Association Between Serum HDL-cholesterol And Stroke In Hypertensive Patients With Different BMI

Background and Objective:Stroke has become the leading cause of disability and death among residents in China,with more than 2 million new-onset stroke patients each year in China.High density lipoprotein cholesterol(HDL-C)is considered a “good cholesterol”,and higher levels of HDL-C can significantly reduce the risk of cardiovascular disease(CVD).Previous studies exploring the relationship between HDL-C and stroke are limited and inconsistent.In addition,body mass index(BMI),a commonly used index to reflect obesity,the elevated BMI could lead to a reduction in HDL-C levels.So,BMI may also influence the relationship between HDL-C and stroke.Therefore,the aim of this study was to explore the relationship between HDL-C and stroke in hypertensive patients with different BMI,and to examine whether BMI could have an impact on the association between HDL-C and stroke.Subjects and Methods:The study population was obtained from the China Hypertension Registry Study,which is a noninterventional,prospective,observational,real-world study that enrolled 14,234 hypertensive patients from Wuyuan,Jiangxi,from March 2018 to August 2018.After excluded patients with AF and taking lipid-lowering drugs,and finally a total of 10,925 hypertensive patients were included in our analysis.All data analysis and form production used the statistical package R and Empower(R).Statistical methods included Kruskal-Wallis rank sum test,Logistic regression analysis,interaction test,and smoothing curve fitting(penalty spline method).Statistical significance was defined as two-tailed P < 0.05.Results:Among the 10,925 hypertensive patients finally included in the study analysis,the average incidence of stroke was 6.47%(707/10,925)and the average value of HDL-C was 1.51 ± 0.40 mmol/L.The results showed a negative association between HDL-C and stroke in the BMI <24 kg/m2 group,but HDL-C was not associated with stroke in the BMI ≥24 kg/m2 group.In the BMI <24 kg/m2 group,each 1 mmol/L increase in HDL-C was associated with a 50% decreased risk of stroke(odds ratio[OR] = 0.50,95% confidence interval(CI)0.38-0.66).No significant relationship between HDL-C and stroke was observed in the BMI ≥24 kg/m2 group(OR = 0.73,95% CI 0.49-1.10).There was a significant interaction between BMI and HDL-C in regard to the prevalence of stroke in the hypertensive population without AF(P Interaction = 0.027).Conclusions:The study results showed an inverse association between HDL-C and stroke only existed in the BMI <24 kg/m2 group.The finding suggested that BMI could modify the association between HDL-C and stroke in hypertensive populations without AF.