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. 2020 Apr 1;27(4):363-374.
doi: 10.5551/jat.50385. Epub 2019 Sep 19.

Non-High-Density Lipoprotein Cholesterol and Risk of Stroke Subtypes and Coronary Heart Disease: The Japan Public Health Center-Based Prospective (JPHC) Study

Isao Saito  1 , Kazumasa Yamagishi  2 , Yoshihiro Kokubo  3 , Hiroshi Yatsuya  4 , Hiroyasu Iso  5 , Norie Sawada  6 , Manami Inoue  6 , Shoichiro Tsugane  6
Affiliations

Non-High-Density Lipoprotein Cholesterol and Risk of Stroke Subtypes and Coronary Heart Disease: The Japan Public Health Center-Based Prospective (JPHC) Study

Isao Saito et al. J Atheroscler Thromb. .

Abstract

Aim: A positive association between non-high-density lipoprotein cholesterol (non-HDL-C) and coronary heart disease (CHD) has been established; however, associations between non-HDL-C and stroke subtypes have not been determined.

Methods: We conducted a prospective study of 30,554 individuals aged 40-69 yrs with no history of cardiovascular disease (CVD) in Japan. Sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of stroke subtypes and CHD were estimated according to quintiles of non-HDL-C, using Cox proportional hazard models adjusted for other established risk factors.

Results: We identified 1,705 stroke and 296 CHD events over a median 15 yrs of follow-up. The fractional polynomials analysis revealed a U-shaped association between non-HDL-C and stroke risk in men. When analyzed for stroke subtypes, the data revealed an inverse relationship between non-HDL-C and intracerebral hemorrhage (ICH), primarily with lobar ICH, and a positive association between non-HDL-C and large-artery occlusive infarction in men [adjusted HR 0.55 (95% CI, 0.35-0.87) and 2.05 (95% CI, 1.07-3.93) for the highest and lowest quintile of non-HDL-C, respectively]. The lowest risk of ICH in women was observed in the fourth quintile, and the lowest risk of embolic infarction was observed in the third quintile. In contrast, non-HDL-C was positively associated with CHD in both sexes.

Conclusions: In Japanese men, lower non-HDL-C levels were associated with a decreased risk of large-artery occlusive infarction and an increased risk of ICH, particularly lobar ICH.

Keywords: Coronary heart disease; Epidemiology; Intracerebral hemorrhage; Lacunar infarction; Non-HDL-C.

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Figures

Fig. 1.
Fig. 1.
Incidence rates of CHD, stroke, and stroke subtypes according to non-HDL cholesterol quintile and sex
Fig. 2.
Fig. 2.
Multivariable adjusted HRs for deep and lobar ICH, grouped by non-HDL cholesterol quintile in men HRs were adjusted for variables in Model 2 of Table 3.
See this image and copyright information in PMC

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