smoking rate in men and women; the third is that the serum total cholesterol level for middle-aged and elderly populations remains 5-15 mg/dL lower than that of the US elderly counterpart, although men aged 40-49 in Japan and the US had similar serum total cholesterol levels. It was also noted that elderly people in Japan, as observed in the Seven Countries Study, had far lower serum total cholesterol levels in midlife, i.e., around 160 mg/dL in the 1960s. This was not the case for elderly in the US where a higher serum total cholesterol level was observed in midlife. In conclusion, the lower serum cholesterol level in the past of Japanese middle-aged and elderly people compared to Western counterparts helps to maintain the low CHD incidence and mortality supported by the declining trend in blood pressure level and smoking rate for both men and women. J Atheroscler Thromb, 2007; 14:278-286.

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“…5,24,25 However, no increase in hemorrhagic stroke has been seen in patients receiving cholesterol-lowering drugs in the major statin trials. In MIRACL, lowering LDL cholesterol to a mean of 72 mg/dL for 16 weeks in patients with acute coronary syndromes did not cause hemorrhagic stroke, and it reduced the overall incidence of stroke.…”

Section: Waters Et Al Stroke In Acute Coronary Syndromesmentioning

confidence: 99%

Effects of Atorvastatin on Stroke in Patients With Unstable Angina or Non-Q-Wave Myocardial Infarction

et al. 2002

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for the MIRACL Study InvestigatorsBackground-This report describes the effect of intensive cholesterol lowering with atorvastatin on the incidence of nonfatal stroke, a secondary end point, in a randomized, placebo-controlled trial of patients with unstable angina or non-Q-wave myocardial infarction. The primary end point, a composite of death, nonfatal myocardial infarction, resuscitated cardiac arrest, or recurrent symptomatic myocardial ischemia with objective evidence requiring emergency rehospitalization, was reduced from 17.4% in the placebo group to 14.8% in the atorvastatin group over the 16 weeks of the trial (Pϭ0.048). Methods and Results-Strokes were adjudicated by a blinded end-point committee using standard clinical and imaging criteria. The outcomes of nonfatal stroke and fatal plus nonfatal stroke were analyzed by time to first occurrence during the 16-week trial. Of 38 events (in 36 patients) adjudicated as fatal or nonfatal strokes, 3 were classified as hemorrhagic, one as embolic, and 29 as thrombotic or embolic; 5 could not be categorized. Nonfatal stroke occurred in 9 patients in the atorvastatin group and 22 in the placebo group (relative risk, 0.40; 95% confidence intervals, 0.19 to 0.88; Pϭ0.02). Fatal or nonfatal stroke occurred in 12 atorvastatin patients and 24 placebo patients (relative risk, 0.49; 95% confidence intervals, 0.24 to 0.98; Pϭ0.04). All 3 hemorrhagic strokes occurred in the placebo group. Conclusion-Intensive cholesterol lowering with atorvastatin over 16 weeks in patients with acute coronary syndromes reduced the overall stroke rate by half and did not cause hemorrhagic stroke. These findings need to be confirmed in future trials.

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Low Serum Cholesterol as a Risk Factor for Hemorrhagic Stroke in Men

Cited by 68 publications

References 31 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

Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Effects of Atorvastatin on Stroke in Patients With Unstable Angina or Non-Q-Wave Myocardial Infarction

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