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(Stroke. 2002;33:1863.)
© 2002 American Heart Association, Inc.

Original Contributions

Cholesterol Predicts Stroke Mortality in the Women’s Pooling Project

Richard B. Horenstein, MD; Dean E. Smith, PhD Lori Mosca, MD, PhD for the Women’s Pooling Project Investigators

From the Department of Medicine, University of Maryland Medical System, Baltimore (R.B.H.); Department of Medicine, University of Michigan Health System, Ann Arbor (D.E.S.); and Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (L.M.).

Correspondence to Lori Mosca, MD, PhD, Associate Professor of Medicine, Columbia University College of Physicians and Surgeons, New York–Presbyterian Hospital, 622 W 168th St, ICCR PH 10-203D, New York, NY 10032. E-mail ljm10{at}columbia.edu

Background and Purpose— Cholesterol is emerging as a risk factor for stroke; however, few data are available regarding the relation of cholesterol and stroke mortality in women and ethnic minorities.

Methods— We evaluated the risk of death caused by total stroke, nonhemorrhagic stroke, and hemorrhagic stroke by race, age, and cholesterol quintile in 24 343 women with no previous cardiovascular disease who were participating in 8 US longitudinal, prospective, cohort studies included in the Women’s Pooling Project.

Results— We observed 568 stroke deaths (461 nonhemorrhagic, 83 hemorrhagic) for women 30 years of age without previous cardiovascular disease during 339 215 person-years of follow-up. In multivariate models, black women <55 years of age had a 76% increased risk of death caused by stroke compared with white women [relative risk (RR), 1.76; 95% confidence interval (CI), 1.10 to 2.81]. For black women <55 years of age, the top compared with the lowest cholesterol quintile (Q5 versus Q1) remained an independent predictor of stroke mortality (RR, 2.58; 95% CI, 1.05 to 6.32) in multivariate models. For white women <55 years of age, Q5 versus Q1 cholesterol did not predict stroke mortality with significance (RR, 1.47; 95% CI, 0.57 to 3.76). In analogous multivariate models, we found a positive relation between continuous cholesterol and nonhemorrhagic stroke death in women <55 years of age (RR, 1.23; 95% CI, 1.02 to 1.49).

Conclusions— Our results show that cholesterol is a risk factor for nonhemorrhagic stroke death in women <55 years of age and is more strongly associated with mortality in black women <55 years of age than in white women. These data document the importance of cholesterol in addition to established risk factors for predicting stroke mortality in young women and may guide prevention strategies.

Key Words: cholesterol • stroke prevention • women

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