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(Stroke. 2008;39:e61.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Total Cholesterol, Severity of Stroke, and All-Cause Mortality

US Department of Health and Human Services, Centers for Medicare & Medicaid Services, Kansas City, Mo

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

The association of blood cholesterol with the risk of stroke, a very important clinical and public health issue, appears to be in dispute. To fuel the debate, Olsen et al¹ reported a study of 513 patients admitted in a Copenhagen, Denmark hospital with acute ischemic stroke. All study data, including measures of total serum cholesterol (TSC) and the severity of stroke, were collected on admission in the hospital, and poststroke 10-year all-cause mortality was ascertained. The severity of stroke was measured by the Scandinavian Stroke Scale that is based on a composite of neurological deficits, and severity was found to be correlated with the cerebral infarct size seen on CT scans. The authors found that poststroke TSC levels were inversely associated with the severity of stroke, cerebral infarct size, and mortality, which were adjusted for the covariates.¹

The authors concluded that "hypercholesterolemia primarily is associated with minor strokes due to small-vessel occlusion". Their conclusion contradicts the well established role of cholesterol in the pathogenesis of atherosclerosis including that of cerebral and precerebral vessels. Ischemic stroke is predominantly caused by macrovascular disease, not microvascular. The findings of this study¹ are unreliable and misleading simply because poststroke TSC levels are not representative of the levels before the onset of the arterial disease. Cross-sectional data cannot establish the temporal relationship between TSC and the risk of severe ischemic stroke. Only measures of TSC in apparently healthy subjects should be used to determine the effect of cholesterol on the risk of . . . [Full Text of this Article]