High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study.
BACKGROUND
Elevated high-density lipoprotein cholesterol (HDL-C) levels have been shown to be protective against cardiovascular disease. However, the association of specific lipoprotein classes and ischemic stroke has not been well defined, particularly in higher-risk minority populations.


OBJECTIVE
To evaluate the association between HDL-C and ischemic stroke in an elderly, racially or ethnically diverse population.


METHODS
Population-based, incident case-control study conducted July 1993 through June 1997.


METHODS
A multiethnic community in northern Manhattan, New York, NY.


METHODS
Cases (n = 539) of first ischemic stroke (67% aged >/=65 years; 55% women; 53% Hispanic, 28% black, and 19% white) were enrolled and matched by age, sex, and race or ethnicity to stroke-free community residents (controls; n = 905).


METHODS
Independent association of fasting HDL-C levels, determined at enrollment, with ischemic stroke, including atherosclerotic and nonatherosclerotic ischemic stroke subtypes.


RESULTS
After risk factor adjustment, a protective effect was observed for HDL-C levels of at least 35 mg/dL (0.91 mmol/L) (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.39-0.72). A dose-response relationship was observed (OR, 0.65; 95% CI, 0.47-0.90 and OR, 0.31; 95% CI, 0.21-0.46) for HDL-C levels of 35 to 49 mg/dL (0.91-1.28 mmol/L) and at least 50 mg/dL (1.29 mmol/L), respectively. The protective effect of a higher HDL-C level was significant among participants aged 75 years or older (OR, 0.51; 95% CI, 0.27-0.94), was more potent for the atherosclerotic stroke subtype (OR, 0.20; 95% CI, 0.08-0.50), and was present in all 3 racial or ethnic groups studied.


CONCLUSIONS
Increased HDL-C levels are associated with reduced risk of ischemic stroke in the elderly and among different racial or ethnic groups. These data add to the evidence relating lipids to stroke and support HDL-C as an important modifiable stroke risk factor.
Sacco
R L
RL
Neurological Institute, 710 W 168 St, New York, NY 10032, USA. rls1@columbia.edu
Benson
R T
RT
Kargman
D E
DE
Boden-Albala
B
B
Tuck
C
C
Lin
I F
IF
Cheng
J F
JF
Paik
M C
MC
Shea
S
S
Berglund
L
L
D000368:Aged; D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology*; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors
D008076:Cholesterol, HDL; D008055:Lipids