Background and Purpose: Elevated high-density lipoprotein cholesterol (HDL-C) levels have displayed protection against cardiovascular disease. However, the association between specific lipoprotein classes and first ischemic stroke (IS) has not been well defined, particularly in higher-risk hypertensive populations. Our study evaluated the associations of HDL-C with first IS in a Chinese hypertensive population.
Methods: The study population was obtained from a community-based cohort study of hypertension in Lianyungang and Rongcheng, China. A nested case-control design was used that included 2463 identified first IS cases and 2463 controls matched by age ± 1 year, sex, and region.
Results: After adjusting for potential confounders, HDL-C was inversely associated with first IS (adjusted odds ratio [aOR]: 0.91; 95% confidence interval [CI]: 0.85– 0.98). HDL-C levels of at least 65.4 mg/dL displayed a significant protective effect for first IS (aOR: 0.82; 95% CI: 0.69– 0.98). Conversely, adverse effects of first IS were observed for low-density lipoprotein cholesterol (LDL-C) levels ≥ 138.1 mg/dL (aOR: 1.20; 95% CI: 1.02– 1.42) and triglyceride (TG) levels ≥ 140.8 mg/dL (aOR: 1.27; 95% CI: 1.09– 1.49). The risk associations of LDL-C and TG with first IS were attenuated in the presence of high HDL-C (≥ 53.0 mg/dL); an increased risk of first IS was only found in the presence of low HDL-C (< 53.0 mg/dL) when LDL-C (aOR: 1.66; 95% CI: 1.19– 2.31) and TG (aOR: 1.47; 95% CI: 1.17– 1.84) were combined with HDL-C for analysis.
Conclusion: In this community-based Chinese hypertensive population, higher HDL-C was a significant protective factor of first IS. These data add to the evidence describing the relationship between lipids and IS and suggest that HDL-C maybe is a marker of IS risk in Chinses hypertensive population.
Keywords: high-density lipoprotein cholesterol, lipids, ischemic stroke, epidemiology