Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study

doi:10.1136/bmj.38855.610324.80

BMJ, doi: 10.1136/bmj.38855.610324.80, (Published 6 June 2006)

RESEARCH

Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study

Shah Ebrahim ¹, Joohon Sung ²^*, Yun-Mi Song ³, Robert L Ferrer ⁴, Debbie A Lawlor ¹, George Davey Smith ¹

¹ Department of Social Medicine, University of Bristol, Bristol BS8 2PR
² Department of Preventive Medicine, Kangwon National University College of Medicine, Kangwon-Do, Korea
³ Department of Family Medicine, Samsung Medical Centre, SungKyunKwan University School of Medicine, Seoul, Korea
⁴ Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA

^* Correspondence to: sungjohn{at}kangwon.ac.kr.

Objective To investigate risk factors, such as heavy alcoholconsumption, that might explain any increased risk of haemorrhagicstroke associated with low blood cholesterol.

Design Prospectivecohort study.

Setting Korea.

Participants 787 442 civil servants(661 700 men, 125 742 women) aged 30-64.

Main outcome measuresCardiovascular risk factors were assessed at biennial healthcheck. Data on morbidity and mortality were ascertained from1990 to 2001 using hospital admissions and mortality surveillancesystems.

Results 6328 cases of ischaemic stroke (6021 men, 307women), 3947 cases of haemorrhagic stroke (3748 men, 199 women),3170 cases of undefined stroke (2902 men, 268 women), and 4417cases of myocardial infarction (4305 men, 112 women) occurred.Ischaemic stroke and myocardial infarction were strongly andpositively associated with blood cholesterol (hazard ratio per1 mmol/l cholesterol 1.20 (95% confidence 1.16 to 1.24) and1.48 (1.43 to 1.53), respectively). Haemorrhagic stroke showedan inverse association in fully adjusted models (0.91, 0.87to 0.95). This inverse association was confined to participantswith hypertension. When stratified by concentration of ${gamma}$ glutamyltransferase (GGT), an indicator of alcohol consumption, theassociation was not seen in participants with low concentrationsof GGT, and it was independent of hypertension in those withhigh concentrations of GGT (>80 U/l).

(Accepted 14 April 2006)

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