Cholesterol Levels and Hemorrhagic Stroke Risk in East Asian Versus Non-East Asian Populations A Systematic Review and Meta-Analysis

Background: The aim of this work was to evaluate the relationships between cholesterol levels and risk of hemorrhagic stroke [including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)] in East Asian versus non-East Asian populations. Materials and Methods: Relevant prospective studies were identified from systematic searches of PubMed and EMBASE. A random-effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) that were used to compare the relationships between cholesterol levels and risk of hemorrhagic stroke in East Asian versus non-East Asian populations. Results: In terms of overall hemorrhagic stroke risk, both East Asians and non-East Asians displayed no significant difference between high versus low total cholesterol (TC) (RR = 1.26, 95% CI, 0.92-1.72; I-2 = 74.4%, P < 0.001; RR= 1.69, 95% CI, 1.15-2.49; I-2 = 92.4%, P < 0.001, respectively). In terms of ICH risk, East Asians displayed no significant difference between high versus low TC (RR = 1.30, 95% CI, 0.89-1.90; I-2 = 78.6%, P < 0.001), whereas non-East Asians displayed a significant difference between high versus low TC with low TC showing a higher ICH risk (RR = 1.70, 95% CI, 1.08-2.67; I-2 = 91.2%, P < 0.001). With respect to SAH risk, East Asians displayed a significant difference between high versus low TC with low TC showing a higher SAH risk (RR = 1.48, 95% CI, 1.057-2.08; I-2 = 0%, P = 0.682), whereas non-East Asians displayed no significant difference between high versus low TC (RR = 1.14, 95% CI, 0.56-2.31; I-2 = 89.9%, P < 0.001). Conclusions: Under low cholesterol conditions, East Asian ethnic status favors SAH development, whereas non-East Asian ethnic status favors ICH development.