Total cholesterol and stroke mortality in middle-aged and elderly adults: A prospective cohort study

Atherosclerosis. 2018 Mar:270:211-217. doi: 10.1016/j.atherosclerosis.2017.12.003. Epub 2017 Dec 6.

Abstract

Background and aims: The association between cholesterol and stroke has been inconsistent. This study aimed to examine the association between total cholesterol (TC) and mortality from total stroke and stroke subtypes.

Methods: 503,340 Korean adults aged 40-80 years without a history of heart disease or stroke participated in routine health examinations in 2002 and 2003, and were followed up until 2013. Adjusted hazard ratios (HRs) for stroke (I60-I69) mortality were calculated.

Results: Nonlinear associations for total stroke (U-curve) and hemorrhagic stroke (L-curve), especially intracerebral hemorrhage (ICH), but a linear association for ischemic stroke, were found. In the range <200 mg/dL, TC was inversely associated with stroke mortality (HR per 39 mg/dL [1 mmol/L] increase = 0.88 [95% CI = 0.80-0.95]), mainly due to hemorrhagic stroke (HR = 0.78 [0.68-0.90]), especially ICH (HR = 0.72 [0.62-0.85]). In the upper range (200-349 mg/dL), TC was positively associated with stroke mortality (HR = 1.09 [1.01-1.16]); ICH and subarachnoid hemorrhage mortality showed no inverse association. The associations were generally similar in middle-aged (40-64 years) and elderly (≥65 years) adults and, in the upper range, each 1 mmol/L (39 mg/dL) higher TC was associated with 11% higher mortality from stroke (95% CI = 2%-21%) in the elderly. Both middle-aged (39%) and elderly (23%) adults had higher ischemic stroke mortality associated with TC ≥240 mg/dL, compare to <200 mg/dL.

Conclusions: TC level around 200 mg/dL was associated with the lowest risk of overall stroke in the elderly and middle-aged adults. No stroke subtype including ICH, was inversely associated with TC in the range ≥200 mg/dL.

Keywords: Blood cholesterol; Cohort studies; Intracerebral hemorrhage; Ischemic stroke; Subarachnoid hemorrhage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cholesterol / blood*
  • Databases, Factual
  • Dyslipidemias / blood*
  • Dyslipidemias / diagnosis
  • Dyslipidemias / mortality*
  • Female
  • Humans
  • Intracranial Hemorrhages / blood*
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / mortality*
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Republic of Korea / epidemiology
  • Risk Assessment
  • Risk Factors
  • Stroke / blood*
  • Stroke / diagnosis
  • Stroke / mortality*
  • Time Factors

Substances

  • Biomarkers
  • Cholesterol