Stroke, Vol 25, 814-820, Copyright © 1994 by American Heart Association
R Benfante, K Yano, LJ Hwang, JD Curb, A Kagan and W Ross
BACKGROUND AND PURPOSE: The relation between total serum cholesterol level
and thromboembolic or nonhemorrhagic stroke is controversial. The Honolulu
Heart Program cohort of Japanese-American men provides data which show that
elevated serum cholesterol is an independent predictor of thromboembolic
stroke as well as coronary heart disease (CHD). The data are presented to
suggest that the association of elevated cholesterol with stroke is
sometimes underestimated or underreported partly because of competing or
shared risk with CHD, the other major atherosclerotic end point. METHODS:
The data are based on 6352 men (aged 51 to 74 years) at baseline
examination (1971 to 1974) who were free of clinical CHD and stroke and
were followed an average of 15 years for new cases of both end points.
Relative risks of serum cholesterol for CHD and thromboembolic stroke were
calculated, controlling for other major cardiovascular covariates. RESULTS:
There was a continuous and progressive increase in both CHD and
thromboembolic stroke rates with increasing levels of serum cholesterol.
The relative risk between the highest and lowest quartiles of serum
cholesterol was 1.7 (95% confidence interval, 1.4 to 2.0) for CHD and 1.4
(95% confidence interval, 1.1 to 1.9) for thromboembolic stroke. There was
a decline in the difference in relative risks between CHD and
thromboembolic stroke in older men (aged 60 years and older) compared with
younger men (aged younger than 60 years). CONCLUSIONS: These data provide
additional evidence that elevated serum cholesterol should be considered a
primary risk factor for thromboembolic stroke, presumably through its
effect on both coronary and cerebrovascular atherosclerosis. It is
suggested that this association is sometimes underestimated or
underreported partly because of shared or competing risk with CHD, the
clinical manifestation of atherosclerosis that generally occurs earlier in
life and with greater frequency than thromboembolic stroke.
ARTICLES
Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk
Honolulu Heart Program, HI 96817.
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