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

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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.

Original languageEnglish (US)
Pages (from-to)1400-1406
Number of pages7
JournalArchives of neurology
Volume66
Issue number11
DOIs
StatePublished - Nov 1 2009

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ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Willey, J. Z., Xu, Q., Boden-Albala, B., Paik, M. C., Moon, Y. P., Sacco, R. L., & Elkind, M. S. V. (2009). Lipid profile components and risk of ischemic stroke: The Northern Manhattan Study (NOMAS). Archives of neurology, 66(11), 1400-1406. https://doi.org/10.1001/archneurol.2009.210