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Controversies in Neurology
December 1999

Is Cholesterol a Risk Factor for Stroke?Yes

Author Affiliations

From the Departments of Neurology, University of Texas\NHouston Medical School, Houston (Drs Demchuk and Yatsu), Medical College of Georgia and Veterans Affairs Medical Center, Augusta, Ga (Dr Hess), and Yale University School of Medicine, and Veterans Affairs Medical Center, New Haven, Conn (Dr Brass).



Arch Neurol. 1999;56(12):1518-1520. doi:10.1001/archneur.56.12.1518

ATHEROSCLEROSIS is the most common cause of coronary artery disease (CAD), peripheral vascular disease, and stroke worldwide. Atherogenesis is a multifactorial process involving cholesterol internalization, vascular smooth muscle cell proliferation, inflammation, "foam cell" formation, and connective tissue production.1Experimental and epidemiological studies of CAD, peripheral vascular disease, and stroke have identified powerful risk factors that directly affect these multifactorial processes and include hypertension, diabetes, smoking, and aging.2The relevance of cholesterol, however, has only been definitively associated with CAD and peripheral vascular disease, and has a seemingly tentative and controversial role with strokes.3,4For example, in the Framingham Study5no correlation was found between cholesterol and vascular disease of the brain. The Honolulu Heart Study6of Japanese American men showed no significant association with cerebral infarction but an inverse relationship with intracerebral hemorrhage. However, in the large Multiple Risk Factor Intervention Trial7of more than 350,000 men, death from nonhemorrhagic strokes correlated with elevated cholesterol, suggesting but not proving an association with atherothrombotic brain infarction (ABI). The Eastern Stroke and Coronary Heart Disease Collaborative Research Group study8of 69,767 participants revealed a trend toward a reduction in the risk of nonhemorrhagic stroke with decreasing cholesterol concentrations.