Isao Saito1, Kazumasa Yamagishi2, Yoshihiro Kokubo3, Hiroshi Yatsuya4, Hiroyasu Iso5, Norie Sawada6, Manami Inoue6, Shoichiro Tsugane6. 1. Department of Public Health and Epidemiology, Faculty of Medicine, Oita University. 2. Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba. 3. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center. 4. Department of Public Health, Fujita Health University. 5. Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University. 6. Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center.
Abstract
AIM: A positive association between non-high-density lipoprotein cholesterol (non-HDL-C) and coronary heart disease (CHD) has been established; however, associations between non-HDL-C and stroke subtypes have not been determined. METHODS: We conducted a prospective study of 30,554 individuals aged 40-69 yrs with no history of cardiovascular disease (CVD) in Japan. Sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of stroke subtypes and CHD were estimated according to quintiles of non-HDL-C, using Cox proportional hazard models adjusted for other established risk factors. RESULTS: We identified 1,705 stroke and 296 CHD events over a median 15 yrs of follow-up. The fractional polynomials analysis revealed a U-shaped association between non-HDL-C and stroke risk in men. When analyzed for stroke subtypes, the data revealed an inverse relationship between non-HDL-C and intracerebral hemorrhage (ICH), primarily with lobar ICH, and a positive association between non-HDL-C and large-artery occlusive infarction in men [adjusted HR 0.55 (95% CI, 0.35-0.87) and 2.05 (95% CI, 1.07-3.93) for the highest and lowest quintile of non-HDL-C, respectively]. The lowest risk of ICH in women was observed in the fourth quintile, and the lowest risk of embolic infarction was observed in the third quintile. In contrast, non-HDL-C was positively associated with CHD in both sexes. CONCLUSIONS: In Japanese men, lower non-HDL-C levels were associated with a decreased risk of large-artery occlusive infarction and an increased risk of ICH, particularly lobar ICH.
AIM: A positive association between non-high-density lipoprotein cholesterol (non-HDL-C) and coronary heart disease (CHD) has been established; however, associations between non-HDL-C and stroke subtypes have not been determined. METHODS: We conducted a prospective study of 30,554 individuals aged 40-69 yrs with no history of cardiovascular disease (CVD) in Japan. Sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of stroke subtypes and CHD were estimated according to quintiles of non-HDL-C, using Cox proportional hazard models adjusted for other established risk factors. RESULTS: We identified 1,705 stroke and 296 CHD events over a median 15 yrs of follow-up. The fractional polynomials analysis revealed a U-shaped association between non-HDL-C and stroke risk in men. When analyzed for stroke subtypes, the data revealed an inverse relationship between non-HDL-C and intracerebral hemorrhage (ICH), primarily with lobar ICH, and a positive association between non-HDL-C and large-artery occlusive infarction in men [adjusted HR 0.55 (95% CI, 0.35-0.87) and 2.05 (95% CI, 1.07-3.93) for the highest and lowest quintile of non-HDL-C, respectively]. The lowest risk of ICH in women was observed in the fourth quintile, and the lowest risk of embolic infarction was observed in the third quintile. In contrast, non-HDL-C was positively associated with CHD in both sexes. CONCLUSIONS: In Japanese men, lower non-HDL-C levels were associated with a decreased risk of large-artery occlusive infarction and an increased risk of ICH, particularly lobar ICH.
Authors: Jordan Fulcher; Rachel O'Connell; Merryn Voysey; Jonathan Emberson; Lisa Blackwell; Borislava Mihaylova; John Simes; Rory Collins; Adrienne Kirby; Helen Colhoun; Eugene Braunwald; John La Rosa; T R Pedersen; Andrew Tonkin; Barry Davis; Peter Sleight; Maria Grazia Franzosi; Colin Baigent; Anthony Keech Journal: Lancet Date: 2015-01-09 Impact factor: 79.321
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