Lipid profile components and risk of ischemic stroke

The Northern Manhattan Study (NOMAS)

Joshua Z. Willey, Qiang Xu, Bernadette Boden-Albala, Myunghee C. Paik, Yeseon Park Moon, Ralph L. Sacco, Mitchell S V Elkind

Research output: Contribution to journalArticle

Abstract

Objective: To explore the relationship between lipid profile components and incident ischemic stroke in a strokefree prospective cohort. Design: Population-based prospective cohort study. Setting: Northern Manhattan, New York. Patients: Stroke-free community residents. Intervention: As part of the Northern Manhattan Study, baseline fasting blood samples were collected on strokefree community residents followed up for a mean of 7.5 years. Main Outcome Measures: Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for lipid profile components and ischemic stroke after adjusting for demographic and risk factors. In secondary analyses, we used repeated lipid measures over 5 years from a 10% sample of the population to calculate the change per year of each of the lipid parameters and to impute time-dependent lipid parameters for the full cohort. Results: After excluding those with a history of myocardial infarction, 2940 participants were available for analysis. Baseline high-density lipoprotein cholesterol, triglyceride, and total cholesterol levels were not associated with risk of ischemic stroke. Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol levels were associated with a paradoxical reduction in risk of stroke. There was an interaction with use of cholesterol-lowering medication on follow-up, such that LDL-C level was only associated with a reduction in stroke risk among those taking medications. An LDL-C level greater than 130 mg/dL as a time-dependent covariate showed an increased risk of ischemic stroke (adjusted hazard ratio, 3.81; 95% confidence interval, 1.53-9.51). Conclusions: Baseline lipid panel components were not associated with an increased stroke risk in this cohort. Treatment with cholesterol-lowering medications and changes in LDL-C level over time may have attenuated the risk in this population, and lipid measurements at several points may be a better marker of stroke risk.

Original languageEnglish (US)
Pages (from-to)1400-1406
Number of pages7
JournalArchives of Neurology
Volume66
Issue number11
DOIs
StatePublished - Nov 2009

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Stroke
Lipids
LDL Cholesterol
Cholesterol
Confidence Intervals
Population
Manhattan
Risk Reduction Behavior
Proportional Hazards Models
HDL Cholesterol
Fasting
Triglycerides
Cohort Studies
Myocardial Infarction
Demography
Outcome Assessment (Health Care)
Prospective Studies
Cohort
Hazard
Medication

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Lipid profile components and risk of ischemic stroke : The Northern Manhattan Study (NOMAS). / Willey, Joshua Z.; Xu, Qiang; Boden-Albala, Bernadette; Paik, Myunghee C.; Moon, Yeseon Park; Sacco, Ralph L.; Elkind, Mitchell S V.

In: Archives of Neurology, Vol. 66, No. 11, 11.2009, p. 1400-1406.

Research output: Contribution to journalArticle

Willey, Joshua Z. ; Xu, Qiang ; Boden-Albala, Bernadette ; Paik, Myunghee C. ; Moon, Yeseon Park ; Sacco, Ralph L. ; Elkind, Mitchell S V. / Lipid profile components and risk of ischemic stroke : The Northern Manhattan Study (NOMAS). In: Archives of Neurology. 2009 ; Vol. 66, No. 11. pp. 1400-1406.
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abstract = "Objective: To explore the relationship between lipid profile components and incident ischemic stroke in a strokefree prospective cohort. Design: Population-based prospective cohort study. Setting: Northern Manhattan, New York. Patients: Stroke-free community residents. Intervention: As part of the Northern Manhattan Study, baseline fasting blood samples were collected on strokefree community residents followed up for a mean of 7.5 years. Main Outcome Measures: Cox proportional hazard models were used to calculate hazard ratios and 95{\%} confidence intervals for lipid profile components and ischemic stroke after adjusting for demographic and risk factors. In secondary analyses, we used repeated lipid measures over 5 years from a 10{\%} sample of the population to calculate the change per year of each of the lipid parameters and to impute time-dependent lipid parameters for the full cohort. Results: After excluding those with a history of myocardial infarction, 2940 participants were available for analysis. Baseline high-density lipoprotein cholesterol, triglyceride, and total cholesterol levels were not associated with risk of ischemic stroke. Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol levels were associated with a paradoxical reduction in risk of stroke. There was an interaction with use of cholesterol-lowering medication on follow-up, such that LDL-C level was only associated with a reduction in stroke risk among those taking medications. An LDL-C level greater than 130 mg/dL as a time-dependent covariate showed an increased risk of ischemic stroke (adjusted hazard ratio, 3.81; 95{\%} confidence interval, 1.53-9.51). Conclusions: Baseline lipid panel components were not associated with an increased stroke risk in this cohort. Treatment with cholesterol-lowering medications and changes in LDL-C level over time may have attenuated the risk in this population, and lipid measurements at several points may be a better marker of stroke risk.",
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