Cholesterol Levels and Risk of Hemorrhagic Stroke A Systematic Review and Meta-Analysis
Cholesterol Levels and Risk of Hemorrhagic Stroke A Systematic Review and Meta-Analysis
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DOI：
10.1161/strokeaha.113.001326
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发表时间：
2013-07-01
期刊：
影响因子：
8.3
通讯作者：
Hou, Lijun
中科院分区：
文献类型：
--
作者：
Wang, Xiang;Dong, Yan;Hou, Lijun
背景和目的：胆固醇水平与出血性中风风险的相关性并不一致。本研究的目的是使用元分析方法来评估它们之间的关系。方法：检索PubMed和Embase相关英文文章。仅纳入了具有95%可信区间（ci）的前瞻性研究，这些研究报告了出血性卒中对>= 3类胆固醇水平、高与低比较或每1 mmol/L胆固醇浓度增量的影响。我们使用随机效应模型汇总特定研究的结果。结果：纳入23项前瞻性研究，共1430141名受试者，其中出血性卒中7960例（5.6%）。在高与低分析中，出血性卒中的总相对危险度为总胆固醇0.69 (95% CI, 0.59-0.81)，高密度脂蛋白胆固醇0.98 (95% CI, 0.80-1.19)，低密度脂蛋白胆固醇0.62 （95% CI, 0.41-0.92）。在剂量-反应分析中，总胆固醇增加1 mmol/L的总相对危险度为0.85 (95% CI, 0.80-0.91)，高密度脂蛋白胆固醇增加1 mmol/L的总相对危险度为1.11 (95% CI, 0.99-1.25)，低密度脂蛋白胆固醇增加1 mmol/L的总相对危险度为0.90 （95% CI, 0.77-1.05）。高密度脂蛋白胆固醇导致脑出血的总相对危险度为1.17 （95% CI, 1.02-1.35）。结论：总胆固醇水平与出血性中风风险呈负相关。高水平的低密度脂蛋白胆固醇似乎与出血性中风的风险降低有关。高密度脂蛋白胆固醇水平与脑出血风险呈正相关。
Background and Purpose-Cholesterol levels are inconsistently associated with the risk of hemorrhagic stroke. The purpose of this study is to assess their relationships using a meta-analytic approach.Methods-We searched PubMed and Embase for pertinent articles published in English. Only prospective studies that reported effect estimates with 95% confidential intervals (CIs) of hemorrhagic stroke for >= 3 categories of cholesterol levels, for high and low comparison, or for per 1 mmol/L increment of cholesterol concentrations were included. We used the random-effects model to pool the study-specific results.Results-Twenty-three prospective studies were included, totaling 1 430 141 participants with 7960 (5.6%) hemorrhagic strokes. In high versus low analysis, the summary relative risk of hemorrhagic stroke was 0.69 (95% CI, 0.59-0.81) for total cholesterol, 0.98 (95% CI, 0.80-1.19) for high-density lipoprotein cholesterol, and 0.62 (95% CI, 0.41-0.92) for low-density lipoprotein cholesterol. In dose-response analysis, the summary relative risk of hemorrhagic stroke for 1 mmol/L increment of total cholesterol was 0.85 (95% CI, 0.80-0.91), for high-density lipoprotein cholesterol was 1.11 (95% CI, 0.99-1.25), and for low-density lipoprotein cholesterol was 0.90 (95% CI, 0.77-1.05). The pooled relative risk for intracerebral hemorrhage was 1.17 (95% CI, 1.02-1.35) for high-density lipoprotein cholesterol.Conclusions-Total cholesterol level is inversely associated with risk of hemorrhagic stroke. Higher level of low-density lipoprotein cholesterol seems to be associated with lower risk of hemorrhagic stroke. High-density lipoprotein cholesterol level seems to be positively associated with risk of intracerebral hemorrhage.