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October 3, 2001

High-Density Lipoprotein Cholesterol and Risk of Stroke—Reply

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

JAMA. 2001;286(13):1573-1574. doi:10.1001/jama.286.13.1573

In Reply: We agree that both case-control and cross-sectional studies have limitations in defining a causal association between an exposure and a disease because of the inability to accurately define the temporal relationship between the variables. In our study, we assumed that the poststroke HDL-C measurement was a proxy for prestroke HDL-C. We cited references that support the relative stability of HDL-C in acute situations.1-3 There is no literature that suggests that stroke will lead to a decrease in HDL-C acutely. Whether other confounding prior conditions led to a decrease in HDL-C and also increased the risk of stroke is unknown. We adjusted for multiple other risk factors and still found an independent association between HDL-C and ischemic stroke.