Levels of high-density lipoprotein (HDL), the “good” cholesterol, are inversely associated with stroke risk in elderly men, according to a new study.

“HDL cholesterol has been inversely associated with coronary heart disease,” Dr. J. David Curb, of Pacific Health Research Institute, Honolulu, and colleagues write in the American Journal of Epidemiology. “Associations with stroke are less clear, particularly among the elderly.”

The researchers therefore examined the association between HDL cholesterol levels and stroke risk in 2444 men between the ages of 71 and 93 years who were enrolled in the Honolulu Heart Program. The investigators measured levels of HDL cholesterol at examinations between 1991 and 1993 and followed the men through the end of 1998.

One hundred thirty-seven strokes occurred during follow-up that were attributable to either a blood clot (89 cases) or bleeding in the brain (48 cases).

No association was found between HDL cholesterol and strokes caused by bleeding in the brain. However, the incidence of stroke caused by blood clots in the brain declined with increasing HDL cholesterol levels. The team found a 2.7-fold increased risk of a blood clot-related stroke among men with low HDL cholesterol levels compared with those with high levels.

The risk of clot-related stroke declined as HDL cholesterol levels increased for men with normal total cholesterol concentrations and for men with high blood pressure or diabetes, Curb and colleagues add.

These findings indicate that HDL cholesterol is an important risk factor for clot-related stroke in the elderly. “In conjunction with other risk factors,” the researchers suggest, “measurement of HDL cholesterol (commonly available from routine lipid screening) could become an increasingly useful tool for identifying elderly persons at high risk of stroke.”

American Journal of Epidemiology, July 15, 2004.