Low "bad" cholesterol tied to stroke risk in women

Takeaway

• Women with a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL had a more than doubling of hemorrhagic stroke risk relative to counterparts with normal levels.

Why this matters

• Lipid-lowering strategies are a mainstay in cardiovascular disease prevention.

Key results

• 137 hemorrhagic strokes during mean 19.3-year follow-up.
• In multivariate analysis with women having LDL-C 100-129.9 mg/dL as comparator, relative risk (95% CI) for hemorrhagic stroke:
  • LDL-C <70 mg/dL (2.17; 1.05-4.48);
  • LDL-C 70-99.9 mg/dL (1.25; 0.76-2.04);
  • LDL-C 130-159.9 mg/dL (1.14; 0.72-1.80); and
  • LDL-C ≥160 mg/dL (1.53; 0.92-2.52).
• Elevation of risk for those in lowest category seen for intracerebral hemorrhage and subarachnoid hemorrhage individually.
• Women in lowest quartile of triglycerides (≤74 mg/dL) had increased hemorrhagic stroke risk vs peers in top quartile (>156 mg/dL; relative risk, 2.00; 95% CI, 1.18-3.39).
• Neither total cholesterol nor high-density lipoprotein cholesterol levels significantly associated with hemorrhagic stroke risk.

Study design

• Prospective cohort study among 27,937 women in Women’s Health Study with lipid measurement at baseline.
• Main outcome: hemorrhagic stroke confirmed by medical record review.
• Funding: NIH.

Limitations

• Largely white, postmenopausal population with low level of statin use.
• Limited power for stroke subtype analyses.
• Single lipid measurement at baseline.
• Potential residual confounding.