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Lipid Levels & Risk of Hemorrhagic Stroke in Women

Among a cohort of women enrolled in the Women’s Health Study, low-density lipoprotein cholesterol (LDL-C) levels <70 mg/dL and low triglyceride levels were associated with increased risk of hemorrhagic stroke. Researchers performed a prospective cohort study among 27,937 women with measured total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), as well as triglycerides. They found:

  • During a mean of 19.3 years of follow-up, 137 hemorrhagic strokes occurred.
  • Compared to women with LDL-C levels 100-129.9 mg/dL, those with LDL-C levels <70 mg/dL had 2.17 times the risk of experiencing a hemorrhagic stroke.
  • No significant increase in risk was seen for those with LDL-C levels 130-159.9 mg/dL or 70-99.9 mg/dL.
  • 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.

Citation:

Rist PM, Buring JE, Ridker PM, et al. Lipid levels and the risk of hemorrhagic stroke among women. [Published online ahead of print April 10, 2019]. Neurology. doi:10.1212/WNL.0000000000007454.

Commentary:

Previous epidemiologic studies give conflicting results between the association of LCL-C and the risk of hemorrhagic stroke. The Women’s Health Study (WHS) prospectively followed nearly 28,000 women for over 19 years and showed a greater than two-fold risk of experiencing a hemorrhagic stroke in the cohort of women with an LDL-C<70 mg/dL. A similar risk was noted in women with a fasting triglyceride level of <75 mg/dL. Of note, 50% of the women in the study were treated with aspirin. Only about 2% were on statin medication. To date, there is no convincing evidence that statin therapy is associated with hemorrhagic stroke. Meta-analyses of statin trials have not shown an association between statin therapy or the achieved LDL-C level and hemorrhagic stroke. The WHS followed women for a substantially longer period of time than statin trials raising the question about longer term risk of very low LDL-C levels. —Matthew Sorrentino, MD