HDL-cholesterol, total cholesterol, and the risk of stroke in middle-aged British men

Background and Purpose-The purpose of this study was to examine the relatio n between serum HDL cholesterol and total cholesterol and risk of stroke. Methods-We carried out a prospective study in 7735 men, 40 to 59 years of a ge, drawn from 1 group practice in each of 24 British towns. Men with histo ry of stroke were excluded (n=52). Results-During the mean follow-up period of 16.8 years, there were 343 stro ke cases (fatal and nonfatal) in the 7683 men with no history of stroke. Hi gher levels of HDL cholesterol were associated with a significant decrease in risk of stroke even after adjustment for potential confounders (top fift h versus lowest fifth: adjusted relative risk=0.68, 95% CI 0.46 to 0.99). T he inverse relation was seen only for nonfatal strokes (adjusted relative r isk = 0.59, 95% CI 0.39 to 0.90; top fifth versus lowest fifth). Total chol esterol showed no graded association with fatal strokes, but men with level s greater than or equal to 8.1 mmol/L (top 5% of the distribution) showed i ncreased risk of nonfatal stroke, although this was not statistically signi ficant after adjustment (adjusted RR = 1.46, 95% CI 0.91 to 2.32). The bene ficial effects of elevated HDL cholesterol on nonfatal stroke were seen in both smokers and nonsmokers and were more evident in men with hypertension than in normotensives. In hypertensive men, elevated HDL cholesterol (top f ifth) was associated with a significant 50% reduction in risk of nonfatal s trokes compared with men in the lowest fifth. Conclusions-Higher levels of HDL cholesterol were associated with a signifi cant decrease in risk of nonfatal stroke. In contrast, elevated total chole sterol showed a weak positive association with nonfatal strokes. The marked inverse association between HDL cholesterol and stroke seen in hypertensiv es emphasizes the importance of those modifiable risk factors for stroke kn own to lower the concentrations of HDL cholesterol.