BACKGROUND: The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL cholesterol and stroke, particularly for stroke subtypes. METHODS AND RESULTS: Cox survival models were applied to individual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After adjustment for age and regression dilution, hazard ratios (95% confidence intervals) for a 1 standard deviation (SD) lower level of HDL cholesterol (0.4 mmol/L) were: for CHD events, 1.39 (1.22-1.57); for ischaemic stroke, 0.90 (0.75-1.07), and for haemorrhagic stroke, 0.89 (0.74-1.07). As total cholesterol (TC) increased relative to HDL cholesterol, the risk of CHD increased, the risk of ischaemic stroke was unchanged but the risk of haemorrhagic stroke decreased. A 1 SD increase in TC/HDL cholesterol (1.63 units) was associated with a 27% decrease in the risk of haemorrhagic stroke (95% confidence interval, 7-44%). CONCLUSION: There is clear evidence of potential benefit for CHD of increases in HDL cholesterol and decreases in TC relative to HDL cholesterol, but no evidence of an association between either HDL cholesterol or TC/HDL cholesterol and ischaemic stroke. Increasing HDL cholesterol relative to TC may increase the risk of haemorrhagic stroke.
BACKGROUND: The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL cholesterol and stroke, particularly for stroke subtypes. METHODS AND RESULTS: Cox survival models were applied to individual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After adjustment for age and regression dilution, hazard ratios (95% confidence intervals) for a 1 standard deviation (SD) lower level of HDL cholesterol (0.4 mmol/L) were: for CHD events, 1.39 (1.22-1.57); for ischaemic stroke, 0.90 (0.75-1.07), and for haemorrhagic stroke, 0.89 (0.74-1.07). As total cholesterol (TC) increased relative to HDL cholesterol, the risk of CHD increased, the risk of ischaemic stroke was unchanged but the risk of haemorrhagic stroke decreased. A 1 SD increase in TC/HDL cholesterol (1.63 units) was associated with a 27% decrease in the risk of haemorrhagic stroke (95% confidence interval, 7-44%). CONCLUSION: There is clear evidence of potential benefit for CHD of increases in HDL cholesterol and decreases in TC relative to HDL cholesterol, but no evidence of an association between either HDL cholesterol or TC/HDL cholesterol and ischaemic stroke. Increasing HDL cholesterol relative to TC may increase the risk of haemorrhagic stroke.
Authors: Samantha A Reina; Maria M Llabre; Matthew A Allison; John T Wilkins; Armando J Mendez; Martinson K Arnan; Neil Schneiderman; Ralph L Sacco; Mercedes Carnethon; J A Chris Delaney Journal: Atherosclerosis Date: 2015-09-28 Impact factor: 5.162
Authors: Manja Koch; Sarah A Aroner; Annette L Fitzpatrick; W T Longstreth; Jeremy D Furtado; Kenneth J Mukamal; Majken K Jensen Journal: Stroke Date: 2021-10-14 Impact factor: 7.914
Authors: Sangjun Lee; Kwang-Pil Ko; Jung Eun Lee; Inah Kim; Sun Ha Jee; Aesun Shin; Sun-Seog Kweon; Min-Ho Shin; Sangmin Park; Seungho Ryu; Sun Young Yang; Seung Ho Choi; Jeongseon Kim; Sang-Wook Yi; Daehee Kang; Keun-Young Yoo; Sue K Park Journal: J Prev Med Public Health Date: 2022-09-12
Authors: Deanna L Plubell; Alex M Fenton; Sara Rosario; Paige Bergstrom; Phillip A Wilmarth; Wayne M Clark; Neil A Zakai; Joseph F Quinn; Jessica Minnier; Nabil J Alkayed; Sergio Fazio; Nathalie Pamir Journal: Circ Res Date: 2020-08-26 Impact factor: 17.367