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May 07, 2019; 92 (19) Article

Lipid levels and the risk of hemorrhagic stroke among women

Pamela M. Rist, Julie E. Buring, Paul M Ridker, Carlos S. Kase, Tobias Kurth, Kathryn M. Rexrode
First published April 10, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007454
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Abstract

Objective To examine the association between lipid levels and hemorrhagic stroke risk among women.

Methods We performed a prospective cohort study among 27,937 women enrolled in the Women's Health Study with measured total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), as well as triglycerides. Strokes were confirmed by medical record review. We used Cox proportional hazards models to analyze associations between lipid categories and hemorrhagic stroke risk.

Results During a mean of 19.3 years of follow-up, 137 hemorrhagic strokes occurred. Compared to those with LDL-C levels 100–129.9 mg/dL, after multivariable adjustment, those with LDL-C levels <70 mg/dL had 2.17 times the risk (95% confidence interval [CI] 1.05, 4.48) of experiencing a hemorrhagic stroke. No significant increase in risk was seen for those with LDL-C levels 130–159.9 mg/dL (relative risk [RR] 1.14; 95% CI 0.72, 1.80) or 70–99.9 mg/dL (RR 1.25; 95% CI 0.76, 2.04). There was a suggestion, although not significant, of increased risk for those with LDL-C levels ≥160 mg/dL (RR 1.53; 95% CI 0.92, 2.52). Women in the lowest quartile of triglycerides had a significantly increased risk of hemorrhagic stroke compared to women in the top quartile after multivariable adjustment (RR 2.00; 95% CI 1.18, 3.39). We observed no significant associations between total cholesterol or HDL-C levels and hemorrhagic stroke risk.

Conclusion LDL-C levels <70 mg/dL and low triglyceride levels were associated with increased risk of hemorrhagic stroke among women.

Glossary

CI=
confidence interval;
HDL-C=
high-density lipoprotein cholesterol;
ICH=
intracerebral hemorrhage;
IVH=
intraventricular hemorrhage;
LDL-C=
low-density lipoprotein cholesterol;
PMH=
postmenopausal hormone;
RR=
relative risk;
SAH=
subarachnoid hemorrhage;
WHS=
Women's Health Study

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • CME Course: NPub.org/cmelist

  • Received July 25, 2018.
  • Accepted in final form January 14, 2019.
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