The associations of lipids and lipid ratios with stroke: A prospective cohort study

Abstract

Lipids and lipid ratios have been proven to be associated with cardiovascular disease; however, their relationships with stroke and stroke subtypes had not been fully understood. This study aims to assess the associations of lipids and lipid ratios with type‐specific stroke and compare their predictive capacities for stroke occurrence. In this prospective cohort study, a total of 42 005 Chinese participants aged 20 to 80 who were free of stroke at baseline were included and selected into subgroups of stroke subtypes (ischemic, hemorrhagic, and total). Total stroke outcome included a combination of ischemic and hemorrhagic stroke. Over an average follow‐up of 3.6 years, 781 participants developed stroke (623 ischemic and 158 hemorrhagic). In men, the highest TC/HDL‐C quartile was significantly associated with increased ischemic stroke risk (multivariable‐adjusted hazard ratio [HR], 1.52, 95% confidence interval [CI], 1.14‐2.03) and total stroke risk (HR, 1.45, 95% CI, 1.12‐1.87), and TC/HDL‐C had the highest area under the receiver operating characteristic curve (AUC) for predicting ischemic (AUC, 0.868) and total stroke (AUC, 0.874). In women, the highest TG quartile was significantly associated with increased risk of ischemic (HR, 1.99, 95% CI, 1.11‐3.59) and total stroke (HR, 1.85, 95% CI, 1.07‐3.20), with AUCs of 0.850 and 0.861, respectively. No lipid variables were significantly associated with hemorrhagic stroke in both sex. In conclusion, TC/HDL‐C ratio may better predict stroke risk in men, whereas TG was more valuable in predicting stroke risk in women. TC/HDL‐C and TG may help to discriminate high stroke risk individuals and serve as potential targets for stroke prevention.

Hypertriglyceridemia: A Neglected Risk Factor for Ischemic Stroke?

“…https://doi.org/10.5853/jos.2021.02831 spective cohort study involving 42,005 volunteers aged 20 to 80 years with an average follow-up period of 3.6 years, the researchers found that after adjusting for age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure, cigarette smoking, alcohol consumption, use of lipid-lowering drugs, diabetes, history of hypertension, family history of cardiovascular disease, and other confounding factors, whether in men or women, high TG levels were associated with an increased risk of ischemic stroke (men: adjusted HR, 1.06; 95% CI, 1.00 to 1.12 and women: adjusted HR, 1.12; 95% CI, 1.01 to 1.23); additionally, this association was more notable among women. 26 In another nested case-control study, 5,475 ischemic stroke cases, 4,776 intracerebral hemorrhage cases, and 6,290 common control subjects without prior history of cardiovascular disease, cancer, or lipid-lowering, anticoagulant, or antiplatelet treatment at baseline were enrolled. The results demonstrated that plasma TG concentrations were weakly correlated with ischemic stroke risk (relative risk [RR], 1.02; 95% CI, 1.00 to 1.04 per 30% higher TGs).…”

Dose–Response Association Between High-Density Lipoprotein Cholesterol and Stroke: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

“…Another meta-analysis in 2013 investigated the association between HDL-C level and risk of hemorrhagic stroke (15). However, up to 10 more cohort studies have been published recently on the association of HDL-C level with total stroke, ICH, and SAH, showing inconsistent results (9)(10)(11)(16)(17)(18)(19)(20)(21)(22)(23)(24). No metaanalysis has been performed on the association of HDL-C level with IS, and a dose-response meta-analysis on the association of HDL-C level with total stroke and IS is lacking.…”

“…After screening the titles and abstracts, we selected 201 potentially eligible articles. After detailed evaluation, we included 29 articles describing 62 prospective cohort studies in our metaanalysis with a total of 900,501 study participants of which 25,678 had stroke (5)(6)(7)(8)(9)(10)(11)(16)(17)(18)(19)(20)(21)(22)(23)(24)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52).…”

“…Eleven studies were conducted in Asia (including Iran and Israel) (7,8,10,17,18,20,21,23,24,46,52), 9 in the United States (9,19,22,40,42,44,(48)(49)(50), 7 in Europe (5,11,16,41,43,47,51), and 2 in Australia (6,45). Three prospective cohorts included only men (5,51,52), another 3 included only women (8,40,49), and the rest included both sexes (Table 1).…”

“…Among the 22 studies included for the association between HDL-C level and IS risk in the current meta-analysis (7,10,11,17,19-21,23,24,41,42,44,45,47,49-52,42,43,45,46,48,50 -53), 16 showed an inverse association (7,10,11,19,20,23,24,41,42,47,(49)(50)(51)(52), 10 of which reached a significant level (7,10,11,24,41,42,47,51) while the remaining 6 showed no statistical significance (10,19,21,23,49,50). After pooling the 22 studies with a larger sample size, we observed a significant inverse nonlinear association between HDL-C level and IS.…”