Stroke, Vol 24, 954-964, Copyright © 1993 by American Heart Association
M Konishi, H Iso, Y Komachi, M Iida, T Shimamoto, DR Jacobs Jr, A Terao, S Baba, T Sankai and M Ito
BACKGROUND AND PURPOSE: The relation between serum total cholesterol levels
and stroke is controversial. The Akita Pathology Study provides data on the
association of serum total cholesterol, different types of stroke, and
distribution of stenosis in cerebral arteries. METHODS: The data are based
on 750 autopsied men aged 30 years and older who were admitted to a local
hospital in northeast Japan between 1966 and 1984. The overall autopsy rate
was 88%. The grade of stenosis in the cerebral arteries was determined
blindly by one pathologist using Baker's method for basal cerebral arteries
(atherosclerosis scores) and using microscopic examination of a single
basal ganglion slide for the intracerebral penetrating arteries
(arteriolosclerosis scores). RESULTS: The age-adjusted mean value of serum
total cholesterol concentration was 164 mg/dL for cerebral hemorrhage, 177
mg/dL for infarction in penetrating artery regions, and 200 mg/dL for
infarction in cortical artery regions. Mean serum cholesterol was lower in
deaths caused by cerebral hemorrhage than in those caused by myocardial
infarction and other cardiovascular disease. Mean atherosclerosis score of
basal cerebral arteries was low for cerebral hemorrhage, intermediate for
penetrating artery infarction, and high for cortical artery infarction.
Stenosis of both basal and penetrating arteries was minimum or absent in
cases of cerebral hemorrhage. Only the basal arteries were stenotic in
cases of cortical artery infarction, whereas both basal and penetrating
arteries were stenosed in cases of penetrating artery infarction. There
were positive associations of serum cholesterol with stenosis of basal and
penetrating arteries. Among cases of cerebral hemorrhage, serum total
cholesterol levels were even lower in men with no significant stenosis in
either basal or penetrating arteries than in men with stenosis in either
type of artery. CONCLUSIONS: The association of serum cholesterol with
pathogenesis varies among stroke types. Elevated serum cholesterol levels
were associated with the presence of cortical artery infarction, while low
serum cholesterol levels were associated with cerebral hemorrhage.
ARTICLES
Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries. The Akita Pathology Study
Department of Preventive Medicine, National Cardiovascular Center, Osaka, Japan.
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