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Low- and High-Density Lipoprotein Cholesterol and Ischemic Cerebrovascular Disease
The Bezafibrate Infarction Prevention Registry
Nira Koren-Morag, PhD;
David Tanne, MD;
Eran Graff, PhD;
Uri Goldbourt, PhD;
for the Bezafibrate Infarction Prevention Study Group
Arch Intern Med. 2002;162:993-999.
Background Despite increasing evidence that  -hydroxy--methyglutaryl
coenzyme A reductase inhibitors reduce the incidence of stroke in patients
with coronary heart disease (CHD), the associations between blood lipid levels
and cerebrovascular disease (CVD) are not clear.
Objective To evaluate whether blood cholesterol level and its fractions are risk
factors for stroke in a large group of patients with CHD.
Methods We followed up 11 177 patients with documented CHD who were screened
for but not included in the Bezafibrate Infarction Prevention study, a secondary
prevention randomized clinical trial of lipid modification, and had no history
of stroke for subsequent CVD. During a 6- to 8-year follow-up period, 941
patients were identified as having nonhemorrhagic CVD, of whom 487 had verified
ischemic stroke or transient ischemic attack (TIA).
Results Increases in age-adjusted rates of both nonhemorrhagic CVD and verified
ischemic stroke or TIA were identified with increasing cholesterol and low-density
lipoprotein cholesterol levels, decreasing high-density lipoprotein cholesterol
levels, and decreasing percentage of total serum cholesterol contained in
the HDL moiety. In logistic regression models, adjusting for clinical covariates,
the following odds ratios (95% confidence intervals) were identified for lipid
values in the upper vs lower tertile for the end point of nonhemorrhagic CVD:
total cholesterol, 1.43 (1.20-1.70); low-density lipoprotein cholesterol,
1.52 (1.27-1.81), high-density lipoprotein cholesterol, 0.84 (0.70-1.00);
and percentage of serum cholesterol contained in HDL, 0.69 (0.58-0.83). Similar
trends appeared for the end point of verified ischemic stroke or TIA.
Conclusion These findings clearly support the role of total cholesterol and its
fractions in prediction of ischemic CVD among patients with established CHD.
From the Division of Epidemiology and Preventive Medicine, Sackler
School of Medicine, Tel-Aviv University (Drs Koren-Morag and Goldbourt), Stroke
Unit, Department of Neurology, Sheba Medical Center, Tel Hashomer (Dr Tanne),
Biochemical Laboratory, Ichilov Hospital, Tel Aviv Medical Center, and Institute
for Physiological Hygiene, Wolfson Medical Center (Dr Graff), and Neufeld
Cardiac Research Institute, Sheba Medical Center, Tel Hashomer (Dr Goldbourt),
Israel. A complete list of the members, participating centers, and committee
membership of the Bezafibrate Infarction Prevention Study Group was published
previously (Circulation. 2000;102:21-27).
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