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(Stroke. 2003;34:2930.)
© 2003 American Heart Association, Inc.

Original Contributions

Cholesterol and the Risk of Ischemic Stroke

Thomas S. Bowman, MD, MPH; Howard D. Sesso, ScD, MPH; Jing Ma, MD, PhD; Tobias Kurth, MD, ScD; Carlos S. Kase, MD; Meir J. Stampfer, MD, DrPH J. Michael Gaziano, MD, MPH

From Harvard University General Internal Medicine Fellowship Program (T.S.B.); Veterans Affairs Boston Healthcare System–Massachusetts Veterans Affairs Epidemiology, Research, and Information Center (T.S.B., H.D.S., J.M.G.); Department of Epidemiology, Harvard School of Public Health (M.J.S.); Channing Laboratory (J.M., M.J.S.); Department of Neurology, Boston University School of Medicine (C.S.K.); and the Divisions of Preventive Medicine and Aging, Brigham and Women’s Hospital (T.S.B., H.D.S., T.K., J.M.G.), Boston, Mass.

Correspondence to Thomas S. Bowman, MD MPH, Massachusetts Veterans Affairs Epidemiology, Research, and Information Center, 150 S Huntington Ave, MAV-151, Boston, MA 02130. E-mail thomasbowman{at}pol.net

Background and Purpose— Large epidemiological studies have not established cholesterol levels as a risk factor for ischemic stroke, but recent clinical trials have demonstrated a reduction in the ischemic stroke rate for patients taking HMG-CoA reductase inhibitors ("statins"). The goal of this study was to evaluate whether total cholesterol (TC), high-density lipoprotein (HDL), triglycerides, and the TC:HDL ratio are risk factors for ischemic stroke in apparently healthy men enrolled in the Physicians’ Health Study.

Methods— We used a nested case-control study design and matched 296 ischemic stroke cases with an equal number of controls on age, tobacco use, and follow-up time. At baseline, TC, HDL, and triglyceride levels were measured. We calculated odds ratios (ORs) and their 95% confidence intervals (CIs) using conditional logistic regression, adjusting for major risk factors for ischemic stroke.

Results— Compared with the reference lowest quartile, the highest quartile for TC had an adjusted OR of 1.56 (95% CI, 0.84 to 2.92), the highest quartile of HDL had an adjusted OR of 0.75 (95% CI, 0.43 to 1.30), and the highest quartile of triglycerides had an adjusted OR of 1.07 (95% CI, 0.63 to 1.82). Although the highest quartile of the TC:HDL ratio had an adjusted OR of 1.62 (95% CI, 0.93 to 2.82), the risk of ischemic stroke was not a linear relationship.

Conclusions— After adjustment, TC, HDL, and triglycerides were not significantly associated with ischemic stroke risk, and for the TC:HDL ratio, a suggestion of increased risk of ischemic stroke was limited to those with the highest levels.

Key Words: cerebrovascular disorders • epidemiology • lipids • risk factors • stroke

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