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Title: Higher High-Density Lipoprotein Cholesterol Levels Offer Elderly Stroke Protection

URL: http://jama.ama-assn.org/issues/v285n21/abs/joc02275.html

JAMA, 2001; 285: 2729-2735. "High-Density Lipoprotein Cholesterol and Ischemic Stroke in the Elderly The Northern Manhattan Stroke Study"
06/05/2001 04:03:00 PM
By Elda Hauschildt

Increased high-density lipoprotein cholesterol (HDL-C) levels have a protective effect for ischemic stroke in both elderly men and women. This protective effect holds true among racial and ethnic groups. New York researchers concluded: "Higher HDL-C levels were significantly more protective against atherosclerotic ischemic stroke than non-atherosclerotic stroke sub-types." They note that the protective dose-response relationship held even when HDL-C levels were adjusted for total cholesterol or low-density lipoprotein cholesterol (LDL-C) and triglyceride levels. Investigators from the College of Physicians and Surgeons and Columbia University suggest this protective effect is "not mediated by relationships between HDL-C and their lipid levels." In their study, they made adjustments for multiple potential confounders and for other known stroke risk factors. These included: hypertension, diabetes, cardiac disease, current smoking status, physical activity, body mass index and educational level as a marker of socioeconomic status. They did a population-based, incident case-control study between July 1993 and June 1997 in a multi-ethnic community in northern Manhattan, New York. Fasting HDL-C levels of participants were determined at enrollment. Case subjects included 539 people who had had a first ischemic stroke. Approximately 67 percent were 65 years and older, and 55 percent were women. Ethnicity make-up of the group was 53 percent Hispanic, 28 percent black and 19 percent white. Case subjects were matched by age, sex and race or ethnicity with 905 stroke-free community residents. "After risk factor adjustment, a protective effect was observed for HDL-C levels of at least 35 mg/dL (0.91 mmol/L)," the researchers report. "A dose-response relationship was observed for HDL-C levels of 35 to 449 mg/dL (0.91-1.28 mmol/L) and at least 50 mg/dL (1.29 mmol/L)." Investigators point out that the protective effect of higher HDL-C level was more potent for people 75 years or older as well as for the atherosclerotic stroke subtype. They also note the effect was present in all three racial or ethnic groups studied. "Our study has important public-health implications for minority groups and elderly persons," the researchers say. "Blacks and Hispanics have a greater mortality and incidence of stroke." They say the study has shown a significant modifiable risk factor that is pertinent to each of the three ethnic groups studied and to both sexes. It has also demonstrated a protective effect for ischemic stroke among the "older-elderly, a finding significant in that several researchers have questioned the need to diagnose or treat dyslipidemia in individuals older than 70 years."

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