(Stroke. 2000;31:1882.)
© 2000 American Heart Association, Inc.
Original Contributions |
HDL-Cholesterol, Total Cholesterol, and the Risk of Stroke in Middle-Aged British Men
From the Department of Primary Care and Population Sciences (S.G.W., A.G.S.), Royal Free and University College Medical School, and the Department of Social Medicine (S.E.), University of Bristol, Canynge Hall, Bristol, UK.
Correspondence to Dr S. Goya Wannamethee, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill St, London NW3 2PF, UK. E-mail goya{at}rfhsm.ac.uk
Background and Purpose—The purpose of this study was to examine the relation between serum HDL cholesterol and total cholesterol and risk of stroke.
Methods—We carried out a prospective study in 7735 men, 40 to 59 years of age, drawn from 1 group practice in each of 24 British towns. Men with history of stroke were excluded (n=52).
Results—During the mean follow-up period of 16.8 years, there
were 343 stroke cases (fatal and nonfatal) in the 7683 men with no
history of stroke. Higher levels of HDL cholesterol were
associated with a significant decrease in risk of stroke even after
adjustment for potential confounders (top fifth versus lowest fifth:
adjusted relative risk=0.68, 95% CI 0.46 to 0.99). The inverse
relation was seen only for nonfatal strokes (adjusted relative
risk=0.59, 95% CI 0.39 to 0.90; top fifth versus lowest fifth). Total
cholesterol showed no graded association with fatal
strokes, but men with levels 
8.1 mmol/L (top 5% of the
distribution) showed increased risk of nonfatal stroke, although this
was not statistically significant after adjustment (adjusted RR=1.46,
95% CI 0.91 to 2.32). The beneficial effects of elevated HDL
cholesterol on nonfatal stroke were seen in both smokers
and nonsmokers and were more evident in men with hypertension than in
normotensives. In hypertensive men, elevated HDL
cholesterol (top fifth) was associated with a significant
50% reduction in risk of nonfatal strokes compared with men in the
lowest fifth.
Conclusions—Higher levels of HDL cholesterol were associated with a significant decrease in risk of nonfatal stroke. In contrast, elevated total cholesterol showed a weak positive association with nonfatal strokes. The marked inverse association between HDL cholesterol and stroke seen in hypertensives emphasizes the importance of those modifiable risk factors for stroke known to lower the concentrations of HDL cholesterol.
Key Words: cholesterol • lipoproteins, HDL cholesterol • stroke
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