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1. HDL cholesterol and stroke risk: The Multi-Ethnic Study of Atherosclerosis

Author

Reina, Samantha A, Llabre, Maria M, Allison, Matthew A, Wilkins, John T, Mendez, Armando J, Arnan, Martinson K, Schneiderman, Neil, Sacco, Ralph L, Carnethon, Mercedes, and Delaney, JA Chris

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Prevention, Atherosclerosis, Aging, Brain Disorders, Cardiovascular, Stroke, Black or African American, Aged, Aged, 80 and over, Brain Ischemia, Cholesterol, HDL, Cholesterol, LDL, Cohort Studies, Ethnicity, Female, Humans, Incidence, Male, Middle Aged, Multivariate Analysis, Risk Factors, United States, Cholesterol, Lipids, Risk factors for stroke, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

Background and purposeAccurate identification of risk factors for stroke is important for public health promotion and disease prevention. HDL cholesterol is a potential risk factor, yet its role in stroke risk is unclear, as is whether HDL cholesterol content or particle number might be a better indicator of stroke risk. Furthermore, the degree to which ethnicity moderates the risk is unknown. As such, the current study examines the associations between incident stroke and both HDL cholesterol concentration and particle number, and assesses the moderating role of race and ethnicity.MethodsThe sample is a racially diverse cohort of US adults between the ages of 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis between 2000 and 2002 and followed until December 2011. The associations among cholesterol content and stroke risk, particle number and stroke risk, and the interaction with race were explored.ResultsThe incidence of stroke was 2.6%. HDL cholesterol concentration (mmol/L) (Hazard Ratio (HR) = .56; 95% Confidence Interval (CI): .312-.988) and number of large HDL particles (μmol/L) (HR = .52, CI: .278-.956) were associated with lower stroke risk. When interactions with race were evaluated, the relationship between both HDL variables and stroke were significant in Blacks, but not other races.ConclusionsHigher HDL cholesterol and a higher concentration of large particles are associated with lower risk of stroke in Blacks. Further research is needed to elucidate the mechanisms by which HDL subfractions may differentially affect stroke outcome in different races/ethnicities.

Published
2015

2. Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study

Author

O Gibson, Ashleigh, Blaha, Michael J., Arnan, Martinson K, Sacco, Ralph L., Szklo, Moyses, Herrington, David M, and Yeboah, Joseph

Subjects
Male, Time Factors, Coronary Artery Disease, Kaplan-Meier Estimate, Coronary Angiography, Severity of Illness Index, Disease-Free Survival, Article, Sex Factors, Predictive Value of Tests, Risk Factors, Multidetector Computed Tomography, Humans, Vascular Calcification, Aged, Proportional Hazards Models, Aged, 80 and over, Chi-Square Distribution, Incidence, Discriminant Analysis, Middle Aged, United States, Stroke, Ischemic Attack, Transient, Asymptomatic Diseases, Female
Abstract

This study assessed the predictive value of coronary artery calcium (CAC) score for cerebrovascular events (CVE) in an asymptomatic multiethnic cohort.The CAC score, a measure of atherosclerotic burden, has been shown to improve prediction of coronary heart disease events. However, the predictive value of CAC for CVE is unclear.CAC was measured at baseline examination of participants (N = 6,779) of MESA (Multi-Ethnic Study of Atherosclerosis) and then followed for an average of 9.5 ± 2.4 years for the diagnosis of incident CVE, defined as all strokes or transient ischemic attacks.During the follow-up, 234 (3.5%) adjudicated CVE occurred. In Kaplan-Meier analysis, the presence of CAC was associated with a lower CVE event-free survival versus the absence of CAC (log-rank chi-square: 59.8, p 0.0001). Log-transformed CAC was associated with increased risk for CVE after adjusting for age, sex, race/ethnicity, body mass index, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, cigarette smoking status, blood pressure medication use, statin use, and interim atrial fibrillation (hazard ratio [HR]: 1.13 [95% confidence interval (CI): 1.07 to 1.20], p 0.0001). The American College of Cardiology/American Heart Association-recommended CAC cutoff was also an independent predictor of CVE and strokes (HR: 1.70 [95% CI: 1.24 to 2.35], p = 0.001, and HR: 1.59 [95% CI: 1.11 to 2.27], p = 0.01, respectively). CAC was an independent predictor of CVE when analysis was stratified by sex or race/ethnicity and improved discrimination for CVE when added to the full model (c-statistic: 0.744 vs. 0.755). CAC also improved the discriminative ability of the Framingham stroke risk score for CVE.CAC is an independent predictor of CVE and improves the discrimination afforded by current stroke risk factors or the Framingham stroke risk score for incident CVE in an initially asymptomatic multiethnic adult cohort.

Published
2014

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