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October 28, 2013

Cholesterol Level and Stroke: A Complex Relationship

Author Affiliations
  • 1Division of Stroke, Department of Neurology, Columbia University Medical Center, New York, New York
JAMA Intern Med. 2013;173(19):1765-1766. doi:10.1001/jamainternmed.2013.10100

Identification of the role that plasma lipid components play in the pathogenesis of ischemic heart disease is one of the major successes of biomedical research in the 20th century. It has led to successful public health and individual-level interventions for lowering cholesterol levels as part of the strategy for prevention of ischemic heart disease.

The data on the effect of dyslipidemia on stroke, however, are more complicated. Prospective cohort studies and meta-analyses evaluating the association between dyslipidemia and stroke have shown mixed results. Explanations of why dyslipidemia is strongly associated with ischemic heart disease but variably associated with stroke are centered on biological differences, differences in study methodology, inconsistent definitions of stroke, and residual confounding by other stroke risk factors.