Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Stroke. 2013 Jul;44(7):1833-9. doi: 10.1161/STROKEAHA.113.001326. Epub 2013 May 23.
Cholesterol levels are inconsistently associated with the risk of hemorrhagic stroke. The purpose of this study is to assess their relationships using a meta-analytic approach.
We searched PubMed and Embase for pertinent articles published in English. Only prospective studies that reported effect estimates with 95% confidential intervals (CIs) of hemorrhagic stroke for ≥3 categories of cholesterol levels, for high and low comparison, or for per 1 mmol/L increment of cholesterol concentrations were included. We used the random-effects model to pool the study-specific results.
Twenty-three prospective studies were included, totaling 1 430 141 participants with 7960 (5.6%) hemorrhagic strokes. In high versus low analysis, the summary relative risk of hemorrhagic stroke was 0.69 (95% CI, 0.59-0.81) for total cholesterol, 0.98 (95% CI, 0.80-1.19) for high-density lipoprotein cholesterol, and 0.62 (95% CI, 0.41-0.92) for low-density lipoprotein cholesterol. In dose-response analysis, the summary relative risk of hemorrhagic stroke for 1 mmol/L increment of total cholesterol was 0.85 (95% CI, 0.80-0.91), for high-density lipoprotein cholesterol was 1.11 (95% CI, 0.99-1.25), and for low-density lipoprotein cholesterol was 0.90 (95% CI, 0.77-1.05). The pooled relative risk for intracerebral hemorrhage was 1.17 (95% CI, 1.02-1.35) for high-density lipoprotein cholesterol.
Total cholesterol level is inversely associated with risk of hemorrhagic stroke. Higher level of low-density lipoprotein cholesterol seems to be associated with lower risk of hemorrhagic stroke. High-density lipoprotein cholesterol level seems to be positively associated with risk of intracerebral hemorrhage.
胆固醇水平与出血性卒中风险的关系并不一致。本研究旨在采用荟萃分析方法评估它们之间的关系。
我们检索了 Pubmed 和 Embase 数据库中发表的相关英文文献。仅纳入了报告了≥3 组胆固醇水平（高、中、低）、高与低比较或每 mmol/L 胆固醇浓度升高的出血性卒中事件发生率及 95%可信区间（95%CI）的前瞻性研究。我们使用随机效应模型对研究特异性结果进行了汇总。
共纳入 23 项前瞻性研究，总计 1430141 名参与者，其中 7960 例（5.6%）为出血性卒中。在高与低的分析中，总胆固醇的出血性卒中相对风险比为 0.69（95%CI，0.59-0.81），高密度脂蛋白胆固醇为 0.98（95%CI，0.80-1.19），低密度脂蛋白胆固醇为 0.62（95%CI，0.41-0.92）。在剂量-反应分析中，总胆固醇每升高 1mmol/L 的出血性卒中相对风险比为 0.85（95%CI，0.80-0.91），高密度脂蛋白胆固醇为 1.11（95%CI，0.99-1.25），低密度脂蛋白胆固醇为 0.90（95%CI，0.77-1.05）。高密度脂蛋白胆固醇的颅内出血合并相对风险为 1.17（95%CI，1.02-1.35）。
总胆固醇水平与出血性卒中风险呈负相关。较低水平的低密度脂蛋白胆固醇似乎与较低的出血性卒中风险相关。高密度脂蛋白胆固醇水平似乎与颅内出血风险呈正相关。
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