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Cholesterol and the Risk of Ischemic Stroke
Open accessAbstract
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.
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“There have been many reports, including those from Japan, stating that the lower the HDL-C level, the higher the incidence rate of cerebral infarction46, 859–861).”
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Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000757 · Cited by 9,175
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Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000558 · Cited by 7,146
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Metadata
- Authors
- Bowman, T. S., Sesso, H. D., Ma, J., Kurth, T., Kase, C. S., Stampfer, M. J., & Gaziano, J. M.
- Affiliations
- Boston University (US)
- Venue
- Stroke
- Published
- 2003-12
- Volume
- 34
- Issue
- 12
- Pages
- 2930-2934
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2080056609
- Cited by
- 157
- References
- 45
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 8 · 2022: 10 · 2021: 7 · 2020: 5 · 2019: 9 · 2018: 10 · 2017: 5 · 2016: 8 · 2015: 6 · 2014: 4 · 2013: 6 · 2012: 7
- FWCI
- 7.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institutes of Health (CA 34944, HL-26490)
- National Heart, Lung, and Blood Institute (HL-34595, HL 26490, R01HL034595)
- National Cancer Institute (R01CA040360, CA 34944, R01CA097193, CA 40360)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- ischemic stroke, total cholesterol, high-density lipoprotein, triglycerides, TC/HDL-C ratio, stroke risk factors, statins, Physicians' Health Study, healthy men
- MeSH terms
- Brain Ischemia, Cholesterol, Humans, Lipoproteins, HDL, Male, Middle Aged, Prospective Studies, Risk, Risk Factors, Triglycerides, United States, Comorbidity, Logistic Models, Odds Ratio, Case-Control Studies, Randomized Controlled Trials as Topic, Stroke
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