Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
Ann Neurol. 2019 Apr;85(4):550-559. doi: 10.1002/ana.25432. Epub 2019 Mar 3.
High remnant cholesterol concentrations are associated with high risk of ischemic heart disease, but whether this is also the case for ischemic stroke is unknown. We tested the hypothesis that high remnant cholesterol concentrations are associated with increased risk of ischemic stroke in the general population.
A total of 102,964 individuals from the Copenhagen General Population Study with information on remnant cholesterol at baseline in 2003-2015 were included in a prospective, observational association study. Individuals were followed for up to 14 years, during which time 2,488 were diagnosed with an ischemic stroke. Hazard ratios were estimated using Cox proportional hazard regression models. Results were independently confirmed in 9,548 individuals enrolled in the Copenhagen City Heart Study in 1991-1994; 983 ischemic strokes developed during up to 26 years of follow-up.
Step-wise higher remnant cholesterol concentrations were associated with step-wise higher ischemic stroke risk in the Copenhagen General Population Study, with multivariable adjusted hazard ratios up to 1.99 (95%confidence interval: 1.49-2.67) for individuals with remnant cholesterol concentrations ≥1.5 mmol/l (58 mg/dl), compared to individuals with remnant cholesterol <0.5 mmol/l (19 mg/dl). Results were similar in the Copenhagen City Heart Study. Cumulative incidence of ischemic stroke at age 80 in the Copenhagen General Population Study ranged from 7.3% for individuals with remnant cholesterol <0.5 mmol/l (19 mg/dl) to 11.5% for individuals with remnant cholesterol ≥1.5 mmol/l (58 mg/dl).
Individuals with high remnant cholesterol concentrations had higher risk of ischemic stroke. These results indicate that randomized clinical trials with remnant cholesterol lowering in individuals with high concentrations, with the aim of preventing ischemic strokes, are needed. Ann Neurol 2019;85:550-559.
高残余胆固醇浓度与缺血性心脏病的高风险相关，但这种情况是否也存在于缺血性卒中尚不清楚。我们检验了这样一个假设，即高残余胆固醇浓度与普通人群中缺血性卒中风险增加相关。
共纳入 102964 名个体，他们在 2003-2015 年基线时具有残余胆固醇信息，参与了一项前瞻性观察性关联研究。这些个体随访时间长达 14 年，在此期间有 2488 人被诊断为缺血性卒中。使用 Cox 比例风险回归模型估计危险比。结果在纳入 1991-1994 年哥本哈根城市心脏研究的 9548 名个体中得到独立确认；在长达 26 年的随访期间，发生了 983 例缺血性卒中。
在哥本哈根普通人群研究中，逐步升高的残余胆固醇浓度与逐步升高的缺血性卒中风险相关，在多变量调整后，残余胆固醇浓度≥1.5mmol/l（58mg/dl）的个体的危险比高达 1.99（95%置信区间：1.49-2.67），而残余胆固醇<0.5mmol/l（19mg/dl）的个体。在哥本哈根城市心脏研究中结果相似。在哥本哈根普通人群研究中，80 岁时缺血性卒中的累积发生率范围为残余胆固醇<0.5mmol/l（19mg/dl）的个体为 7.3%，至残余胆固醇≥1.5mmol/l（58mg/dl）的个体为 11.5%。
残余胆固醇浓度高的个体发生缺血性卒中的风险更高。这些结果表明，需要进行针对高浓度残余胆固醇个体的降低残余胆固醇的随机临床试验，以预防缺血性卒中。
