Causal associations of blood lipids with risk of ischemic stroke and intracerebral hemorrhage in Chinese adults

Journal article

Stroke is the second leading cause of death worldwide and accounts for >2 million deaths annually in China1,2. Ischemic stroke (IS) and intracerebral hemorrhage (ICH) account for an equal number of deaths in China, despite a fourfold greater incidence of IS1,2. Stroke incidence and ICH proportion are higher in China than in Western populations3–5, despite having a lower mean low-density lipoprotein cholesterol (LDL-C) concentration. Observational studies reported weaker positive associations of LDL-C with IS than with coronary heart disease (CHD)6,7, but LDL-C-lowering trials demonstrated similar risk reductions for IS and CHD8–10. Mendelian randomization studies of LDL-C and IS have reported conflicting results11–13, and concerns about the excess risks of ICH associated with lowering LDL-C14,15 may have prevented the more widespread use of statins in China. We examined the associations of biochemically measured lipids with stroke in a nested case-control study in the China Kadoorie Biobank (CKB) and compared the risks for both stroke types associated with equivalent differences in LDL-C in Mendelian randomization analyses. The results demonstrated positive associations of LDL-C with IS and equally strong inverse associations with ICH, which were confirmed by genetic analyses and LDL-C-lowering trials. Lowering LDL-C is still likely to have net benefit for the prevention of overall stroke and cardiovascular disease in China.

Authors: Sun, L; Clarke, R; Bennett, D; Guo, Y; Walters, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer Nature
• Journal: Nature Medicine
• Volume: 25
• Issue: 4
• Pages: 569-574
• Publication date: 2019-03-11
• Acceptance date: 2019-01-16
• DOI: 10.1038/s41591-019-0366-x
• EISSN: 1546-170X
• ISSN: 1078-8956
• Pmid: 30858617
• Language: English