Chinese people

Engineering

Intracerebral hemorrhage

Biochemistry

Physics

Disease

Stroke (engine)

Incidence (geometry)

Biology

Gene

Optics

Political science

China

Genotype

Cardiology

Mendelian randomization

Subarachnoid hemorrhage

Internal medicine

Genetic variants

Medicine

Mechanical engineering

Nature Medicine

Stroke is the second leading cause of death worldwide and accounts for &gt;2 million deaths annually in China1,2. Ischemic stroke (IS) and intracerebral hemorrhage (ICH) account for an equal number of deaths in China, despite a fourfold greater incidence of IS1,2. Stroke incidence and ICH proportion are higher in China than in Western populations3–5, despite having a lower mean low-density lipoprotein cholesterol (LDL-C) concentration. Observational studies reported weaker positive associations of LDL-C with IS than with coronary heart disease (CHD)6,7, but LDL-C-lowering trials demonstrated similar risk reductions for IS and CHD8–10. Mendelian randomization studies of LDL-C and IS have reported conflicting results11–13, and concerns about the excess risks of ICH associated with lowering LDL-C14,15 may have prevented the more widespread use of statins in China. We examined the associations of biochemically measured lipids with stroke in a nested case-control study in the China Kadoorie Biobank (CKB) and compared the risks for both stroke types associated with equivalent differences in LDL-C in Mendelian randomization analyses. The results demonstrated positive associations of LDL-C with IS and equally strong inverse associations with ICH, which were confirmed by genetic analyses and LDL-C-lowering trials. Lowering LDL-C is still likely to have net benefit for the prevention of overall stroke and cardiovascular disease in China. In a nested case-control study from the China Kadoorie Biobank, lowering blood low-density lipoprotein cholesterol levels confers lower risk for ischemic stroke but elevated risk for intracerebral hemorrhage, which was confirmed by genetic Mendelian randomization analyses.

Causal associations of blood lipids with risk of ischemic stroke and intracerebral hemorrhage in Chinese adults