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Effect of total cholesterol level variabilities on cerebrovascular disease
1Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. lsw2920@gmail.com.
Insights
Cholesterol changes, particularly significant increases or decreases, are linked to a higher risk of cerebrovascular disease (CVD). This highlights cholesterol variability as a potential factor in CVD development.
Area of Science:
- Cardiovascular Research
- Neurology
- Public Health
Background:
- Hyperlipidemia is a known risk factor for cerebrovascular disease (CVD).
- The specific impact of cholesterol level variability on CVD risk remains less understood.
- Understanding this relationship is crucial for CVD prevention strategies.
Purpose of the Study:
- To investigate the association between cholesterol level changes and the risk of developing cerebrovascular disease (CVD).
- To determine if cholesterol variability is an independent risk factor for different types of stroke and vascular occlusion/stenosis.
Main Methods:
- Analysis of 480,830 individuals aged 20-99 from the Korean National Health Insurance database (2002-2015).
- Participants categorized based on two cholesterol measurements (low, moderate, high) into nine transition groups.
- Statistical analysis using adjusted hazard ratios (aHR) to assess CVD risk associated with cholesterol level changes.
Main Results:
- Cholesterol level increases (e.g., low-to-high) were associated with increased risk of hemorrhagic stroke.
- Both increasing (low-to-moderate/high, moderate-to-high) and decreasing (moderate-to-low, high-to-low) cholesterol changes correlated with higher risks of ischemic stroke and occlusion/stenosis.
- Significant associations were observed across various cholesterol transition groups, indicating a broad impact of variability.
Conclusions:
- Cholesterol level variability, especially pronounced changes, is associated with an increased risk of cerebrovascular disease (CVD).
- These findings suggest that monitoring and managing cholesterol fluctuations may be important for mitigating CVD risk.
- Cholesterol variability should be considered a potential contributing factor to cerebrovascular events.
Objective:
Hyperlipidemia is a risk factor of cerebrovascular disease (CVD). However, the relationship between CVD and cholesterol variability is less clear. This study assesses the relationship between cholesterol change and CVD risk.
Patients And Methods:
We reviewed 480,830 people from 20 to 99 years with 2 health check-ups from 2002 to 2015 from the Korean National Health Insurance (KNHI) database. People's baseline and follow-up cholesterol levels were classified into low (<180 mg/dL), moderate (≥180 mg/dL and <240 mg/dL), and high (≥240 mg/dL). Participants were divided into 9 groups (low-to-low, low-to-moderate, low-to-high, moderate-to-low, moderate-to-moderate, moderate-to-high, high-to-low, high-to-moderate, high-to-high).
Results:
Low to high cholesterol level is associated with hemorrhagic stroke (aHR1 = 1.59; 95% CI 1.12-2.28 and aHR2 = 1.56; 95% CI 1.07-2.25). Low to moderate/high cholesterol level is associated with ischemic stroke and occlusion/stenosis (for low to moderate, aHR1 = 1.11; 95% CI 1.04-1.17 and aHR2 = 1.14; 95% CI 1.07-1.21 for ischemic stroke and aHR1 = 1.18; 95% CI 1.07-1.29 and aHR2 = 1.20; 95% CI 1.08-1.32 for occlusion/stenosis, for low to high, aHR1 = 1.42; 95% CI 1.20-1.67 and aHR2 = 1.28; 95% CI 1.08-1.52 for ischemic stroke and aHR1 = 1.86; 95% CI 1.46-2.36 and aHR2= 1.74; 95% CI 1.36-2.23 for occlusion/stenosis). Moderate to high cholesterol level is associated with ischemic stroke and occlusion/stenosis (for ischemic stroke, aHR1 = 1.12; 95% CI 1.05-1.20 and aHR2 = 1.10; 95% CI 1.03-1.17, for occlusion/stenosis, aHR1 = 1.21; 95% CI 1.10-1.33 and aHR2 = 1.19; 95% CI 1.08-1.32). Moderate to low cholesterol level is associated with ischemic and hemorrhagic stroke and occlusion/stenosis (for ischemic, aHR1 = 1.15; 95% CI 1.09-1.21, for hemorrhagic, aHR1 = 1.14; 95% CI 1.01-1.28, for occlusion/stenosis, aHR1 = 1.14; 95% CI 1.05-1.23). High to low cholesterol level is associated with ischemic stroke and occlusion/stenosis (for ischemic stroke, aHR1 = 1.51; 95% CI 1.33-1.71 and aHR2 = 1.20; 95% CI 1.05-1.36, for occlusion/stenosis, aHR1 = 1.50; 95% CI 1.24-1.81).
Conclusions:
Our study shows that cholesterol changes, especially larger changes, lead to an increase in CVD, which demonstrates that cholesterol variability may increase CVD.
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