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Total and HDL cholesterol and risk of stroke. EUROSTROKE: a collaborative study among research centres in Europe
  1. M L Bots1,2,
  2. P C Elwood3,
  3. Y Nikitin4,
  4. J T Salonen5,
  5. A Freire de Concalves6,
  6. D Inzitari7,
  7. J Sivenius8,
  8. V Benetou9,
  9. J Tuomilehto10,
  10. P J Koudstaal11,
  11. D E Grobbee1,2
  1. 1Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, the Netherlands
  2. 2Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Utrecht, the Netherlands
  3. 3Centre for Applied Public Health Medicine, University of Wales College of Medicine, Cardiff, UK
  4. 4Russian Academy of Medical Sciences Siberian Branch, Institute of Internal Medicine, Novosibirsk, Russia
  5. 5Research Institute of Public Health, University of Kuopio, Kuopio, Finland
  6. 6Neurology, Hospitais da Universidade de Coimbra, Coimbra, Portugal
  7. 7Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
  8. 8Department of Neurology, Kuopio University Hospital, Kuopio, Finland
  9. 9Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
  10. 10Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
  11. 11Neurology, University Hospital Rotterdam Dijkzigt, Rotterdam, the Netherlands
  1. Correspondence to:
 Dr M L Bots, Julius Centre for General Practice and Patient Oriented Research, room D01.335, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands;
 M.L.Bots{at}jc.azu.nl

Abstract

Background: Controversy remains on the relation between serum lipids levels and stroke risk. This paper investigated the association of total and HDL cholesterol level to fatal and non-fatal, and haemorrhagic and ischaemic stroke in four European cohorts participating in EUROSTROKE.

Methods: EUROSTROKE is a collaborative project among ongoing European cohort studies on incidence and risk factors of stroke. EUROSTROKE is designed as a nested case-control study. For each stroke case, two controls were sampled. Strokes were classified according to MONICA criteria or reviewed by a panel of four neurologists. At present, data on stroke and risk factors were available from cohorts in Cardiff (84 cases), Kuopio (74 cases), Rotterdam (157 cases), and Novosibirsk (79 cases).

Results: Pooled analyses showed no significant association between total cholesterol and risk of stroke (odds ratio for increase of 1 mmol/l in cholesterol of 0.98 (95% CI 0.88 to 1.09)). Analyses for haemorrhagic stroke and cerebral infarction revealed odds ratios of 0.80 (95% CI 0.61 to 1.05) and 1.06 (95% CI 0.94 to 1.19), respectively. The association of HDL cholesterol to stroke was different in men compared with women. In men, there was a general trend towards a lower risk of stroke with an increase in HDL (odds ratio per 1 mmol/l increase in HDL cholesterol 0.68 (95% CI 0.40 to 1.16)). In women, however, an increase in HDL was associated with a significant increased risk of non-fatal stroke and of cerebral infarction (odds ratios of 2.46 (95% 0.1.20 to 5.04) and 2.52 (95% CI 1.15 to 5.50), respectively. The difference between men and women in the association of HDL with stroke seemed to differ mainly in smokers and never smokers, but not among ex smokers.

Conclusion: This analysis of the EUROSTROKE project could not disclose an association of total cholesterol with fatal, non-fatal, haemorrhagic or ischaemic stroke. HDL cholesterol however, seemed to be related to stroke differently in men than in women.

  • cohort
  • blood pressure
  • myocardial infarction

https://doi.org/10.1136/jech.56.suppl_1.i19

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    Footnotes

    • Funding: EUROSTROKE is supported by grant BMH1-CT93–1786 from the European Community BIOMED I programme and by grant CIPD-CT94–0256 from the European Community PECO programme.