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.
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.
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