Published Online
on August 30, 2007

A more recent version of this article appeared on October 1, 2007

This Article Full Text (PDF) CME: Take the course for this article: Stroke: October 2007, Volume 38, Number 10 All Versions of this Article: 38/10/2646    most recent STROKEAHA.107.490292v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Olsen, T. S. Articles by Andersen, K. K. Search for Related Content PubMed PubMed Citation Articles by Olsen, T. S. Articles by Andersen, K. K. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CHOLESTEROL Medline Plus Health Information Stroke Related Collections Lipids Secondary prevention Cerebrovascular disease/stroke Risk Factors Primary and Secondary Stroke Prevention

Submitted on April 4, 2007
Accepted on April 12, 2007

Higher Total Serum Cholesterol Levels Are Associated With Less Severe Strokes and Lower All-Cause Mortality. Ten-Year Follow-Up of Ischemic Strokes in the Copenhagen Stroke Study

Tom Skyhøj Olsen MD, PhD^*; Rune Haubo Bojesen Christensen MS; Lars Peter Kammersgaard MD; and Klaus Kaae Andersen MS, PhD

From the Stroke Unit (T.S.O., L.P.K.), Hvidovre University Hospital, Hvidovre, and the Department of Informatics and Mathematical Modeling (R.H.B.C., K.K.A.), Section for Statistics, Technical University of Denmark, Lyngby, Denmark.

^* To whom correspondence should be addressed. E-mail: Tom.Skyhoej.Olsen{at}hvh.regionh.dk.

Background and Purpose—Evidence of a causal relation between serum cholesterol and stroke is inconsistent. We investigated the relation between total serum cholesterol and both stroke severity and poststroke mortality to test the hypothesis that hypercholesterolemia is primarily associated with minor stroke.

Methods—In the study, 652 unselected patients with ischemic stroke arrived at the hospital within 24 hours of stroke onset. A measure of total serum cholesterol was obtained in 513 (79%) within the 24-hour time window. Stroke severity was measured with the Scandinavian Stroke Scale (0=worst, 58=best); a full cardiovascular risk profile was established for all. Death within 10 years after stroke onset was obtained from the Danish Registry of Persons.

Results—Mean±SD age of the 513 patients was 75±10 years, 54% were women, and the mean±SD Scandinavian Stroke Scale score was 39±17. Serum cholesterol was inversely and almost linearly related to stroke severity: an increase of 1 mmol/L in total serum cholesterol resulted in an increase in the Scandinavian Stroke Scale score of 1.32 (95% CI, 0.28 to 2.36, P=0.013), meaning that higher cholesterol levels are associated with less severe strokes. A survival analysis revealed an inverse linear relation between serum cholesterol and mortality, meaning that an increase of 1 mmol/L in cholesterol results in a hazard ratio of 0.89 (95% CI, 0.82 to 0.97, P=0.01).

Conclusions—The results of our study support the hypothesis that a higher cholesterol level favors development of minor strokes. Because of selection, therefore, major strokes are more often seen in patients with lower cholesterol levels. Poststroke mortality, therefore, is inversely related to cholesterol.

Key words: cholesterol • mortality • prognosis • stroke

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