The association between HDL-C and stroke in people over 40 years of age: A NHANES cross-sectional study

Abstract Background Previously, studies have indicated that high-density cholesterol (HDL-C) levels are associated with lower risk of cardiovascular disease. However, this has been challenged in recent years. Method This cross-sectional study was conducted on data from the National Health and Nutrition Examination Survey 2011-2020. There were total of 15232 out of 45462 individuals who were age >40 years old, not missing HDL-C levels and not missing stroke data. The independent variable was HDL-Cholesterol. The outcome variable was stroke. We used multivariate logistic regression models to assess the relationship between stroke and HDL-C in three models consisting of the following explanatory variables: 1. HDL-C alone (unadjusted model), 2. HDL-C and non-modifiable risk factors (age, sex and race), 3. HDL-C, non-modifiable, and modifiable risk factors [hypertension, diabetes and smoking status] risk factors. We also conducted analyses stratified by sex and race. Results HDL-C categories 40-59 mg/dl (unadjusted model- 0.759, CI: 0.639, 0.901; non-modifiable risk factors adjusted- 0.668, CI: 0.558, 0.798) and 60-79 mg/dl (unadjusted model- 0.733, CI: 0.598, 0.898; non-modifiable risk factors adjusted- 0.565, CI: 0.455, 0.701) had significantly lower risk of stroke relative to HDL-C category <40 mg/dl. But when adjusted for modifiable risk factors, risk of stroke HDL-C categories 40-59 mg/dl and 60-79 mg/dl categories were not significantly different from the HDL-C <40 mg/dl category. The risk of stroke HDL-C categories 80-89 mg/dl and >90 mg/dl categories were not significantly different from the HDL-C <40 mg/dl category in all models. In stratified analyses, HDL-C was significantly inversely associated with the risk of stroke in male gender and in non-Hispanic White race. Conclusion Our study reveals various inverse relationship between HDL-C and risk of stroke. These findings suggest that relevant levels of HDL-C may be beneficial in preventing stroke in the absence of modifiable risk-factors.