Plasma Lipid Profile and Incident Ischemic Stroke

Abstract

Background and Purpose-The role of circulating lipids and lipoproteins in the pathogenesis of ischemic stroke remains uncertain despite 3 decades of research. We examined this issue in a large population-based cohort. Methods-Between 1987 and 1989, 14 175 middle-aged men and women, free of clinical cardiovascular disease, took part in the first examination of the Atherosclerosis Risk in Communities (ARIC) study cohort. Baseline measurements included plasma levels of LDL cholesterol, HDL cholesterol, apolipoprotein B, apolipoprotein A-1, and triglycerides and myriad risk factors for cardiovascular disease. The cohort was followed for cardiovascular disease end points. Results-Over an average follow-up of 10 years (142 704 person-years at risk), we documented clinical ischemic stroke in 305 participants (161 men and 144 women). After multivariable adjustment for stroke risk factors, categorical and spline regression analyses of the entire sample, as well as the sample of men alone, revealed weak and inconsistent associations between ischemic stroke and each of the 5 lipid factors. Among women, the most consistent findings were decreasing risk of ischemic stroke within the top half of the distribution of HDL cholesterol and increasing risk within the lower range of the triglyceride distribution. Conclusions-The relation of circulating cholesterol to ischemic stroke does not resemble its well-known relation to coronary heart disease. Either the pathogenesis of a substantial proportion of ischemic strokes does not involve classic atherosclerotic mechanisms, or the effect of plasma lipids on atherogenesis is substantially different in the intracranial vascular bed.

Forced Expiratory Volume in the First Second and Aldosterone as Mediators of Smoking Effect on Stroke in African Americans: The Jackson Heart Study

“…Olsen et al reported that higher total serum cholesterol levels are associated with less severe strokes42; however, in the Framingham Heart Study, the risk of carotid stenosis (a precursor of ischemic stroke) was significantly associated with high total serum cholesterol levels 43. Similarly, we did not find any positive association between elevated triglyceride levels and increased risk of stroke, consistent with several other observational studies 44, 45. In addition, the conclusion that FEV 1 and aldosterone are mediators of smoking effect on incident stroke is robust after adjusting for these additional risk factors (body mass index, hypertension, diabetes mellitus, total cholesterol, and triglyceride) (Table S2).…”

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

“…Shahar et al [15], Bowman et al [16] reported the lack of association between lipids and stroke. Study conducted by Bowman et al, of 296 stroke patients and the same number of controls, found that levels neither of total cholesterol, triglycerides nor HDL were associated with risk of ischemic stroke, although a high total cholesterol/HDL ratio was found to increase the risk.…”

“…Studies of cholesterol levels in stroke patients have revealed results varying from insignificant changes to a moderate elevation [14]. There are several studies which have not found any association between lipid profile and incident ischemic stroke [15,16]. The aim of this study was to delineate the reliability and accuracy of serum lipid profile in assessing the prognosis/neurological worsening in patients with ischemic and hemorrhagic cerebrovascular stroke.…”

Prospective Evaluation of the Alcohol Dehydrogenase γ1/γ2 Gene Polymorphism and Risk of Stroke

“…By contrast, we believe that the observed difference between studies reflects a relative differential contribution of traditional risk factors between MI and cerebrovascular event. In particular, while LDL cholesterol is an important risk factor for MI, lipid levels are poor predictors of stroke, 13 and thus effects of alcohol mediated through lipid changes may be less important for stroke. Conversely, hypertension and diabetes are relatively more powerful predictors of stroke.…”

“…Several speculative explanations have been suggested including nonclassic atherosclerotic mechanisms and differential effect of plasma lipids on atherogenesis in the intracranial vasculature. 13 Thus, if there are as yet unidentified environmental modifiers of the ADH1C gene effect on atherothrombosis, these gene-environment interactions may well differ between MI and stroke.…”