on November 13, 2003
Published online before print November 13, 2003, doi: 10.1161/01.STR.0000102171.91292.DC
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on July 31, 2003
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. * To whom correspondence should be addressed. 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.
Accepted on August 13, 2003
Cholesterol and the Risk of Ischemic Stroke
Thomas S. Bowman MD, MPH*;
Key words: cerebrovascular disorders • epidemiology • lipids • risk factors • stroke
This article has been cited by other articles:
 |
|
 |
|
  S.-Y. Chuang, C.-H. Bai, W.-H. Chen, L.-M. Lien, and W.-H. Pan Fibrinogen Independently Predicts the Development of Ischemic Stroke in a Taiwanese Population: CVDFACTS Study Stroke, May 1, 2009; 40(5): 1578 - 1584. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Freiberg, A. Tybjaerg-Hansen, J. S. Jensen, and B. G. Nordestgaard Nonfasting Triglycerides and Risk of Ischemic Stroke in the General Population JAMA, November 12, 2008; 300(18): 2142 - 2152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Reeves, J. W. Gargano, Z. Luo, A. J. Mullard, B. S. Jacobs, A. Majid, and for the Paul Coverdell National Acute Stroke Regis Effect of Pretreatment With Statins on Ischemic Stroke Outcomes Stroke, June 1, 2008; 39(6): 1779 - 1785. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Woodward, F. Barzi, V. Feigin, D. Gu, R. Huxley, K. Nakamura, A. Patel, S. Ho, K. Jamrozik, and for the Asia Pacific Cohort Studies Collaboration Associations between high-density lipoprotein cholesterol and both stroke and coronary heart disease in the Asia Pacific region Eur. Heart J., November 1, 2007; 28(21): 2653 - 2660. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sanossian, J. L. Saver, M. Navab, and B. Ovbiagele High-Density Lipoprotein Cholesterol: An Emerging Target for Stroke Treatment Stroke, March 1, 2007; 38(3): 1104 - 1109. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kurth, B. M. Everett, J. E. Buring, C. S. Kase, P. M. Ridker, and J. M. Gaziano Lipid levels and the risk of ischemic stroke in women Neurology, February 20, 2007; 68(8): 556 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Everett, T. Kurth, J. E. Buring, and P. M. Ridker The Relative Strength of C-Reactive Protein and Lipid Levels as Determinants of Ischemic Stroke Compared With Coronary Heart Disease in Women J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2235 - 2242. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Campbell, M. Woodward, J. P. Chalmers, S. A. Colman, A. J. Jenkins, B. E. Kemp, B. C. Neal, A. Patel, and S. W. MacMahon Soluble Vascular Cell Adhesion Molecule 1 and N-terminal Pro-B-Type Natriuretic Peptide in Predicting Ischemic Stroke in Patients With Cerebrovascular Disease Arch Neurol, January 1, 2006; 63(1): 60 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. Landau and A. Nassief Editorial Comment-- Time to Burn the TOAST Stroke, April 1, 2005; 36(4): 902 - 904. [Full Text] [PDF]
|
|
|
|
|
|
D. L. Tirschwell, N. L. Smith, S. R. Heckbert, R. N. Lemaitre, W. T. Longstreth Jr., and B. M. Psaty Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups Neurology, November 23, 2004; 63(10): 1868 - 1875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Becker and M. Chopp Role of Statins in the Treatment and Prevention of Stroke: Introduction Stroke, November 1, 2004; 35(11_suppl_1): 2706 - 2707. [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Curb, R. D. Abbott, B. L. Rodriguez, K. H. Masaki, R. Chen, J. S. Popper, H. Petrovitch, G. W. Ross, I. J. Schatz, G. C. Belleau, et al. High Density Lipoprotein Cholesterol and the Risk of Stroke in Elderly Men: The Honolulu Heart Program Am. J. Epidemiol., July 15, 2004; 160(2): 150 - 157. [Abstract] [Full Text] [PDF]
|
|