Low Serum Cholesterol Level and Increased Ischemic Stroke Mortality

Blood Cholesterol Level and Risk of Stroke in Community-based or Worksite Cohort Studies: A Review of Japanese Cohort Studies in the Past 20 years

“…Table 1 summarizes the cohort studies carried out on Japanese populations over the past 20 years, listed in chronological order of date of publication. Of the 14 studies, [8][9][10][11][12][13][14][15][16][17][18][19][20][21] 2 studies were on worksite populations 8,18 and the remaining 12 studies were on residents of various communities. All but one of the studies were cohort studies, the exception being a nested case-control study.…”

“…In the cohort studies, the endpoint in eight studies was the first occurrence of stroke and/or its subtypes during the follow-up period, [8][9][10][14][15][16]18,19 and in six studies, the endpoint was death due to stroke and/or its subtypes. [11][12][13]17,20,21 Apart from two studies, 10.16 all the investigations also examined the relationship between TC (or LDLC or non-HDLC) and myocardial infarction (MI) or CAD. A positive association between hypercholesterolemia and CAD was shown in all but two of the studies 20,21 (data not shown in the table).…”

“…[11][12][13]17,20,21 Apart from two studies, 10.16 all the investigations also examined the relationship between TC (or LDLC or non-HDLC) and myocardial infarction (MI) or CAD. A positive association between hypercholesterolemia and CAD was shown in all but two of the studies 20,21 (data not shown in the table). In contrast, the majority of studies showed no association between hypercholesterolemia and total stroke events.…”

“…Furthermore, some studies reported that community residents with low serum TC or LDLC levels were more likely to develop intracerebral hemorrhage. [11][12][13]17,21 Only one recent report from the Hisayama study showed a positive association between LDLC and atherothrombotic cerebral infarction. 15 Several of the above-mentioned studies are discussed in more detail below.…”

“…[11][12][13]17,21 In 1990, a National Heart, Lung, and Blood Institute (NHLBI) Conference was held to discuss the associations between low blood cholesterol and non-coronary mortality. 34 The conference concluded that most of the inverse associations between cholesterol and non-coronary mortality, such as cancer, could be explained by reverse-causality such as pre-existing disease, unadjusted confounding factors, and socio-economic status.…”