BACKGROUND AND PURPOSE:

• Previous studies have observed an inverse relationship between low-density lipoprotein cholesterol (LDL-C) levels and the risk of hemorrhagic stroke
• Rist et al. (Neurology, 2019) examined the association between lipid levels and risk of hemorrhagic stroke among women

METHODS:

• Prospective cohort study
• Participants derived from Women’s Health Study (WHS)
  • RCT of low-dose aspirin and vitamin E for the primary prevention of cardiovascular disease (CVD) and cancer
  • 39,876 US female health professionals ≥45 years
  • Trial concluded in 2004 with ongoing follow-up
• Measurements included
  • Total cholesterol
  • Low-density lipoprotein cholesterol (LDL-C)
  • High-density lipoprotein cholesterol (HDL-C)
  • Triglycerides
• Strokes confirmed with medical records
• Data analysis
  • Cox proportional hazards models to analyze associations between lipid categories and hemorrhagic stroke risk

RESULTS:

• 27,937 women
  • Mean follow-up: 19.3 years
  • 137 hemorrhagic strokes
• “U-shaped relationship between LDL-C and hemorrhagic stroke risk”
• When compared to those with LDL-C levels 100-129.9 mg/dL, women with lowest LDL-C levels (<70 mg/dL ) were at significant risk of hemorrhagic stroke when adjusted for multiple confounders
  • Relative risk (RR): 2.17 (95% CI, 1.05-4.48)
• There was no significant increase in risk of stroke in those with
  • LDL-C levels 130-159.9 mg/dL: RR 1.14 (95% CI, 0.72-1.80)
  • LDL-C levels 70-99.9 mg/dL: RR 1.25 (95% CI, 0.76-2.04)
• There was a non-significant increase in risk for those with LDL-C levels ≥160 mg/dL
  • RR 1.53 (95% CI, 0.92-2.52)
• Women with the lowest quartile of triglycerides had a significantly increased risk of hemorrhagic stroke compared to women in the top quartile after multivariable adjustment
  • RR 2.00 (95% CI, 1.18-3.39)
• There were no significant associations between total cholesterol or HDL-C levels and hemorrhagic stroke risk

CONCLUSION:

• Women with <70 mg/dL had 2.17 times the risk of hemorrhagic stroke compared to those with LDL-C levels 100-129.9 mg/dL
• There may be benefit to identifying these individuals to help adjust modifiable risk factors such as BP and smoking
• Further studies required to determine if there is additional risk for women with ≥160 mg/dL

Learn More – Primary Sources:

Lipid levels and the risk of hemorrhagic stroke among women

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