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Published on: October 12, 2017
Dyslipidemia and metabolic factors in the genesis of heart attack and stroke
1Royal University Hospital, Saskatoon, Saskatchewan.
Insights
Elevated cholesterol may increase stroke risk, but lowering it shows mixed results. Managing hypertension and obesity, key factors in Syndrome X, is crucial for preventing stroke and coronary heart disease.
Area of Science:
- Cardiovascular Science
- Epidemiology
- Metabolic Syndrome Research
Background:
- The link between high cholesterol and coronary heart disease (CHD) is established, but its association with stroke is debated.
- Ischemic heart disease and stroke share risk factors, necessitating further investigation into cholesterol's role in stroke.
- Hypertension is a primary risk factor for stroke, often accompanied by a cluster of other cardiovascular risks.
Purpose of the Study:
- To examine the controversial relationship between cholesterol levels and stroke incidence.
- To investigate the role of hypertension and associated risk factors (Syndrome X) in cardiovascular disease.
- To explore the impact of weight management and lifestyle interventions on preventing stroke and CHD.
Main Methods:
- Analysis of long-term follow-up data from studies like MRFIT and San Antonio Heart Study.
- Review of findings regarding cholesterol-lowering interventions and their effect on stroke.
- Examination of the association between hypertension, metabolic factors, and cardiovascular outcomes.
Main Results:
- The MRFIT study indicated elevated cholesterol significantly increases the risk for fatal nonhemorrhagic stroke.
- Some studies found no evidence that lowering plasma cholesterol affects stroke incidence or risk.
- Hypertension is linked to a cluster of risk factors, including obesity, insulin resistance (Syndrome X), and unfavorable lipid profiles.
Conclusions:
- While the role of cholesterol in stroke requires further research, managing hypertension and central obesity is vital for prevention.
- Lifestyle interventions targeting weight management and Syndrome X risk factors show promise in reducing risks for both CHD and stroke.
- Further studies on more effective, long-term cholesterol-lowering strategies may be warranted.
Abstract:
The relationship of dyslipidemia, particularly hypercholesterolemia to coronary heart disease is now well established. Although ischemic heart disease and stroke share many of the same risk factors, the relationship of cholesterol to stroke remains controversial. The 6-year and 12-year follow-up of the MRFIT study showed that elevated cholesterol significantly increased the risk for fatal nonhemorrhagic stroke. Atkins found no evidence that lowering plasma cholesterol influenced the incidence of fatal or nonfatal stroke and regression analysis showed no statistical association between the magnitude of cholesterol reduction and the risk for fatal stroke. We cannot preclude the possibility that more effective cholesterol lowering over a longer period of time might be effective. Hypertension is the most powerful risk factor for stroke. The San Antonio Heart Study reported a clustering of cardiovascular risk factors in individuals who developed hypertension during an eight-year follow-up period (higher levels of BP, fasting TC and LDLC, TG, glucose and insulin, and BMI, less favourable fat deposition, and lower HDL). Insulin resistance may be the unifying factor that results in those phenomena, the so-called syndrome X. The important factor underlying syndrome X may be central or visceral obesity, suggesting that maintenance or attainment of ideal weight would be a powerful preventive factor against both CHD and nonhemorrhagic stroke. There is evidence from the Treatment of Mild Hypertension Study that nutritional/hygienic measures can reduce the syndrome X risk factors and hence the risk of coronary heart disease and stroke.
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