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Low density lipoprotein (LDL) cholesterol reduction reduces the risk of heart attack and stroke, with an ideal value below 100 milligrams per deciliter (mg / dL). But can it be too low? New study finds that women with LDL cholesterol levels less than or equal to 70 mg / dL may be more than twice as likely to have hemorrhagic stroke than women with LDL cholesterol levels between 100 and 130 mg / dL dL. The study is published in the online edition of April 10, 2019 Neurology®, the medical journal of the American Academy of Neurology.
LDL cholesterol is called bad cholesterol because it can lead to fat accumulation in the arteries. The study also found that women with the lowest triglyceride levels, a fat found in the blood, exhibited an increased risk of hemorrhagic stroke compared with those with the highest triglyceride levels. high.
Hemorrhagic strokes, also called hemorrhagic strokes, are much less common than ischemic strokes, when blood flow is blocked to the brain. They are also harder to treat and therefore more likely to be deadly.
"Strategies to lower cholesterol and triglyceride levels, such as changing diets or taking statins, are widely used to prevent cardiovascular disease," said Pamela Rist, author of the study, ScD, Brigham and Women's Hospital in Boston, and member of the American Academy. of neurology. "But our large study shows that for women, very low levels can also carry some risk. Women are already at a higher risk of stroke than men, in part because they live longer. It is therefore important to clearly define ways to reduce their risk. "
The study included 27,937 women aged 45 and over enrolled in the health study who had total cholesterol, LDL cholesterol, high density lipoprotein (HDL) cholesterol, called good cholesterol, and triglycerides. measured at the beginning of the study. The researchers then reviewed the medical records to determine how many women had had a stroke. After 19 years of follow-up on average, the researchers identified 137 women with hemorrhagic stroke.
Nine out of 1,069 women with cholesterol levels equal to or less than 70 mg / dL, or 0.8%, experienced haemorrhagic stroke, compared to 40 out of 10,067 women with cholesterol levels of 100 mg / dL up to 39 to 130 mg / dL, or 0.4%. After adjusting for other factors that may influence the risk of stroke, such as age, smoking, high blood pressure, and treatment with cholesterol-lowering medications The researchers found that those with very low LDL cholesterol were 2.2 times more likely to have bleeding. .
For triglyceride levels, researchers divided women into four groups. Women in the lowest level group had fasting levels of 74 mg / dL or less, or non-fasting levels of 85 mg / dL or less. Women in the highest rate group had fasting rates above 156 mg / dL, or fasting rates above 188 mg / dL.
The researchers found that 34 of the 5,714 women with the lowest triglyceride levels, 0.6%, had hemorrhagic stroke, compared with 29 of the 7,989 women with the highest triglyceride , 4%. After adjusting for other factors that may affect risk, the researchers found that people with lower triglycerides were twice as likely to have hemorrhagic stroke. No difference in risk was observed for total cholesterol or HDL cholesterol.
"Women with very low LDL cholesterol or triglycerides should be monitored by their doctor for other risk factors for attack, such as high blood pressure and smoking, in order to reduce their risk of hemorrhagic stroke, "said Rist. "In addition, further research is needed to determine how to reduce the risk of hemorrhagic stroke in women with very low LDL and low triglyceride levels."
One of the limitations of the study was that cholesterol and triglyceride levels were only measured once at the beginning of the study. In addition, many women had already reached menopause when these levels were measured, which prevented researchers from determining whether menopausal status could influence the relationship between cholesterol and triglyceride levels and stroke.
The study was funded by the National Institutes of Health.
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