The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.
Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).
Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI,
1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (
The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.
The association of lipids, lipoproteins, and apolipoproteins with stroke is more complex than that reported for acute myocardial infarction (AMI), with inconsistent findings among epidemiological studies [
The INTERSTROKE study is the largest international epidemiologic study to evaluate the association of cholesterol, lipoproteins lipids and apolipoproteins with stroke categorized by routine neuroimaging [
INTERSTROKE is a large international case-control study [
Cases were patients with acute first stroke admitted to hospital (within 72 hours) and within 5 days of symptom onset. Stroke was defined using the World Health Organization (WHO) clinical criteria for stroke [
Structured questionnaires were administered, and physical examinations were undertaken, in the same manner in cases and controls. Key vascular risk factors were measured in a manner consistent with the INTERHEART study [
Means and medians were calculated to summarise continuous variables and were compared by paired t-tests or appropriate paired non-parametric tests. Categorising of data by tertiles was based on control data. We used restricted cubic spline plots to explore the pattern of association of cholesterol, lipoproteins, and apolipoproteins with ischemic stroke, ischemic stroke etiological subtypes, and ICH. We fitted a restricted cubic spline function with four knots (5th, 35th, 65th, and 95th centiles), and completed a likelihood ratio test for non-linearity (included in figure legends). We used conditional logistic regression for all analyses of association of lipid fraction variables with stroke outcomes. All analyses were adjusted for age, hypertension, smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, cardiac risk factors (including atrial fibrillation), pre-admission statin use, and alcohol intake. To optimize power to detect associations for the analyses of the ICH subgroups, we supplemented the control group with controls for ischemic stroke to match additional controls to ICH cases (using the same matching criteria). Estimates of odds ratios (ORs) and accompanying 95% confidence intervals (CIs) are presented for every risk factor and their combinations. We estimated PAR% using the method described by Benichou and Gail [
Data from INTERSTROKE are not available for public use.
The mean±standard deviation (SD) age was 62.2±13.6 years. Non-fasting blood samples were obtained from 11,898 matched case-control pairs (n=23,796).
Total cholesterol had an inverse association with ischemic stroke (OR, 0.91; 95% CI, 0.87 to 0.95 per SD) and ICH (OR, 0.81; 95% CI, 0.77 to 0.86 per SD) (
Increasing apoB was associated with an increase in risk of ischemic stroke (OR, 1.10; 95% CI, 1.06 to 1.14), with an apparent threshold effect over approximately 1.0 g/L and associated with a reduced risk of ICH (OR, 0.88; 95% CI, 0.83 to 0.93 per SD) (
Increasing LDL-C/HDL-C ratio was associated with a higher risk of ischemic stroke (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) and a lower risk of ICH (OR, 0.83; 95% CI, 0.78 to 0.88 per SD). The apoB/A1 ratio was associated with a higher risk of ischemic stroke (OR, 1.38; 95% CI, 1.32 to 1.44) but was not significantly associated with ICH (OR, 1.00; 95% CI, 0.94 to 1.06 per SD) (
The pattern of association of lipoproteins and apolipoproteins with ischemic stroke was generally consistent among regions (
We report no difference in magnitude of association between apoB/A1 ratio and odds of ischemic stroke in those reporting pre-admission statin use (OR, 1.50; 95% CI, 1.12 to 1.99 and OR, 2.53; 95% CI, 1.85 to 3.45 for tertile 2 and 3 vs. tertile 1) and those not reporting pre-admission statin use (OR, 1.31; 95% CI, 1.16 to 1.48 and OR, 1.93; 95% CI, 1.71 to 2.18 for tertile 2 and 3 vs. tertile 1).
In the INTERSTROKE study, the risk of first-ever ischemic stroke was associated with concentrations of apolipoproteins and lipoproteins. However, the magnitude and pattern of the associations differed amongst different etiological subtypes, with the strongest association of apoB reported for large vessel ischemic stroke, and the weakest for cardioembolic stroke. The ratio of apoB/A1 was associated with a higher OR for risk of ischemic stroke than LDL-C/HDL-C ratio overall, and consistent among different ethnicities. A reversed association of LDL-C, HDL-C, and apoB with ICH, compared to ischemic stroke was identified, but the observations for ICH were inconsistent among different regions. Increasing levels of apoA1 were associated with both a lower risk of ICH, and ischemic stroke, and the only lipid fraction to have a generally consistent association for ischemic and hemorrhagic stroke.
We previously reported that apoB/A1 ratio was associated with 34% of the PAR for ischemic stroke, which is lower than the PAR reported for myocardial infarction in INTERHEART (49%). Ischemic stroke is more etiologically heterogenous than AMI, where large vessel atherosclerosis is the predominant etiology for AMI but accounts for only about 20% of ischemic stroke etiologies. Unlike AMI, where a linear increase in risk is reported with apoB, the association of apoB with ischemic stroke is curvilinear, with an increased risk only becoming evident with apoB levels over 1 g/L, a finding that supports an important role in pathogenesis of ischemic stroke, though less important than for AMI. Within ischemic stroke subtypes, we observed variations in the magnitude of association of apoB and LDL by stroke etiology. The association of apoB and ischemic stroke was strongest for large vessel (PAR of 13.4%) and stroke of undetermined etiology (PAR 7.1%) (
Differences in case mix of ischemic stroke subtypes might explain inconsistent findings in prior studies [
Both apoB and apoA1, and their ratio, had a larger magnitude of association with ischemic stroke than did lipoprotein cholesterol levels, and their ratios. These findings are consistent with those reported for AMI in the INTERHEART study [
Consistent with reports from other epidemiological studies, we found an inverse association of total cholesterol and LDL-C with ICH, while higher levels of HDL-C were associated with a higher risk, although some prior studies report a null association [
The only lipid fraction with a consistent association across all stroke subtypes was apoA1, which was associated with a lower risk of both ICH and ischemic stroke, and each of the etiological ischemic stroke subtypes. Unlike HDL-C, apoA1 has a number of functions [
In addition to known limitations inherent in case controls studies (e.g., recall bias, social desirability bias), our study has specific limitation relevant to the current analyses. We relied on clinical assessment for determination of ischemic stroke subtypes, as most cases did not undergo etiologic diagnostic testing, including vascular imaging. At the outset of the INTERSTROKE study, we appreciated the limited availability of a variety of diagnostic modalities and elected to have the stroke physician complete the case report form, for their assessment of most probable etiological source of ischemic stroke, based on clinical assessment when diagnostic tests were unavailable. However, this may be associated with misclassification of ischemic stroke subtype, which can be challenging, even in centers with routine access to etiological diagnostic testing, since common ischemic stroke etiologies share risk factors, and commonly co-exist. Therefore, we cannot draw definitive conclusions by ischemic stroke subtype. However, this source of bias should diminish, rather than amplify, our ability to detect differences among ischemic stroke subtypes. The case-control design incurred a potential effect of acute phase measurement, which may have also differed by stroke subtype, which is associated with stroke severity. However, in INTERSTROKE, we targeted recruitment of cases shortly after admission to hospital, to reduce this source of bias. Acute phase may have affected levels of lipoproteins in cases, and may contribute to a lower OR reported in our study compared to prospective cohorts studies for the association of LDL-C and risk of ischemic stroke. Alternatively, some [
The association of cholesterol, lipoproteins, and apolipoproteins with stroke varied by stroke subtype and etiological mechanism. The ratio of apoB/A1 was a better predictor of risk of ischemic stroke than LDL-C/HDL-C ratio. Population-level interventions to reduce LDL-C or apoB, or introduce statin therapy in intermediate and high cardiovascular risk populations,57 are expected to have a major impact on the global burden of stroke, but with differing magnitudes of effect on stroke subtypes.
Supplementary materials related to this article can be found online at
Exclusion criteria for cases
Guidance to sites for selection of controls
Demographic and clinical characteristics of cases
Mean concentration of lipids, lipoproteins, apolipoproteins, and their ratios in controls (men and women) by region
Adjusted mean concentration of lipids, lipoproteins, apolipoproteins, and their ratios in cases and controls
Association of total cholesterol with (A) ischemic stroke and (B) intracerebral hemorrhage. Restricted cubic spline plots of association of total cholesterol (X-axis) with ischemic stroke and intracerebral hemorrhage. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, and alcohol intake).
Association of total cholesterol by ischemic stroke subtype. (A) Large vessel, (B) small vessel, (C) cardioembolism, (D) undetermined. Restricted cubic spline plot of association of total cholesterol (X-axis) with ischemic stroke subtypes. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, and alcohol intake).
Association of lipoprotein/apolipoproteins ratio with ischemic stroke and intracerebral hemorrhage. (A) Ischemic stroke (low-density lipoprotein cholesterol [LDL-C]/apolipoprotein B [apoB]), (B) ischemic stroke (high-density lipoprotein cholesterol [HDL-C]/apoA1), (C) intracerebral hemorrhage (LDL-C/apoB), (D) intracerebral hemorrhage (HDL-C/apoA1). Restricted cubic spline plot of association of apolipoproteins (ApoB and ApoA1) (X-axis) with ischemic stroke, by age cut-point. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, and alcohol intake).
Association of (A) apolipoprotein B (apoB) and (B) apoA1 and ischemic stroke subtype by age. Restricted cubic spline plot of association of lipoproteins (low-density lipoprotein cholesterol and high-density lipoprotein cholesterol) (X-axis) with ischemic stroke by China, India, and other regions of the world. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, and alcohol intake).
Association of lipoproteins with ischemic stroke (China, India, and all other regions). Restricted cubic spline plot of association of lipoproteins (A: low-density lipoprotein cholesterol [LDL-C]; B: high-density lipoprotein cholesterol [HDL-C]) (X-axis) with intracerebral hemorrhage by China, India, and other regions of the world. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-tohip ratio, and alcohol intake).
Association of apolipoproteins with ischemic stroke (China, India, and all other regions). Restricted cubic spline plot of association of apolipoproteins (A: apoB; B: apoA1) (X-axis) with ischemic stroke by China, India, and other regions of the world. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, and alcohol intake).
Association of lipoproteins and intracerebral hemorrhage (ICH) (China, India, and all other regions). Restricted cubic spline plot of association of apolipoproteins (A: low-density lipoprotein cholesterol [LDL-C]; B: high-density lipoprotein cholesterol [HDL-C]) (X-axis) with ICH by China, India, and other regions of the world. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-tohip ratio, and alcohol intake).
Association of apolipoproteins with intracerebral hemorrhage (ICH) (China, India, and all other regions). Restricted cubic spline plot of association of (A) apoB and (B) apoA1 (X-axis) with ischemic stroke and ICH. Spline curves truncated at highest and lowest 2% of values. Light blue shading denotes 95% confidence interval. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, and alcohol intake).
The INTERSTROKE study was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Vastra Gotaland (Sweden), and through unrestricted grants from several pharmaceutical companies with major contributions from AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Swedish Heart and Lung Foundation, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK-Stroke Research Network. The sponsors had no role in data collection, analyses or the decision to submit for publications.
Graeme J. Hankey reports personal fees from Bayer and Medscape, outside of the submitted work. All other authors declare no competing interests.
Association of total cholesterol, lipoproteins and apolipoprotein (Apo), and stroke. Forest plot for association of total cholesterol, non-high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), HDL-C, non-HDL/HDL ratio, LDL/HDL ratio, apoB, apoA1, and apoB/A1 ratio, and ischemic stroke, ischemic stroke subtypes, and intracerebral hemorrhage. Odd ratio and 95% confidence interval (CI) per standard deviation (SD) change.
(A) Association of lipoproteins with ischemic stroke and intracerebral hemorrhage (ICH). (B) Association of apolipoproteins with ischemic stroke and ICH. Restricted cubic spline plot of association of (A) lipoproteins (low-density lipoprotein cholesterol [LDL-C] and high-density lipoprotein cholesterol [HDL-C]) (X-axis) and (B) apolipoproteins (apoB and apoA1) (X-axis) with ischemic stroke and ICH. Spline curve truncated at highest and lowest 2% of values. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet risk score, psychosocial factors, waist-to-hip ratio, pre-admission statin, and alcohol intake).
Association of (A) low-density lipoprotein cholesterol (LDL-C), (B) high-density lipoprotein cholesterol (HDL-C), (C) apolipoprotein B (apoB), (D) apoA1 by ischemic stroke subtype. Restricted cubic spline plot of association of (A) LDL-C (X-axis), (B) HDL-C (X-axis), (C) apoB (X-axis), (D) apoA1 (X-axis) with ischemic stroke subtypes. Spline curve truncated at highest and lowest 2% of values. All splines adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, pre-admission statin, and alcohol intake).
Association of lipids, lipoproteins, apolipoproteins, and their ratios with ischemic stroke, by etiology
Risk factor | Large vessel |
Small vessel |
Cardioembolism |
Undetermined |
||||
---|---|---|---|---|---|---|---|---|
OR (95% CI) | PAR (95% CI) | OR (95% CI) | PAR (95% CI) | OR (95% CI) | PAR (95% CI) | OR (95% CI) | PAR (95% CI) | |
LDL T2 vs. T1 | 1.02 (0.83–1.25) | 5.9 (0.9–31.7) | 0.88 (0.76–1.02) | - | 1.14 (0.80–1.62) | 9.2 (1.4–42.6) | 1.07 (0.89–1.28) | 10.6 (4.1–24.5) |
LDL T3 vs. T1 | 1.18 (0.96–1.47) | 0.89 (0.77–1.04) | 1.25 (0.84–1.85) | 1.32 (1.09–1.59) | ||||
HDL T2 vs. T1 | 0.80 (0.66–0.97) | 35.7 (27.1–45.3) | 0.71 (0.61–0.82) | 31.0 (24.6–38.2) | 0.74 (0.52–1.05) | 13.1 (2.6–45.9) | 0.89 (0.74–1.07) | 23.1 (15.3–33.4) |
HDL T3 vs. T1 | 0.50 (0.40–0.62) | 0.51 (0.44–0.60) | 0.70 (0.47–1.05) | 0.65 (0.53–0.79) | ||||
LDL/HDL T2 vs. T1 | 1.27 (1.03–1.58) | 28.7 (20.3–39.0) | 1.29 (1.10–1.51) | 23.7 (17.0–31.9) | 1.28 (0.90–1.84) | 18.1 (7.1–38.7) | 1.14 (0.94–1.38) | 20.4 (12.7–31.1) |
LDL/HDL T3 vs. T1 | 2.00 (1.61–2.50) | 1.61 (1.38–1.88) | 1.55 (1.02–2.34) | 1.68 (1.39–2.03) | ||||
ApoB T2 vs. T1 | 1.03 (0.84–1.26) | 13.4 (4.3–34.8) | 1.06 (0.92–1.22) | 5.8 (1.4–20.5) | 0.88 (0.61–1.27) | - | 1.04 (0.87–1.25) | 7.7 (1.3–35.3) |
ApoB T3 vs. T1 | 1.44 (1.18–1.77) | 1.14 (0.98–1.32) | 1.05 (0.70–1.57) | 1.19 (0.99–1.44) | ||||
ApoA1 T2 vs. T1 | 0.52 (0.42–0.63) | 49.5 (39.0–59.9) | 0.57 (0.49–0.66) | 40.9 (35.2–46.8) | 0.74 (0.52–1.07) | 43.2 (28.9–58.8) | 0.59 (0.49–0.71) | 36.8 (29.4–45.0) |
ApoA1 T3 vs. T1 | 0.31 (0.24–0.39) | 0.36 (0.31–0.43) | 0.43 (0.25–0.74) | 0.41 (0.33–0.51) | ||||
ApoB/A1 T2 vs. T1 | 1.72 (1.37–2.16) | 47.6 (40.1–55.2) | 1.32 (1.14–1.53) | 27.6 (21.6–34.6) | 1.34 (0.90–1.98) | 32.0 (17.5–51.0) | 1.26 (1.04–1.52) | 28.6 (20.9–37.8) |
ApoB/A1 T3 vs. T1 | 3.10 (2.47–3.89) | 1.91 (1.63–2.23) | 1.99 (1.32–2.99) | 2.02 (1.65–2.46) |
All models adjusted for age, sex, geographic region, and potential confounders (smoking, hypertension, diabetes mellitus, physical activity, diet, psychosocial factors, waist-to-hip ratio, alcohol intake, and cardiac causes of stroke). For LDL and small vessel ischemic stroke, apoB and cardioembolism, PAR was negative and not reported.
OR, odds ratio; CI, confidence interval; PAR, population attributable risk; LDL, low-density lipoprotein; HDL, high-density lipoprotein; Apo, apolipoprotein.
Association of lipoprotein and apolipoprotein ratios with ischemic stroke, by ethnicity
Risk factor | Prevalence |
Ischemic stroke |
||
---|---|---|---|---|
No. of controls (%) | No. of ischemic (%) | OR (95% CI) | PAR (95% CI) | |
European | ||||
ApoB/A1 T2 vs. T1 | 924 (36.9) | 810 (32.6) | 1.33 (1.09–1.60) | 32.9 (25.0–41.9) |
ApoB/A1 T3 vs. T1 | 796 (31.8) | 1,151 (46.4) | 2.15 (1.76–2.63) | |
LDL/HDL T2 vs. T1 | 811 (32.9) | 744 (30.6) | 1.28 (1.07–1.53) | 23.0 (16.7–30.8) |
LDL/HDL T3 vs. T1 | 543 (22.0) | 793 (32.6) | 1.99 (1.63–2.43) | |
Chinese | ||||
ApoB/A1 T2 vs. T1 | 990 (34.6) | 1,047 (36.7) | 1.45 (1.25–1.69) | 26.1 (20.7–32.4) |
ApoB/A1 T3 vs. T1 | 522 (18.2) | 824 (28.9) | 2.04 (1.71–244) | |
LDL/HDL T2 vs. T1 | 1,050 (36.5) | 931 (32.6) | 1.09 (0.91–1.30) | 15.7 (8.2–27.9) |
LDL/HDL T3 vs. T1 | 1,041 (36.2) | 1,264 (44.2) | 1.41 (1.19–1.68) | |
South Asian | ||||
ApoB/A1 T2 vs. T1 | 538 (31.4) | 441 (27.3) | 1.27 (0.98–1.64) | 33.7 (23.4–45.9) |
ApoB/A1 T3 vs. T1 | 763 (44.6) | 897 (55.6) | 2.02 (1.59–2.58) | |
LDL/HDL T2 vs. T1 | 450 (28.0) | 421 (27.6) | 1.35 (1.06–1.74) | 27.5 (17.9–39.9) |
LDL/HDL T3 vs. T1 | 666 (41.4) | 749 (49.1) | 1.71 (1.35–2.16) | |
Other Asian | ||||
ApoB/A1 T2 vs. T1 | 145 (35.5) | 96 (23.2) | 1.54 (0.82–2.90) | 55.4 (34.7–74.4) |
ApoB/A1 T3 vs. T1 | 167 (40.8) | 274 (66.2) | 3.51 (1.96–6.28) | |
LDL/HDL T2 vs. T1 | 140 (36.0) | 118 (28.7) | 2.10 (1.14–3.87) | 52.3 (32.8–71.1) |
LDL/HDL T3 vs. T1 | 139 (35.7) | 229 (55.7) | 3.08 (1.71–5.54) | |
Latin American | ||||
ApoB/A1 T2 vs. T1 | 315 (30.7) | 267 (27.8) | 1.48 (1.06–2.07) | 33.3 (19.6–50.4) |
ApoB/A1 T3 vs. T1 | 474 (46.1) | 542 (56.5) | 1.73 (1.27–2.37) | |
LDL/HDL T2 vs. T1 | 354 (35.8) | 330 (35.0) | 1.24 (0.93–1.66) | 16.1 (6.3–35.5) |
LDL/HDL T3 vs. T1 | 299 (30.2) | 333 (35.3) | 1.35 (1.00–1.83) | |
African | ||||
ApoB/A1 T2 vs. T1 | 129 (30.0) | 97 (23.2) | 1.40 (0.84–2.32) | 47.5 (30.4–65.2) |
ApoB/Apo-A1 T3 vs. T1 | 179 (41.6) | 263 (62.9) | 2.88 (1.76–4.69) | |
LDL/HDL T2 vs. T1 | 138 (32.2) | 137 (32.4) | 1.55 (1.00–2.40) | 32.6 (18.0–51.5) |
LDL/HDL T3 vs. T1 | 130 (30.4) | 189 (44.7) | 1.89 (1.21–2.93) |
All models adjusted for age, sex, geographic region, and potential confounders (smoking, diabetes mellitus, physical activity, diet, psychosocial factors, waistto-hip ratio, and alcohol intake).
OR, odds ratio; CI, confidence interval; PAR, population attributable risk; Apo, apolipoprotein; LDL, low-density lipoprotein; HDL, high-density lipoprotein.
INTERSTROKE project office staff, national coordinators, investigators and key staff
INTERSTROKE (methods, risk factor measurement)