title: LDL cholesterol and the development of stroke subtypes and coronary heart disease in a general Japanese population: the Hisayama study.
abstract: OBJECTIVE
  Although the relation between serum LDL cholesterol level and coronary heart disease (CHD) is well established, its relation with stroke subtypes is less clear.
  
  
  METHODS
  A total of 2351 inhabitants age >or=40 years in a Japanese community were followed up for 19 years.
  
  
  RESULTS
  During follow-up, 271 subjects developed stroke and 144 developed CHD. Whereas the age- and sex-adjusted incidences of CHD significantly increased with increasing LDL cholesterol levels (P for trend <0.001), the associations between LDL cholesterol level and the incidences of ischemic or hemorrhagic stroke were not significant. The age- and sex-adjusted incidences of atherothrombotic infarctions (ATIs) and lacunar infarctions (LIs) significantly increased with increasing LDL cholesterol level (P for trend=0.03 for ATIs and=0.02 for LIs), but no such association was observed for cardioembolic infarction. After multivariate adjustment, the positive associations of LDL cholesterol level with the risks of ATI and CHD remained significant (P for trend=0.02 for ATIs and=0.03 for CHD), whereas the association with LIs was not significant. The risk of ATI significantly increased in the fourth quartile of LDL cholesterol compared with the first quartile (multivariate-adjusted hazard ratio=2.84; 95% CI, 1.17 to 6.93). The multivariate-adjusted risks for developing nonembolic infarction (ATIs and LIs) and CHD were significantly elevated in the groups with elevated LDL cholesterol values with and without the metabolic syndrome.
  
  
  CONCLUSIONS
  Our findings suggest that an elevated LDL cholesterol level is a significant risk factor for developing ATI as well as CHD, and these associations are independent of the metabolic syndrome.
authors.affiliation: Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. timamura@envmed.med.kyushu-u.ac.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Imamura
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Doi
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.forename: Koji
authors.initials: K
authors.lastname: Yonemoto
authors.forename: Jun
authors.initials: J
authors.lastname: Hata
authors.forename: Michiaki
authors.initials: M
authors.lastname: Kubo
authors.forename: Yumihiro
authors.initials: Y
authors.lastname: Tanizaki
authors.forename: Setsuro
authors.initials: S
authors.lastname: Ibayashi
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iida
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000097:blood* / Q000145:classification / Q000453:epidemiology*; D009626:Terminology as Topic
chemical_list: D008078:Cholesterol, LDL