From the Division of Preventive Medicine, Department of Medicine (P.M. Rist, J.E.B., P.M Ridker), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Neurology (C.S.K.), Emory University, Atlanta, GA; Institute of Public Health (T.K.), Charité-Universitätsmedizin, Berlin, Germany; and Division of Women's Health, Department of Medicine (K.M.R.), Brigham and Women's Hospital, Boston, MA.
Neurology. 2019 May 7;92(19):e2286-e2294. doi: 10.1212/WNL.0000000000007454. Epub 2019 Apr 10.
To examine the association between lipid levels and hemorrhagic stroke risk among women.
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.
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.
LDL-C levels <70 mg/dL and low triglyceride levels were associated with increased risk of hemorrhagic stroke among women.
研究女性血脂水平与出血性卒中风险的相关性。
我们对参加妇女健康研究的 27937 名女性进行了一项前瞻性队列研究，这些女性的总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯均有测量。通过病历回顾来确诊卒中。我们使用 Cox 比例风险模型分析了血脂分类与出血性卒中风险之间的关系。
在平均 19.3 年的随访期间，发生了 137 例出血性卒中。经多变量调整后，与 LDL-C 水平在 100-129.9mg/dL 的女性相比，LDL-C 水平<70mg/dL 的女性出血性卒中风险增加 2.17 倍（95%置信区间 [CI] 1.05，4.48）。LDL-C 水平在 130-159.9mg/dL（相对风险 [RR] 1.14；95% CI 0.72，1.80）或 70-99.9mg/dL（RR 1.25；95% CI 0.76，2.04）的女性出血性卒中风险未见显著增加。LDL-C 水平≥160mg/dL 的女性出血性卒中风险虽然不显著，但有增加的趋势（RR 1.53；95% CI 0.92，2.52）。经多变量调整后，甘油三酯最低四分位数的女性出血性卒中风险明显高于甘油三酯最高四分位数的女性（RR 2.00；95% CI 1.18，3.39）。我们未观察到总胆固醇或 HDL-C 水平与出血性卒中风险之间存在显著相关性。
LDL-C 水平<70mg/dL 和低甘油三酯水平与女性出血性卒中风险增加相关。
