High-density lipoprotein cholesterol and ischemic stroke in the elderly - The northern Manhattan stroke study
High-density lipoprotein cholesterol and ischemic stroke in the elderly - The northern Manhattan stroke study
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DOI：
10.1001/jama.285.21.2729
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发表时间：
2001-06-06
影响因子：
120.7
通讯作者：
Berglund, L
中科院分区：
文献类型：
--
作者：
Sacco, RL;Benson, RT;Berglund, L
背景升高的高密度脂蛋白胆固醇(HDLC)水平已被证明对心血管疾病具有保护作用。目的评价老年、种族或民族多样性人群中高密度脂蛋白胆固醇与缺血性卒中的关系。设计以人群为基础的事件病例对照研究，在纽约曼哈顿北部建立一个多民族社区。53%的西班牙裔、28%的黑人和19%的白人)被纳入并按年龄、性别和种族或民族匹配到无中风社区居民(对照组；n=905)。主要结果衡量登记时确定的空腹高密度脂蛋白胆固醇水平与包括动脉粥样硬化性和非动脉粥样硬化性缺血性卒中亚型在内的缺血性卒中的独立相关性。结果经过危险因素调整后，观察到高密度脂蛋白胆固醇水平至少35 mg/dL(0.91 mmol/L)的保护作用(优势比[OR]，0.53；95%可信区间[CI]，0.39-0.72)。高密度脂蛋白胆固醇水平在35~49 mg/dL(0.91~1.28 mm o l/L)和至少50 mg/dL(1.29 m o l/L)时，剂量-反应关系(OR)分别为0.65；95%CI，0.31；95%CI，0.21~0.46。高密度脂蛋白胆固醇水平的保护作用在75岁或以上的人群中显著(OR，0.51；95%CI，0.27~0.94)，对动脉粥样硬化性卒中亚型的保护作用更强(OR，0.20；95%CI，0.08~0.50)，并且在所研究的3个种族或民族中都存在。结论高密度脂蛋白水平升高与老年人以及不同种族或民族之间的缺血性卒中风险降低有关。这些数据增加了血脂与中风相关的证据，并支持高密度脂蛋白胆固醇是一种重要的可修改的中风风险因素。
Context Elevated high-density lipoprotein cholesterol (HDL-C) levels have been shown to be protective against cardiovascular disease. However, the association of specific lipoprotein classes and ischemic stroke has not been well defined, particularly in higher risk minority populations.Objective To evaluate the association between HDL-C and ischemic stroke in an elderly, racially or ethnically diverse population.Design Population-based, incident case-control study conducted July 1993 through June 1997.Setting A multiethnic community in northern Manhattan, New York, NY.Participants Cases (n = 539) of first ischemic stroke (67% aged greater than or equal to 65 years; 55% women; 53% Hispanic, 28% black, and 19% white) were enrolled and matched by age, sex, and race or ethnicity to stroke-free community residents (controls; n=905).Main Outcome Measure Independent association of fasting HDL-C levels, determined at enrollment, with ischemic stroke, including atherosclerotic and nonatherosclerotic ischemic stroke subtypes.Results After risk factor adjustment, a protective effect was observed for HDL-C levels of at least 35 mg/dL (0.91 mmol/L) (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.39-0.72). A dose-response relationship was observed (OR, 0.65; 95% CI, 0.47-0.90 and OR, 0.31; 95% CI,0.21-0.46) for HDL-C levels of 35 to 49 mg/dL (0.91-1.28 mmol/L) and at least 50 mg/dL (1.29 mmol/L), respectively. The protective effect of a higher HDL-C level was significant among participants aged 75 years or older (OR, 0.51;95% CI,0.27-0.94), was more potent for the atherosclerotic stroke subtype (OR, 0.20; 95% CI, 0.08-0.50), and was present in all 3 racial or ethnic groups studied.Conclusions Increased HDL-C levels are associated with reduced risk of ischemic stroke in the elderly and among different racial or ethnic groups. These data add to the evidence relating lipids to stroke and support HDL-C as an important modifiable stroke risk factor.