Editorials

Cholesterol and strokes

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7233.459 (Published 19 February 2000) Cite this as: BMJ 2000;320:459

Cholesterol lowering is indicated for strokes due to carotid atheroma

  1. Michael F Oliver, professor emeritus
  1. Cardiac Medicine, National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London SW3 6LY

    Strong correlations between plasma lipoprotein concentrations and the risk of stroke have never been clearly established. Unlike coronary heart disease, there is no significant direct relation between an increased risk of stroke and increased plasma total cholesterol or low density lipoprotein (LDL) cholesterol; nor is there an inverse relation with high density lipoprotein (HDL) cholesterol.1 Indeed, an inverse relation exists between total cholesterol concentrations and cerebral haemorrhage.2

    The reasons for this weak or absent relation are several. The most compelling is that virtually all coronary heart disease can be ascribed to coronary atheroma, whereas less than half the incidence of stroke is due to large vessel atheroma. Non-atheromatous causes such as cardiac arrhythmias, small cerebral artery disease, and cortical degeneration are responsible for most of the rest. Another is that, in general, coronary deaths occur at a younger age than strokes, so the population with raised plasma lipids and large vessel atheroma, such as carotid artery disease, is …

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