Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS).
OBJECTIVE
To explore the relationship between lipid profile components and incident ischemic stroke in a stroke-free prospective cohort.


METHODS
Population-based prospective cohort study.


METHODS
Northern Manhattan, New York.


METHODS
Stroke-free community residents. Intervention As part of the Northern Manhattan Study, baseline fasting blood samples were collected on stroke-free community residents followed up for a mean of 7.5 years.


METHODS
Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for lipid profile components and ischemic stroke after adjusting for demographic and risk factors. In secondary analyses, we used repeated lipid measures over 5 years from a 10% sample of the population to calculate the change per year of each of the lipid parameters and to impute time-dependent lipid parameters for the full cohort.


RESULTS
After excluding those with a history of myocardial infarction, 2940 participants were available for analysis. Baseline high-density lipoprotein cholesterol, triglyceride, and total cholesterol levels were not associated with risk of ischemic stroke. Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol levels were associated with a paradoxical reduction in risk of stroke. There was an interaction with use of cholesterol-lowering medication on follow-up, such that LDL-C level was only associated with a reduction in stroke risk among those taking medications. An LDL-C level greater than 130 mg/dL as a time-dependent covariate showed an increased risk of ischemic stroke (adjusted hazard ratio, 3.81; 95% confidence interval, 1.53-9.51).


CONCLUSIONS
Baseline lipid panel components were not associated with an increased stroke risk in this cohort. Treatment with cholesterol-lowering medications and changes in LDL-C level over time may have attenuated the risk in this population, and lipid measurements at several points may be a better marker of stroke risk.
Willey
Joshua Z
JZ
Department of Neurology, College of Physicians and Surgeons, Joseph P. Mailman School of Public Health, Columbia University, and the Columbia University Medical Center of New York Presbyterian Hospital, New York, NY 10032, USA.
Xu
Qiang
Q
Boden-Albala
Bernadette
B
Paik
Myunghee C
MC
Moon
Yeseon Park
YP
Sacco
Ralph L
RL
Elkind
Mitchell S V
MS
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
D008055:Lipids