HDL-cholesterol, total cholesterol, and the risk of stroke in middle-aged British men
HDL-cholesterol, total cholesterol, and the risk of stroke in middle-aged British men
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DOI：
10.1161/01.str.31.8.1882
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发表时间：
2000-08-01
期刊：
影响因子：
8.3
通讯作者：
Ebrahim, S
中科院分区：
文献类型：
--
作者：
Wannamethee, SG;Shaper, AG;Ebrahim, S
背景和目的：本研究的目的是研究血清高密度脂蛋白胆固醇和总胆固醇与卒中风险的关系。方法：我们对7735名40至59岁的男性进行了一项前瞻性研究，他们来自24个英国城镇的1组实践。排除有中风史的男性（n=52）。结果：在平均16.8年的随访期间，7683名无脑卒中史的男性中有343例脑卒中（包括致死性和非致死性）。即使在对潜在混杂因素进行校正后，较高水平的高密度脂蛋白胆固醇也与中风风险的显著降低相关（前五分之一vs最低五分之一：校正相对风险=0.68,95% CI 0.46 ~ 0.99）。仅在非致死性中风中出现负相关（调整后的相对风险= 0.59,95% CI 0.39 ~ 0.90；前五分之一vs后五分之一）。总胆固醇水平大于或等于8.1 mmol/L（分布前5%）的男性非致死性卒中风险增加，但调整后无统计学意义（调整后RR = 1.46, 95% CI 0.91至2.32）。高密度脂蛋白胆固醇升高对非致死性中风的有益影响在吸烟者和非吸烟者中均可见，并且在高血压患者中比在血压正常者中更为明显。在高血压男性中，高密度脂蛋白胆固醇升高（前五分之一）与最低五分之一的男性相比，非致命性中风风险显著降低50%。结论：较高水平的高密度脂蛋白胆固醇与非致命性中风风险的显著降低相关。相比之下，总胆固醇升高与非致命性中风呈微弱正相关。高密度脂蛋白胆固醇与中风在高血压患者中的显著负相关强调了那些已知可改变的中风危险因素降低高密度脂蛋白胆固醇浓度的重要性。
Background and Purpose-The purpose of this study was to examine the relation between serum HDL cholesterol and total cholesterol and risk of stroke.Methods-We carried out a prospective study in 7735 men, 40 to 59 years of age, drawn from 1 group practice in each of 24 British towns. Men with history of stroke were excluded (n=52).Results-During the mean follow-up period of 16.8 years, there were 343 stroke cases (fatal and nonfatal) in the 7683 men with no history of stroke. Higher levels of HDL cholesterol were associated with a significant decrease in risk of stroke even after adjustment for potential confounders (top fifth versus lowest fifth: adjusted relative risk=0.68, 95% CI 0.46 to 0.99). The inverse relation was seen only for nonfatal strokes (adjusted relative risk = 0.59, 95% CI 0.39 to 0.90; top fifth versus lowest fifth). Total cholesterol showed no graded association with fatal strokes, but men with levels greater than or equal to 8.1 mmol/L (top 5% of the distribution) showed increased risk of nonfatal stroke, although this was not statistically significant after adjustment (adjusted RR = 1.46, 95% CI 0.91 to 2.32). The beneficial effects of elevated HDL cholesterol on nonfatal stroke were seen in both smokers and nonsmokers and were more evident in men with hypertension than in normotensives. In hypertensive men, elevated HDL cholesterol (top fifth) was associated with a significant 50% reduction in risk of nonfatal strokes compared with men in the lowest fifth.Conclusions-Higher levels of HDL cholesterol were associated with a significant decrease in risk of nonfatal stroke. In contrast, elevated total cholesterol showed a weak positive association with nonfatal strokes. The marked inverse association between HDL cholesterol and stroke seen in hypertensives emphasizes the importance of those modifiable risk factors for stroke known to lower the concentrations of HDL cholesterol.