Total cholesterol and stroke mortality in middle-aged and elderly adults: A prospective cohort study

Background and aims: The association between cholesterol and stroke has been inconsistent. This study aimed to examine the association between total cholesterol (TC) and mortality from total stroke and stroke subtypes. Methods: 503,340 Korean adults aged 40-80 years without a history of heart disease or stroke participated in routine health examinations in 2002 and 2003, and were followed up until 2013. Adjusted hazard ratios (HRs) for stroke (I60-I69) mortality were calculated. Results: Nonlinear associations for total stroke (U-curve) and hemorrhagic stroke (L-curve), especially intracerebral hemorrhage (ICH), but a linear association for ischemic stroke, were found. In the range <200 mg/dL, TC was inversely associated with stroke mortality (HR per 39 mg/dL [1 mmol/L] increase = 0.88 [95% CI = 0.80-0.95]), mainly due to hemorrhagic stroke (HR = 0.78 [0.68-0.90]), especially ICH (HR = 0.72 [0.62-0.85]). In the upper range (200-349 mg/dL), TC was positively associated with stroke mortality (HR = 1.09 [1.01-1.16]); ICH and subarachnoid hemorrhage mortality showed no inverse association. The associations were generally similar in middle-aged (40-64 years) and elderly (>= 65 years) adults and, in the upper range, each 1 mmol/L (39 mg/dL) higher TC was associated with 11% higher mortality from stroke (95% CI = 2%-21%) in the elderly. Both middle-aged (39%) and elderly (23%) adults had higher ischemic stroke mortality associated with TC >= 240 mg/dL, compare to <200 mg/dL. Conclusions: TC level around 200 mg/dL was associated with the lowest risk of overall stroke in the elderly and middle-aged adults. No stroke subtype including ICH, was inversely associated with TC in the range >= 200 mg/dL. (c) 2017 Elsevier B.V. All rights reserved.