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Low- and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: the bezafibrate infarction prevention registry.

Abstract

BACKGROUND

Despite increasing evidence that beta-hydroxy-beta-methyglutaryl coenzyme A reductase inhibitors reduce the incidence of stroke in patients with coronary heart disease (CHD), the associations between blood lipid levels and cerebrovascular disease (CVD) are not clear.

OBJECTIVE

To evaluate whether blood cholesterol level and its fractions are risk factors for stroke in a large group of patients with CHD.

METHODS

We followed up 11 177 patients with documented CHD who were screened for but not included in the Bezafibrate Infarction Prevention study, a secondary prevention randomized clinical trial of lipid modification, and had no history of stroke for subsequent CVD. During a 6- to 8-year follow-up period, 941 patients were identified as having nonhemorrhagic CVD, of whom 487 had verified ischemic stroke or transient ischemic attack (TIA).

RESULTS

Increases in age-adjusted rates of both nonhemorrhagic CVD and verified ischemic stroke or TIA were identified with increasing cholesterol and low-density lipoprotein cholesterol levels, decreasing high-density lipoprotein cholesterol levels, and decreasing percentage of total serum cholesterol contained in the HDL moiety. In logistic regression models, adjusting for clinical covariates, the following odds ratios (95% confidence intervals) were identified for lipid values in the upper vs lower tertile for the end point of nonhemorrhagic CVD: total cholesterol, 1.43 (1.20-1.70); low-density lipoprotein cholesterol, 1.52 (1.27-1.81), high-density lipoprotein cholesterol, 0.84 (0.70-1.00); and percentage of serum cholesterol contained in HDL, 0.69 (0.58-0.83). Similar trends appeared for the end point of verified ischemic stroke or TIA.

CONCLUSION

These findings clearly support the role of total cholesterol and its fractions in prediction of ischemic CVD among patients with established CHD.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.

    , ,

    Source

    Archives of internal medicine 162:9 2002 May 13 pg 993-9

    MeSH

    Adult
    Aged
    Bezafibrate
    Brain Ischemia
    Cholesterol
    Cholesterol, HDL
    Cholesterol, LDL
    Colestipol
    Coronary Disease
    Follow-Up Studies
    Humans
    Hypolipidemic Agents
    Ischemic Attack, Transient
    Lovastatin
    Middle Aged
    Multivariate Analysis
    Odds Ratio
    Registries
    Risk Factors
    Survival Analysis
    Time Factors

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    11996608

    Citation

    Koren-Morag, Nira, et al. "Low- and High-density Lipoprotein Cholesterol and Ischemic Cerebrovascular Disease: the Bezafibrate Infarction Prevention Registry." Archives of Internal Medicine, vol. 162, no. 9, 2002, pp. 993-9.
    Koren-Morag N, Tanne D, Graff E, et al. Low- and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: the bezafibrate infarction prevention registry. Arch Intern Med. 2002;162(9):993-9.
    Koren-Morag, N., Tanne, D., Graff, E., & Goldbourt, U. (2002). Low- and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: the bezafibrate infarction prevention registry. Archives of Internal Medicine, 162(9), pp. 993-9.
    Koren-Morag N, et al. Low- and High-density Lipoprotein Cholesterol and Ischemic Cerebrovascular Disease: the Bezafibrate Infarction Prevention Registry. Arch Intern Med. 2002 May 13;162(9):993-9. PubMed PMID: 11996608.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low- and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: the bezafibrate infarction prevention registry. AU - Koren-Morag,Nira, AU - Tanne,David, AU - Graff,Eran, AU - Goldbourt,Uri, PY - 2002/5/9/pubmed PY - 2002/6/1/medline PY - 2002/5/9/entrez SP - 993 EP - 9 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 162 IS - 9 N2 - BACKGROUND: Despite increasing evidence that beta-hydroxy-beta-methyglutaryl coenzyme A reductase inhibitors reduce the incidence of stroke in patients with coronary heart disease (CHD), the associations between blood lipid levels and cerebrovascular disease (CVD) are not clear. OBJECTIVE: To evaluate whether blood cholesterol level and its fractions are risk factors for stroke in a large group of patients with CHD. METHODS: We followed up 11 177 patients with documented CHD who were screened for but not included in the Bezafibrate Infarction Prevention study, a secondary prevention randomized clinical trial of lipid modification, and had no history of stroke for subsequent CVD. During a 6- to 8-year follow-up period, 941 patients were identified as having nonhemorrhagic CVD, of whom 487 had verified ischemic stroke or transient ischemic attack (TIA). RESULTS: Increases in age-adjusted rates of both nonhemorrhagic CVD and verified ischemic stroke or TIA were identified with increasing cholesterol and low-density lipoprotein cholesterol levels, decreasing high-density lipoprotein cholesterol levels, and decreasing percentage of total serum cholesterol contained in the HDL moiety. In logistic regression models, adjusting for clinical covariates, the following odds ratios (95% confidence intervals) were identified for lipid values in the upper vs lower tertile for the end point of nonhemorrhagic CVD: total cholesterol, 1.43 (1.20-1.70); low-density lipoprotein cholesterol, 1.52 (1.27-1.81), high-density lipoprotein cholesterol, 0.84 (0.70-1.00); and percentage of serum cholesterol contained in HDL, 0.69 (0.58-0.83). Similar trends appeared for the end point of verified ischemic stroke or TIA. CONCLUSION: These findings clearly support the role of total cholesterol and its fractions in prediction of ischemic CVD among patients with established CHD. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/11996608/full_citation L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/162/pg/993 DB - PRIME DP - Unbound Medicine ER -