Total and High-Density Lipoprotein Cholesterol and Stroke Risk

Abstract

Background and Purpose-The association of total and high-density lipoprotein (HDL) cholesterol with stroke risk is unclear, especially regarding hemorrhagic stroke. Methods-We prospectively investigated the associations of serum total and HDL cholesterol and total/HDL cholesterol ratio with total and type-specific stroke incidence among 58 235 Finnish people aged 25 to 74 years and free of coronary heart disease and stroke at baseline. Results-During a mean follow-up period of 20.1 years, 3914 participants developed stroke events (3085 ischemic, 497 intracerebral hemorrhage, and 332 subarachnoid hemorrhage). The multivariable-adjusted hazard ratios at different levels of total cholesterol (Ͻ5 [reference], 5-5.9, 6 -6.0, Ն7.0 mmol/L) were 1.00, 1.05, 1.16, and 1.22 for total stroke (P trend ϭ0.036) and 1.00, 1.06, 1.19, and 1.27 for ischemic stroke (P trend ϭ0.02) in men and 1.00, 0.58, 0.61, and 0.50 for intracerebral hemorrhagic stroke (P trend ϭ0.02) in women, respectively. Low levels of HDL cholesterol and high total/HDL cholesterol ratio were associated with increased risks of total and ischemic stroke in both men and women. These associations disappeared in men but remained significant in women after further adjustment for body mass index, blood pressure, and history of diabetes. Conclusions-The study showed a positive association between total cholesterol and total and ischemic stroke risks in men and an inverse association between total cholesterol and intrahemorrhagic stroke risk in women. The inverse association of HDL cholesterol and a positive association of total/HDL cholesterol ratio with total and ischemic stroke risks were found in men and women. These associations attenuated after adjustment for body mass index, blood pressure, and history of diabetes.

Blood lipid levels, statin therapy and risk of intracerebral hemorrhage versus ischemic vascular events: a prospective case control study from tertiary care center of south India

“…Level of HDL cholesterol positively correlated with risk of ICH, suggesting that increased level of HDL cholesterol may be related to higher risk of ICH. 5 However in the present study no significant difference in HDL level and occurrence of ICH was observed.…”

“…Our findings are consistent with previous studies which confirm the role of low lipids and risk of ICH specifically for hemorrhage due to hypertensive vasculopathy. [4][5][6] Mean LDL cholesterol was significantly lower in ICH patients with alcohol when compared with ischemic group. This is attributed to the fact that LDL cholesterol level decreased significantly as alcohol intake increased.…”

“…Our findings are against the prospective study reported by Zhang et al, where significant low total cholesterol was associated with risk of ICH in women, but not in men. 5 Bonaventure et al in his study demonstrated that low levels of TG was associated with a more than two fold increased risk of ICH. 4 Similar findings were observed in present study (P value= 0.022).…”

“…3 Many epidemiological and case control studies showed low lipid levels as risk factor for ICH, especially for hemorrhage due to hypertensive vasculopathy. [4][5][6] This was attributed to the fact that lipids especially cholesterol and TG are essential component of cell membrane and play an important role in maintaining the stability of cerebral blood vessels. 7 So far our study has been first of its kind that compared blood lipids and use of statins in ICH and ischemic group and being the largest from India.…”

Lipid and lipoprotein measurements and the risk of ischemic vascular events

“…[4][5][6][7][8][9][10][11][12][13][14] Ascertainment of vascular events varies among studies; few have utilized the clinical records and objective clinical evidence at the time of the event as has the Framingham Heart Study (FHS). Furthermore, while the majority of studies used a combined endpoint of all strokes (ischemic and hemorrhagic) and rarely discriminated among stroke subtypes, 4,5,8,15,16 only a few studies examined the value of a wide range of lipid biomarkers in risk prediction of IS. 4,7,8,15,16 Therefore, some studies found increased risk of stroke with higher TC and/or lower HDL-C, 4-8 while others did not.…”