This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Cerebrovascular Disease  • Stroke  • Nutritional and Metabolic Disorders  • Lipids and Lipid Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

The Northern Manhattan Study (NOMAS)

Joshua Z. Willey, MD, MS; Qiang Xu, PhD; Bernadette Boden-Albala, DrPH; Myunghee C. Paik, PhD; Yeseon Park Moon, MPH; Ralph L. Sacco, MD, MS; Mitchell S. V. Elkind, MD, MS

Arch Neurol. 2009;66(11):1400-1406.

Objective  To explore the relationship between lipid profile components and incident ischemic stroke in a stroke-free prospective cohort.

Design  Population-based prospective cohort study.

Setting  Northern Manhattan, New York.

Patients  Stroke-free community residents.

Intervention  As part of the Northern Manhattan Study, baseline fasting blood samples were collected on stroke-free community residents followed up for a mean of 7.5 years.

Main Outcome Measures  Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for lipid profile components and ischemic stroke after adjusting for demographic and risk factors. In secondary analyses, we used repeated lipid measures over 5 years from a 10% sample of the population to calculate the change per year of each of the lipid parameters and to impute time-dependent lipid parameters for the full cohort.

Results  After excluding those with a history of myocardial infarction, 2940 participants were available for analysis. Baseline high-density lipoprotein cholesterol, triglyceride, and total cholesterol levels were not associated with risk of ischemic stroke. Low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein cholesterol levels were associated with a paradoxical reduction in risk of stroke. There was an interaction with use of cholesterol-lowering medication on follow-up, such that LDL-C level was only associated with a reduction in stroke risk among those taking medications. An LDL-C level greater than 130 mg/dL as a time-dependent covariate showed an increased risk of ischemic stroke (adjusted hazard ratio, 3.81; 95% confidence interval, 1.53-9.51).

Conclusions  Baseline lipid panel components were not associated with an increased stroke risk in this cohort. Treatment with cholesterol-lowering medications and changes in LDL-C level over time may have attenuated the risk in this population, and lipid measurements at several points may be a better marker of stroke risk.

Author Affiliations: Department of Neurology, College of Physicians and Surgeons (Drs Willey, Boden-Albala, Moon, and Elkind), and Departments of Sociomedical Science (Dr Boden-Albala) and Biostatistics (Dr Paik), Joseph P. Mailman School of Public Health, Columbia University, and the Columbia University Medical Center of New York Presbyterian Hospital (Drs Willey, Boden-Albala, Moon, and Elkind), New York; Food and Drug Administration, Rockville, Maryland (Dr Xu); and Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida (Dr Sacco).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Neurology
Arch Neurol. 2009;66(11):1320-1321.
FULL TEXT