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. 2023 Mar;13(3):e2901.
doi: 10.1002/brb3.2901. Epub 2023 Feb 7.

The association between HDL-C and stroke in the middle-aged and elderly: A cross-sectional study

Yang Hu  1 , Min Song  1 , Dongmei Wu  1 , Yuqing Zhang  1 , Gongbo Li  1 , Haiyan Luo  1
Affiliations

The association between HDL-C and stroke in the middle-aged and elderly: A cross-sectional study

Yang Hu et al. Brain Behav. 2023 Mar.

Abstract

Background: Previous epidemiological studies have indicated that high-density lipoprotein cholesterol (HDL-C) is inversely associated with the risk of cardiovascular disease. However, this issue has aroused controversy in recent years. Besides, the relationship between HDL-C and the risk of total stroke in sex and race is less clear. Thus, we aimed to examine the association between different ranges of HDL-C and the risk of total stroke in adults over 40 years old.

Methods: This cross-sectional study was conducted on a sample of 8643 participants (4222 men and 4421 women) aged ≥40 years old from the National Health and Nutrition Examination Survey 2007-2016. HDL-C was an independent variable and stroke was a dependent variable in this study, with the other variables as potential effect modifiers. To examine the associations between them, we used multivariate logistical regression models and smooth curve fittings, as well as subgroup analyses.

Results: HDL-C was inversely associated with stroke when HDL-C was less than 1.55 mmol/L (odds ratio [OR] = 0.36, 95% confidence interval [CI] :0.21-0.62, p < .05). However, above 1.55 mmol/L, the incidence of stroke was not significant (OR = 1.29, 95% CI: 0.79-2.09, p>.05). Stratified by race/ethnicity and sex, the subgroup analyses demonstrated that HDL-C was inversely associated with stroke in men and Whites, but no significant differences among women, Mexicans, blacks, and other races.

Conclusion: We found a nonlinear relationship between HDL-C and total stroke. Our study reveals a range of inverse associations between HDL-C and stroke (HDL-C<1.55 mmol/L), especially among men and Whites. This finding suggested that maintaining an appropriate HDL-C range may be beneficial in reducing the incidence of stroke.

Keywords: HDL; aged; cholesterol; middle aged; stroke.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the screening and enrollment of study participants. Total people from the National Health and Nutrition Examination Survey (NHANES) 2007−2016.
FIGURE 2
FIGURE 2
A nonlinear relationship between high‐density lipoprotein cholesterol (HDL‐C) and stroke using smooth curve fitting and generalized additive models was detected after adjusting for age, sex, race/ethnicity, low‐density lipoprotein cholesterol (LDL‐C), cholesterol, triglycerides, glycated haemoglobinA1c (HbA1c), income‐to‐poverty ratio, education level, smoking status, alcohol consumption, body mass index (BMI), diabetes, and hypertension. The inflection point of the study was 1.55 mmol/L. Below 1.55 mmol/L, the risk of stroke decreased by 64%(p < .05) for each unit increase of HDL‐C. Above 1.55 mmol/L, the risk of stroke increased for each unit increase, but there was no statistically significant difference(p>.05).The solid line and dashed line represent the estimated values and their corresponding 95% confidence intervals, respectively.
See this image and copyright information in PMC

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