ABSTRACT
Stroke is a common cause of disability and death1, but it can be prevented. The prevention advisory board of the National Stroke Association has recently identified a group of potent, yet modifiable, risk factors for stroke that include hyperlipidemia and diabetes mellitus2. In the past, considerable controversy existed regarding the relationship of hyperlipidemia to stroke. However, important recent data appear to confirm a relationship between the two. Middle-aged men from Finland who died of stroke had higher cholesterol levels when compared to subjects who were alive at the end of the study3. The Multiple Risk Factor Intervention Trial (MRFIT) study4 and the Honolulu Heart Study5 have clearly demonstrated that higher cholesterol levels are associated with an increase in stroke mortality. In the MRFIT study the adjusted relative risk for developing a non-hemorrhagic stroke was 1.8 when serum cholesterol levels were between 240 and 279 mg/dl and 2.6 for levels greater than 280 mg/dl compared to subjects with total cholesterol levels less than 160 mg/dl. In addition, an independent association between lowdensity liprotein cholesterol (LDL-C) and risk of dementia with stroke has been reported6. Recently a protective role of high-density
lipoprotein cholesterol (HDL-C) in reduction of stroke risk, similar to that in coronary artery disease (CAD), has been found. HDL-C level was inversely associated with the risk for non-fatal stroke in both smokers and nonsmokers, and was apparent more in lean men, in men with CAD and in patients with hypertension (HTN)7. In the Northern Manhattan Stroke (NOMAS) study, a similar finding of reduced risk for ischemic stroke was observed in elderly subjects of varying ethnic backgrounds with higher levels of HDL-C8.
