Stroke Risk in Elderly Diabetics Related to HDL Cholesterol

Dr. Toshio Hayashi of Nagoya University Graduate School of Medicine, Japan, and colleagues used data from the prospective Japan Cholesterol and Diabetes Mellitus Study to examine the association between lipid levels, ischemic heart disease and cerebrovascular disease in 4,014 patients with Type 2 diabetes (1,936 women; mean age 67.4 years). Participants were grouped by age: <65 years (n=1267), 65 to 74 years (n=1731), and 75 years or older (n=1016).

Overall, 83 vascular events occurred in the first year and 69 in the second year. A first ischemic heart disease event occurred in 0.80% of patients per year and a first stroke in 0.71% of patients per year.

 

Lower HDL and higher low-density lipoprotein (LDL) cholesterol were significantly associated with ischemic heart disease in patients younger than 65 years of age, the authors report.

 

In patients 65 years and older, lower HDL was also significantly related to risk of stroke (odds ratio [OR] = 0.758; p = 0.04), with the relationship “prominent” in subjects older than 75 years (OR = 0.511; p = 0.04), the researchers say.

 

In a statement Dr. Hayashi stated that, “The data suggest that simple LDL cholesterol control may not prevent ischemic heart disease or cerebrovascular disease enough in elderly.”

 

“Our study shows the importance of HDL cholesterol in cerebrovascular disease in elderly diabetics and in ischemic heart disease in middle-aged diabetics,” he said. “If HDL cholesterol is well controlled in elderly diabetics, then cerebrovascular disease and ischemic heart disease might be decreased to the levels found in middle-aged cohorts.”

 

“This study represents one of the largest scale attempts to examine ischemic heart disease and cerebrovascular disease in middle-aged and elderly diabetic individuals,” Dr. Hayashi noted. “We believe our data and our study have the potential to reveal important evidence in this field.”