title: Blood cholesterol level and risk of stroke in community-based or worksite cohort studies: a review of Japanese cohort studies in the past 20 years.
abstract: Evidence of the causal relationship between hypercholesterolemia and coronary artery       disease (CAD) has been established worldwide. However, little attention has been paid to the       relationship between hypercholesterolemia and stroke, despite stroke being the most common       cardiovascular disease in Japan. We therefore reviewed cohort studies that investigated this       relationship in the Japanese population over the past 20 years, and compared their findings       with clinical trials and cohort studies in Western countries. Fourteen cohort studies were       carried out in Japan during this period. The number of subjects in the studies ranged from       1621 to 91,219 and the mean follow-up period ranged from 7.6 to 32 years. The majority of       studies showed no association between hypercholesterolemia and total stroke. However, one       report showed a positive association between low-density lipoprotein cholesterol and       atherothrombotic cerebral infarction. The relationship between hypercholesterolemia and       cerebral infarction may be modified by the proportion of atherothrombotic infarctions in the       population surveyed. Randomized controlled trials on statins have shown a substantial       reduction in cerebral infarction, and so the discrepancy between cohort studies and clinical       trials requires further study. However, some studies have reported that subjects with low       blood cholesterol are more susceptible to intracerebral hemorrhage. Two hypotheses have been       proposed to explain this association between low cholesterol and intracerebral hemorrhage.       First, low blood cholesterol may induce angionecrosis, possibly in combination with       hypertension, and second, low blood cholesterol may reflect a poor nutritional status. Either       way, further continuous research in various fields of medical science is required to clarify       the overall effect of blood cholesterol on stroke in humans.
authors.affiliation: Department of Health Sciences, Interdisciplinary Graduate School of Medicine           and Engineering, University of Yamanashi, Yamanashi, Japan.
authors.forename: Taichiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
mesh_terms: D002543:Cerebral Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D002544:Cerebral Infarction / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D015999:Multivariate Analysis; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D020521:Stroke / Q000097:blood / Q000209:etiology* / Q000517:prevention & control
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol