Low Cholesterol Linked to Higher Risk for Hemorrhagic Stroke in Women

Women with low levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides have a higher risk for hemorrhagic stroke, according to new research.¹

To analyze the association between lipid levels and hemorrhagic stroke risk among women, the researchers studied data on 27,937 women aged 45 or older who were enrolled in the Women’s Health Study. The participants’ total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides were measured at baseline. Medical records were also reviewed to assess for the incidence of hemorrhagic stroke.

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During the mean 19.3 years of follow-up, there were 137 hemorrhagic strokes. Participants with LDL-C levels less than 70 mg/dL were 2.17-times more likely to experience a hemorrhagic stroke than participants who had LDL-C levels between 100 mg/dL and 129.9 mg/dL.

Participants who had LDL-C levels of 130 mg/dL to 159.9 mg/dL or 70 mg/dL to 99.9 mg/dL had no significant increase in risk for hemorrhagic stroke. While there was a suggestion that women with LDL-C levels of 160 mg/dL or more had an increased risk for hemorrhagic stroke, the suggestion was not significant.

Participants who were in the lowest quartile of triglycerides (fasting levels 74 mg/dL or lower, or non-fasting levels of 85 mg/dL or lower) also demonstrated a significantly increased risk for hemorrhagic stroke compared with participants in the top quartile (fasting levels higher than 156 mg/dL, or non-fasting levels higher than 188 mg/dL). In fact, those with the lowest triglyceride levels were twice as likely to have a hemorrhagic stroke than those with the highest triglyceride levels.²

The researchers determined there to be no significant associations between total cholesterol or HDL-C.

“Women with very low LDL-C or low triglycerides should be monitored by their doctors for other stroke risk factors that can be modified, like high blood pressure and smoking, in order to reduce their risk of hemorrhagic stroke,” said study co-author Pamela Rist, ScD. “Also, additional research is needed to determine how to lower the risk of hemorrhagic stroke in women with very low LDL and low triglycerides.”²

—Colleen Murphy

References:

1. Rist PM, Buring JE, Ridker PM, Kase CS, Kurth T, Rexrode KM. Lipid levels and the risk of hemorrhagic stroke among women [published online April 10, 2019]. Neurology. https://doi.org/10.1212/WNL.0000000000007454.

2. Low cholesterol linked to higher risk of bleeding stroke in women [press release]. Minneapolis, MN; April 10, 2019. https://www.aan.com/PressRoom/Home/PressRelease/2714. Accessed April 10, 2019.