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European Heart Journal Advance Access originally published online on October 11, 2007
European Heart Journal 2007 28(21):2653-2660; doi:10.1093/eurheartj/ehm427
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Associations between high-density lipoprotein cholesterol and both stroke and coronary heart disease in the Asia Pacific region

Mark Woodward*, Federica Barzi, Valery Feigin, Dongfeng Gu, Rachel Huxley, Koshi Nakamura, Anushka Patel, Suzanne Ho, Konrad Jamrozik for the Asia Pacific Cohort Studies Collaboration

Received 30 March 2007; revised 13 August 2007; accepted 31 August 2007; online publish-ahead-of-print 11 October 2007.

* Corresponding author. Mark Woodward, Department of Medicine, One Gustave L. Levy Place, P.O. Box 1087, New York, NY 10029-6574, USA. Tel: +1 212 241 5451; fax: +1 212 831 8116. E-mail address: mwoodward{at}george.org.au

Background: The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL cholesterol and stroke, particularly for stroke subtypes.

Methods and results: Cox survival models were applied to individual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After adjustment for age and regression dilution, hazard ratios (95% confidence intervals) for a 1 standard deviation (SD) lower level of HDL cholesterol (0.4 mmol/L) were: for CHD events, 1.39 (1.22–1.57); for ischaemic stroke, 0.90 (0.75–1.07), and for haemorrhagic stroke, 0.89 (0.74–1.07). As total cholesterol (TC) increased relative to HDL cholesterol, the risk of CHD increased, the risk of ischaemic stroke was unchanged but the risk of haemorrhagic stroke decreased. A 1 SD increase in TC/HDL cholesterol (1.63 units) was associated with a 27% decrease in the risk of haemorrhagic stroke (95% confidence interval, 7–44%).

Conclusion: There is clear evidence of potential benefit for CHD of increases in HDL cholesterol and decreases in TC relative to HDL cholesterol, but no evidence of an association between either HDL cholesterol or TC/HDL cholesterol and ischaemic stroke. Increasing HDL cholesterol relative to TC may increase the risk of haemorrhagic stroke.

Key Words: Cholesterol • Coronary disease • Stroke • Lipids


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