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The Northern Manhattan Stroke Study

Ralph L. Sacco, MD,MS; Richard T. Benson, MD,PhD; Douglas E. Kargman, MS,MD; Bernadette Boden-Albala, MPH; Catherine Tuck, MD; I-Feng Lin, DrPh; J. F. Cheng, MD,MS; Myunghee C. Paik, PhD; Steven Shea, MD,MS; Lars Berglund, MD,PhD

JAMA. 2001;285:2729-2735.

Context  Elevated high-density lipoprotein cholesterol (HDL-C) levels have been shown to be protective against cardiovascular disease. However, the association of specific lipoprotein classes and ischemic stroke has not been well defined, particularly in higher-risk minority populations.

Objective  To evaluate the association between HDL-C and ischemic stroke in an elderly, racially or ethnically diverse population.

Design  Population-based, incident case-control study conducted July 1993 through June 1997.

Setting  A multiethnic community in northern Manhattan, New York, NY.

Participants  Cases (n = 539) of first ischemic stroke (67% aged 65 years; 55% women; 53% Hispanic, 28% black, and 19% white) were enrolled and matched by age, sex, and race or ethnicity to stroke-free community residents (controls; n = 905).

Main Outcome Measure  Independent association of fasting HDL-C levels, determined at enrollment, with ischemic stroke, including atherosclerotic and nonatherosclerotic ischemic stroke subtypes.

Results  After risk factor adjustment, a protective effect was observed for HDL-C levels of at least 35 mg/dL (0.91 mmol/L) (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.39-0.72). A dose-response relationship was observed (OR, 0.65; 95% CI, 0.47-0.90 and OR, 0.31; 95% CI, 0.21-0.46) for HDL-C levels of 35 to 49 mg/dL (0.91-1.28 mmol/L) and at least 50 mg/dL (1.29 mmol/L), respectively. The protective effect of a higher HDL-C level was significant among participants aged 75 years or older (OR, 0.51; 95% CI, 0.27-0.94), was more potent for the atherosclerotic stroke subtype (OR, 0.20; 95% CI, 0.08-0.50), and was present in all 3 racial or ethnic groups studied.

Conclusions  Increased HDL-C levels are associated with reduced risk of ischemic stroke in the elderly and among different racial or ethnic groups. These data add to the evidence relating lipids to stroke and support HDL-C as an important modifiable stroke risk factor.

Author Affiliations: Department of Neurology (Drs Sacco, Benson, Kargman, and Lin and Ms Boden-Albala), Sergievsky Center (Dr Sacco), Department of Medicine, Division of General Medicine (Dr Shea), Preventive Medicine and Nutrition (Drs Tuck and Berglund), and Irving Center for Clinical Research (Dr Berglund), College of Physicians and Surgeons,and Divisions of Epidemiology (Drs Sacco and Shea), Socio-Medical Science (Ms Boden-Albala), and Biostatistics (Drs Lin, Paik, and Cheng) the Mailman School of Public Health, Columbia University, New York, NY.

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