Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk.

Benfante, Richard; Yano, Katsuhiko; Hwang, Lie-Ju; Curb, J. David; Kagan, Abraham; Ross, William

doi:10.1161/01.str.25.4.814

Cited by 157 publications

(104 citation statements)

References 38 publications

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“…10 The fact that the incidence of hemorrhagic stroke is higher in Asian populations has led to the hypothesis that low cholesterol, in addition to lean body weight, may be associated with increased risk of hemorrhagic strokes. 20,35 The low numbers of hemorrhagic strokes in most of the studies may explain in part the uncertainty with regard to the association between BMI and hemorrhagic stroke. Future studies are needed to determine whether lean BMI and/or low cholesterol or other factors are important contributors to hemorrhagic stroke.…”

Section: Discussionmentioning

confidence: 99%

Prospective Study of Body Mass Index and Risk of Stroke in Apparently Healthy Women

et al. 2005

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Background-Obesity is an escalating pandemic in the United States, and its association with coronary heart disease is well understood. Several studies have found positive associations between body mass index (BMI) and stroke in men, but the association with stroke and its subtypes is less clear in women. Methods and Results-This was a prospective cohort study among 39 053 women participating in the Women's Health Study. BMI was measured as self-reported weight (in kilograms) divided by height (in meters) squared. Incident stroke was self-reported and confirmed by medical record review. We used the Cox proportional hazards model to evaluate the association between BMI and stroke. After a mean follow-up of 10 years, a total of 432 strokes (347 ischemic, 81 hemorrhagic, and 4 undefined) occurred. We found a statistically significant trend for increased risk of total and ischemic stroke across 7 BMI categories. With World Health Organization criteria, women who were obese (BMI Ն30 kg/m 2 ) had hazard ratios of 1.50 (95% CI 1.16 to 1.94) for total stroke, 1.72 (95% CI 1.30 to 2.28) for ischemic stroke, and 0.82 (95% CI 0.43 to 1.58) for hemorrhagic stroke compared with women with BMI Ͻ25 kg/m 2 . Additional control for history of hypertension, diabetes, and elevated cholesterol substantially attenuated the hazard ratios for total and ischemic stroke. There was no effect modification for age, exercise, or smoking. Conclusions-In this large prospective cohort study among women, BMI was a strong risk factor for total and ischemic stroke but not for hemorrhagic stroke. The association was highly mediated by hypertension, diabetes, and elevated cholesterol.

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Section: Discussionmentioning

confidence: 99%

Prospective Study of Body Mass Index and Risk of Stroke in Apparently Healthy Women

et al. 2005

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“…In the United States, however, a relatively strong and positive relationship between serum cholesterol and cerebral infarction is usually observed (25,26). Possible differences in the effects of serum cholesterol at different vascular sites could lead to the complex association between serum cholesterol levels and cerebral infarction as a single entity.…”

Section: Serum Cholesterol and Cerebral Infarctionmentioning

confidence: 99%

Dietary Lipids and Incidence of Cerebral Infarction in a Japanese Rural Community.

Seino¹,

Date

Nakayama³

et al. 1997

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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SummaryObjective: To assess the relationship between dietary lipids and incidence of cerebral infarction in a Japanese rural population. Design: A cohort study from July 1977 through December 1992. Setting: Akadani-Ijimino (A-I) district, Niigata Prefecture, Japan. Subjects and methods: All the residents, 1,182 men and 1,469 women, aged 40 years and over. Out of these members, 954 men and 1,329 women who were initially free of stroke completed a semiquantitative food frequency ques tionnaire in 1977, and were then subjected to a follow-up for 15.5 years. The occurrence of stroke was determined by the annual follow-up exam ination and registry. Dietary lipid was adjusted for total energy or fat intake by the residual method. Sex and age-stratified and blood pressure and atrial fibrillation-adjusted relative risk for cerebral infarction was estimated by the Cox proportional hazard model. Results: There were 75 new cases of cerebral infarction during the observation period. The relative risk for cerebral infarction was less than one in the highest quartile level of total fat, saturated fatty acids (S), Keys score and west ernized dietary pattern: 0.68-0.94. It ranged between 1.36 and 1.57 in the highest level of polyunsaturated (P), n-3 and n-6 fatty acids, and P/S ratio. Conclusion: This study suggests the possibility that the traditional Japanese diet, very low fat intake, was likely to increase the risk of stroke through the low level of serum cholesterol as an intermediary factor. Key Words dietary lipids, cerebral infarction, cohort study, serum cho lesterol, "diet-stroke" hypothesis According to the "diet-heart" hypothesis (1, 2), a high intake of saturated fatty acids and cholesterol and low intake of polyunsaturated fatty acids increase the 83 84 F. SEINO et al. level of serum cholesterol, and hypercholesterolemia results in the occurrence of coronary heart disease and stroke. In Japan, however, some ecological studies compared stroke incidence rates among several defined populations, and showed that the rates were inversely correlated with mean serum cholesterol and fat intake (3, 4). Afterwards, some cohort studies indicated that the level of serum cholester ol was inversely associated with the risk of stroke; particularly cerebral hemorrhage and cerebral infarction in perforating artery regions after adjustment for some confounding variables such as sex, age and blood pressure (5-7).To date, however, there have been few prospective studies on the relationship between dietary fat and stroke among Japanese in Japan. Using all of the residents aged 40 years and over in Akadani-Ijimino district (hereinafter referred to as A-I district), Shibata City, Niigata Prefecture, Japan, their dietary lipid intakes were assessed by a semiquantitative food frequency questionnaire in July 1977. Those who were initially free of stroke have been subjected to a follow-up ever since. In this report, we deal with the relationship of dietary lipid intake to the subsequent 15.5-year incidence of cerebral infarction which sho...

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“…Studies of cholesterol levels in stroke patients have revealed results varying from insignificant changes to a moderate elevation [14]. There are several studies which have not found any association between lipid profile and incident ischemic stroke [15,16].…”

Section: Introductionmentioning

confidence: 99%

Effect of Lipid Profile Upon Prognosis in Ischemic and Haemorrhagic Cerebrovascular Stroke

Bharosay

Bandyopadhyay

et al. 2013

Ind J Clin Biochem

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Stroke is the third major cause of death worldwide. Elevated plasma concentration of low density lipoproteins and low plasma concentration of high density lipoprotein concentration are associated with an increased risk of atherosclerosis and coronary heart disease but the relation between serum lipids, and cerebrovascular disease is less clear. The aim of this study was to investigate the reliability and accuracy of serum lipid profile in assessing the prognosis/neurological worsening in patients with ischemic and hemorrhagic cerebrovascular stroke. The subjects in the present study comprised of 101 healthy controls and 150 cerebrovascular stroke patients (including 90 with ischemic stroke and 60 with intracerebral hemorrhagic stroke). In both the groups fasting lipid profile was determined within 72 h of the stroke. A statistically significant association was observed (p \ 0.001) between the parameters of lipid profile of cases and healthy controls, and also with the prognosis of the stroke.

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Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk.

Cited by 157 publications

References 38 publications

Prospective Study of Body Mass Index and Risk of Stroke in Apparently Healthy Women

Prospective Study of Body Mass Index and Risk of Stroke in Apparently Healthy Women

Dietary Lipids and Incidence of Cerebral Infarction in a Japanese Rural Community.

Effect of Lipid Profile Upon Prognosis in Ischemic and Haemorrhagic Cerebrovascular Stroke

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