Very Low LDL Cholesterol Associated with Hemorrhagic Stroke in Women Interview with:

Pamela M. Rist, ScDAssistant Professor of Medicine, Harvard Medical SchoolBrigham and Women's Hospital, Division of Preventive MedicineBoston, MA 02215 

Dr. Rist

Pamela M. Rist, ScD
Assistant Professor of Medicine, Harvard Medical School
Brigham and Women’s Hospital, Division of Preventive Medicine
Boston, MA 02215 What is the background for this study? What are the main findings?

Response: Although hypercholesterolemia is a risk factor for ischemic stroke, some prior studies have observed an inverse association between total and low-density lipoprotein (LDL) cholesterol and risk of hemorrhagic stroke.  However, many studies were not able to study this association specifically among women.

Our main result was very low levels of low-density lipoprotein (LDL) cholesterol or low levels of triglycerides were associated with an increased risk of hemorrhagic stroke among women. What should readers take away from your report?

 Response: Although women with very low levels of LDL are usually considered to be at low risk of heart attacks and ischemic strokes, these women may have an increased risk of experiencing a hemorrhagic stroke. Given the high morbidity and mortality associated with hemorrhagic stroke events, it is important to manage other risk factors for hemorrhagic stroke among these women, such as hypertension or smoking. What recommendations do you have for future research as a result of this work? 

Response: Additional research is needed to determine how to lower the risk of hemorrhagic stroke in women with very low LDL or low triglycerides.

In addition to our results for very low levels of LDL cholesterol and triglycerides, we found a suggestion that high levels of LDL cholesterol (≥160 mg/dL) may be associated with an increased risk of hemorrhagic stroke, although this increase in risk was not statistically significant. Since other studies have not explored whether high levels of LDL cholesterol are associated with increased risk of hemorrhagic stroke, future studies will be needed to determine if this finding can be replicated. 

Disclosures: The authors have no disclosures relevant to the manuscript. Full disclosures can be founded at study was supported by the National Institutes of Health.


Pamela M. Rist, Julie E. Buring, Paul M Ridker, Carlos S. Kase, View ORCID ProfileTobias Kurth, Kathryn M. Rexrode. Lipid levels and the risk of hemorrhagic stroke among women. Neurology, 2019 DOI: 10.1212/WNL.0000000000007454



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