Women with LDL levels below 70 mg/dL and low triglyceride levels had increased risk for hemorrhagic stroke, according to a study published in Neurology.
“Strategies to lower cholesterol and triglyceride levels, like modifying diet or taking statins, are widely used to prevent cardiovascular disease, but our large study shows that in women, very low levels may also carry some risks,” Pamela M. Rist, ScD, assistant professor in the division of preventive medicine at Brigham and Women’s Hospital and Harvard Medical School, said in a press release. “Women already have a higher risk of stroke than men, in part because they live longer, so clearly defining ways to reduce their risk is important.”
Women’s Health Study
Researchers analyzed data from 27,937 patients from the Women’s Health Study. Blood samples were taken to measure LDL, HDL, total cholesterol and triglycerides. Women were then categorized by LDL: < 70 mg/dL (n = 1,069; mean age, 53 years), 70 mg/dL to 99.9 mg/dL (n = 5,739; mean age, 53 years), 100 mg/dL to 129.9 mg/dL (n = 10,067; mean age, 54 years), 130 mg/dL to 159.9 mg/dL (n = 7,187; mean age, 56 years) and 160 mg/dL (n = 3,875; mean age, 57 years).
Questionnaires were completely annually to collect information on outcomes including stroke. Follow-up was conducted until the first stroke event, loss to follow-up or study completion, whichever occurred first for a mean of 19.3 years.
There were 137 incident hemorrhagic strokes during follow-up. Compared with women with LDL levels between 100 mg/dL and 129.9 mg/dL, those with levels less than 70 mg/dL had 2.17 times the risk for a hemorrhagic stroke after multivariable adjustment (95% CI, 1.05-4.48). Women with LDL levels greater than 160 mg/dL had an elevated risk for hemorrhagic stroke, although it was not statistically significant (RR = 1.53; 95% CI, 0.92-2.52). An increased risk for hemorrhagic stroke was not seen in women with LDL levels between 70 mg/dL and 99.9 mg/dL (RR = 1.25; 95% CI, 0.76-2.04) or between 130 mg/dL and 159.9 mg/dL (RR = 1.14; 95% CI, 0.72-1.8).
Low triglyceride levels
A significantly increased risk for hemorrhagic stroke was seen in women in the lowest quartile of triglycerides vs. those in the top quartile after multivariable adjustment (RR = 2; 95% CI, 1.18-3.39).
No significant associations were observed between total cholesterol or HDL and the risk for hemorrhagic stroke.
“Women with very low LDL-C or low triglycerides should be monitored for other modifiable risk factors for hemorrhagic stroke, for example, hypertension and smoking, to help reduce their overall risk of experiencing a hemorrhagic stroke event,” Rist and colleagues wrote. “Additional targeted research is needed to determine if our finding of elevated LDL-C levels ( 160 mg/dL) being associated with an increased risk of hemorrhagic stroke can be replicated in other cohorts and to provide insights on how to reduce hemorrhagic stroke risk in these individuals.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.