Low-Density Lipoprotein Cholesterol and the Risk of Dementia With Stroke

Objective To investigate the relationship of plasma lipids and lipoproteins to dementia with stroke. Design and Setting Prospective longitudinal community-based study over a 7-year period (1991-1998). Participants A total of 1111 nondemented participants (mean [SD] age, 75.0 [5.9] years) were followed up for an average of 2.1 years (range, 1-7.8 years). Main Outcome Measure Incident dementia with stroke according to standardized criteria, by baseline levels of total plasma cholesterol and triglycerides, lowdensity lipoprotein (LDL) cholesterol, LDL levels corrected for lipoprotein(a), highdensity lipoprotein cholesterol, lipoprotein(a), and apolipoprotein E genotype. Results Two hundred eighty-six (25.7%) of the 1111 subjects developed dementia during follow-up; 61 (21.3%) were classified as having dementia with stroke and 225 (78.7%) as having probable Alzheimer disease. Levels of LDL cholesterol were significantly associated with an increased risk of dementia with stroke. Compared with the lowest quartile, the highest quartile of LDL cholesterol was associated with an approximately 3-fold increase in risk of dementia with stroke, adjusting for vascular risk factors and demographic variables (relative risk [RR], 3.1; 95% confidence interval [CI], 1.5-6.1). Levels of LDL corrected for lipoprotein(a) were an even stronger predictor of dementia with stroke in the adjusted multivariate analysis. Compared with the lowest quartile, the RR of dementia with stroke for the highest quartile of lipoprotein(a)–corrected LDL cholesterol was 4.1 (95% CI, 1.8-9.6) after adjusting for vascular factors and demographic variables. Lipid or lipoprotein levels were not associated with the development of Alzheimer disease in our cohort. Conclusions Elevated levels of LDL cholesterol were associated with the risk of dementia with stroke in elderly patients. Further study is needed to determine whether treatment of elevated LDL cholesterol levels will reduce the risk of dementia with stroke. JAMA. 1999;282:254-26