European Heart Journal Advance Access originally published online on July 8, 2005
European Heart Journal 2005 26(18):1910-1915; doi:10.1093/eurheartj/ehi407
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Plasma lipids predict myocardial infarction, but not stroke, in patients with established cerebrovascular disease
1The George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia
2St Vincent's Institute of Medical Research, Victoria, Australia
3Department of Medicine, University of Melbourne, Victoria, Australia
4Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, Australia
Received 19 January 2005; revised 13 June 2005; accepted 16 June 2005; online publish-ahead-of-print 8 July 2005.
* Corresponding author. Tel: +61 2 9993 4564; fax: +61 2 9993 4502. E-mail address: apatel{at}thegeorgeinstitute.org
See page 1818 for the editorial comment on this article (doi:10.1093/eurheartj/ehi309)
Aims To evaluate the role of plasma lipids in recurrent vascular events, including stroke, among individuals with established cerebrovascular disease.
Methods and results Plasma total cholesterol, HDL cholesterol, and triglycerides were measured at baseline among individuals participating in the Perindopril Protection Against Recurrent Stroke (PROGRESS) study, a randomized clinical trial of blood pressure lowering among patients with previous stroke or transient ischaemic attack. A series of nested case–control studies were used to investigate the association between each of these lipid variables and the risk of subsequent haemorrhagic stroke, ischaemic stroke, myocardial infarction (MI), and heart failure. A total of 895 patients were selected as cases (83 haemorrhagic stroke, 472 ischaemic stroke, 206 MI, and 258 heart failure) and each was matched with one to three controls. After adjustment for other major cardiovascular risk factors, none of the lipid variables was associated with the risk of either stroke subtype. There were significant positive and negative associations for total cholesterol and HDL, respectively, with the risk of MI; the odds ratio comparing the highest and lowest thirds of each of these lipid variables was 2.00 (95% CI: 1.30–3.09) for total cholesterol and 0.58 (95% CI: 0.37–0.90) for HDL. HDL was inversely associated with the risk of heart failure; however, this result was of borderline statistical significance (P=0.05).
Conclusion Lipid variables are associated with the risk of MI, but not recurrent stroke, in patients with established cerebrovascular disease.
Key Words: Nested case–control study • Ischaemic stroke • Haemorrhagic stroke • Myocardial infarction • Heart failure
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