Cholesterol and the risk of ischemic stroke.
OBJECTIVE
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.
Bowman
Thomas S
TS
Harvard University General Internal Medicine Fellowship Program, Veterans Affairs Boston Healthcare System--Massachusetts Veterans Affairs Epidemiology, Research, and Information Center, Boston, MA 02130, USA. thomasbowman@pol.net
Sesso
Howard D
HD
Ma
Jing
J
Kurth
Tobias
T
Kase
Carlos S
CS
Stampfer
Meir J
MJ
Gaziano
J Michael
JM
D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood*; D015897:Comorbidity; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology*; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology
D008075:Lipoproteins, HDL; D014280:Triglycerides; D002784:Cholesterol