Low- and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: the bezafibrate infarction prevention registry.
BACKGROUND
Despite increasing evidence that beta-hydroxy-beta-methyglutaryl coenzyme A reductase inhibitors reduce the incidence of stroke in patients with coronary heart disease (CHD), the associations between blood lipid levels and cerebrovascular disease (CVD) are not clear.


OBJECTIVE
To evaluate whether blood cholesterol level and its fractions are risk factors for stroke in a large group of patients with CHD.


METHODS
We followed up 11 177 patients with documented CHD who were screened for but not included in the Bezafibrate Infarction Prevention study, a secondary prevention randomized clinical trial of lipid modification, and had no history of stroke for subsequent CVD. During a 6- to 8-year follow-up period, 941 patients were identified as having nonhemorrhagic CVD, of whom 487 had verified ischemic stroke or transient ischemic attack (TIA).


RESULTS
Increases in age-adjusted rates of both nonhemorrhagic CVD and verified ischemic stroke or TIA were identified with increasing cholesterol and low-density lipoprotein cholesterol levels, decreasing high-density lipoprotein cholesterol levels, and decreasing percentage of total serum cholesterol contained in the HDL moiety. In logistic regression models, adjusting for clinical covariates, the following odds ratios (95% confidence intervals) were identified for lipid values in the upper vs lower tertile for the end point of nonhemorrhagic CVD: total cholesterol, 1.43 (1.20-1.70); low-density lipoprotein cholesterol, 1.52 (1.27-1.81), high-density lipoprotein cholesterol, 0.84 (0.70-1.00); and percentage of serum cholesterol contained in HDL, 0.69 (0.58-0.83). Similar trends appeared for the end point of verified ischemic stroke or TIA.


CONCLUSIONS
These findings clearly support the role of total cholesterol and its fractions in prediction of ischemic CVD among patients with established CHD.
Koren-Morag
Nira
N
Division of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
Tanne
David
D
Graff
Eran
E
Goldbourt
Uri
U
D000328:Adult; D000368:Aged; D001629:Bezafibrate / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003084:Colestipol / Q000627:therapeutic use; D003327:Coronary Disease / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control; D008148:Lovastatin / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D002784:Cholesterol; D008148:Lovastatin; D003084:Colestipol; D001629:Bezafibrate