Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention (BIP) Registry: high triglycerides constitute an independent risk factor.
BACKGROUND
Despite unclear associations between blood lipids, including fractionated cholesterol and triglycerides, and stroke, recent evidence demonstrates that lipid-modifying agents decrease the risk of stroke in patients with coronary heart disease (CHD).


RESULTS
Patients with documented CHD who were screened for but not included in the Bezafibrate Infarction Prevention study and had no history of stroke or transient ischemic attack (TIA) (n=11 177) were followed up. At baseline, medical histories were obtained and blood lipids assessed at a central study laboratory. During a 6- to 8-year follow-up period, 941 patients were identified as having nonhemorrhagic cerebrovascular disease, of whom 487 had verified ischemic stroke (per clinical findings and brain CT) or TIA. Patients experiencing an ischemic stroke/TIA had higher mean levels of triglycerides, lower levels of HDL cholesterol, and lower percentages of cholesterol contained in the HDL cholesterol moiety (%HDL; P<0.01 for all). In a logistic regression model, the adjusted ORs for developing an ischemic stroke/TIA were 1.27 (95% CI 1.01 to 1.60) associated with triglycerides >200 mg/dL and 0.87 (95% CI 0.78 to 0.97) associated with a 5% decrease in %HDL. The increased risk associated with high triglycerides was found across subgroups of age, sex, patient characteristics, and cholesterol fractions.


CONCLUSIONS
High triglycerides constitute an independent risk factor for ischemic stroke/TIA across subgroups of age, sex, patient characteristics, and cholesterol fractions, whereas high %HDL was an independent protective factor among patients with CHD. These findings support the role of blood lipids, including triglycerides, as important modifiable stroke risk factors.
Tanne
D
D
Department of Neurology, Stroke Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel. tanne@post.tau.ac.il
Koren-Morag
N
N
Graff
E
E
Goldbourt
U
U
D000367:Age Factors; D000368:Aged; D001629:Bezafibrate / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D002546:Ischemic Attack, Transient / Q000097:blood*; D008055:Lipids / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D000960:Hypolipidemic Agents; D008055:Lipids; D014280:Triglycerides; D001629:Bezafibrate