Nonfasting Triglycerides, Cholesterol, and Ischemic Stroke in the General Population

Objective: Current guidelines on stroke prevention have recommendations on desirable cholesterol levels, but not on nonfasting triglycerides. We compared stepwise increasing levels of nonfasting triglycerides and cholesterol for their association with risk of ischemic stroke in the general population. Methods: A total of 7,579 women and 6,372 men from the Copenhagen City Heart Study with measurements of nonfasting triglycerides and cholesterol at baseline in 1976-1978 were followed for up to 33 years; of these, 837 women and 837 men developed ischemic stroke during follow-up, which was 100% complete. Results: The fluctuation of nonfasting triglycerides and cholesterol over 15 years was similar. In both women and men, stepwise increasing levels of nonfasting triglycerides were associated with increased risk of ischemic stroke. Compared to women with triglycerides <1 mmol/liter, multivariate adjusted hazard ratios ranged from 1.2 (95% confidence interval [CI], 0.9-1.7) for triglyceride levels of 1.00-1.99 mmol/liter to 3.9 (95% CI, 1.3-11.1) for triglyceride levels >= 5 mmol/liter (trend: p < 0.001); corresponding hazard ratios in men ranged from 1.2 (95% CI, 0.8-1.7) to 2.3 (95% CI, 1.2-4.3) (p 0.001). Increasing cholesterol levels were not associated with risk of ischemic stroke except in men with cholesterol levels >= 9.00 mmol/liter vs <5.00 mmol/liter, with a hazard ratio of 4.4 (95% CI, 1.9-10.6). Interpretation: In women, stepwise increasing levels of nonfasting triglycerides were associated with increasing risk of ischemic stroke while increasing cholesterol levels were not. In men, these results were similar except that cholesterol >= 9.00 mmol/liter was associated with increased risk of ischemic stroke. ANN NEUROL 2011; 69: 628-634