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'Good' Cholesterol Fights Strokes in Elderly

Higher HDL level lowers risk at any age

TUESDAY, June 5, 2001 (HealthDayNews) --- Improving your "good" cholesterol count can cut your risk of stroke no matter how old you are.

That's the conclusion of a new study showing that increasing levels of high-density lipoprotein (HDL) can significantly reduce the risk of strokes even among the very elderly. HDL is a blood fat that pulls cholesterol away from blood vessel walls, where it can form dangerous buildup, or plaque, that narrows the channel and can starve the brain of blood.

While high HDL is known to help guard against heart attacks and heart disease, its role in preventing strokes has been less clear. Moreover, earlier research had questioned the benefit of controlling cholesterol in seniors, particularly low-density lipoprotein (LDL), the "bad" form of the fat.

But the latest work strongly suggests that taking steps to lift HDL can be lifesaving, says Dr. Ralph Sacco, a Columbia University neurologist and lead author of the study, which appears in the June 6 issue of The Journal of the American Medical Association.

"At any age stroke can cause problems, and it's particularly more important in the elderly," Sacco says. "It's never too late to think of lifestyle changes that can increase HDL." These include regular exercise, up to two drinks of alcohol a day, and certain medications.

What's more, although blacks and Hispanics have roughly twice the risk of strokes as whites, the reduction in risk from increased HDL held for all three ethnic groups. "It's nice to find that a risk protector is not biased" against particular races, Sacco says.

Sacco's group compared HDL cholesterol levels and other variables in 539 Manhattan stroke patients and 905 others without vessel trouble. All the stroke patients, whose average age was almost 70, had suffered ischemic forms of the attack, in which a clot stuck in a plaque-hardened artery cut off blood supply to the brain. Ischemic strokes, which can also result from clots that lodge in the brain itself, account for between 70 percent and 80 percent of all strokes.

People with HDL cholesterol counts of at least 35 milligrams per deciliter of blood had a 47 percent lower risk of ischemic stroke than those with less of the fat, Sacco's group found. And the higher the level, the better.

Those whose HDL topped 50 mg/dL had a 69 percent reduction in stroke risk, which was double the benefit of those whose HDL counts fell between 35 and 49 mg/dL. "This kind of reduction in stroke risk is comparable to that of hypertension control," Sacco says.

Patients 75 or older had roughly half the risk of stroke if their HDL was elevated. And increased HDL cut the risk of stroke related to hardened arteries by 80 percent.

"There's been some controversy as to whether cholesterol is important in the elderly population, and [now] there's no reason to think that it's not," says Dr. Michael Lauer, a Cleveland Clinic cardiologist.

Although the impact on heart and vessel disease of raising HDL may not be as powerful for the old as it is for the young, "even a more modest effect is very important" because the elderly have a much higher incidence of these conditions, Lauer says.

What To Do

Vessel experts estimate that, with the aging of the population, one million Americans a year will suffer strokes by 2010.

Earlier this spring, a panel of cholesterol experts released new guidelines that push for much more vigilant control of blood fats. In particular, the committee stressed aggressive use of cholesterol-lowering drugs called statins, effectively tripling the population of candidates for the medications.

Although statins target LDL, by doing so they can bring about a relative increase in HDL that could help trim the risk of heart and vessel disease.

For people over age 70, a total cholesterol level of 200 to 239 mg/dL is considered borderline high, while anything over 240 is high. The American Heart Association recommends reducing cholesterol levels to below 200 mg/dL. Under the new guidelines, HDL under 35 mg/dL is considered dangerously low.

Cutting back on meats and other fats high in animal foods and also switching to monounsaturated fats -- found in olive oil, canola oil and many nuts -- can improve your HDL count. Diets high in soy may also help increase HDL levels.

Another easy way to improve your HDL is to do a minimum of 20 minutes of moderate exercise at least three days a week.

To learn more about strokes, visit the National Stroke Association. For more on cholesterol, try the American Heart Association.

Read more HealthDay articles about strokes.

SOURCES: Interviews with Ralph Sacco, M.D., M.S., associate chair of neurology, Columbia University College of Physicians and Surgeons, Mailman School of Public Health, New York; Michael S. Lauer, M.D., director of clinical research, department of cardiology, Cleveland Clinic Foundation, Cleveland, and contributing editor, The Journal of the American Medical Association; June 6, 2001 The Journal of the American Medical Association
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