(November 30, 2007 - Insidermedicine) While dyslipidemia is clearly an independent risk factor for ischemic heart disease, its relationship with ischemic stroke is far less clear, according to research published in The Lancet.

Here are some tips on managing dyslipidemia:

•    For high risk patients with coronary heart disease (CHD) or CHD risk equivalents, low-density lipoprotein (LDL) cholesterol goal is <70- 100 mg/dL. Therapeutic lifestyle changes should be initiated and drug therapy should be considered when LDL cholesterol is >100 mg/dL.

•    For moderately high risk patients with two or more risk factors, LDL goal is <130 mg/dL. Initiate therapeutic lifestyle changes and consider drug therapy when LDL levels are >130 mg/dL.

•    For moderate risk patients with two or more risk factors, the LDL goal is <130 mg/dL. Initiate therapeutic lifestyle changes when LDL is >130 mg/dL and consider drug therapy when LDL is >160 mg/dL.

Investigators from Oxford University reanalyzed data from 61 observational studies involving nearly 900,000 adults without ischemic heart disease primarily living in Western Europe and America. Among these adults, there were over 55,000 vascular deaths in those aged 40 to 89 years, with about 34,000 occurring as a result of ischemic heart disease and 12,000 from stroke.

Among the 150,000 individuals for whom information on high-density lipoprotein (HDL) cholesterol was available, there were 3,000 deaths from ischemic heart disease and 1,000 from stroke. A drop of only 1 mmol/L in total cholesterol led to a 56% reduced risk of ischemic heart disease mortality in those aged 40 to 49, a 34% reduced risk in those aged 50 to 69, and a 17% reduced risk in those aged 70 to 89. The absolute risk associated with a given difference in cholesterol was independent of blood pressure. Total cholesterol to HDL ratio was much more predictive of heart disease than total cholesterol alone.

In contrast the relationship between total cholesterol and ischemic and total stroke mortality was weak or absent for each age group. When a relationship was present, it was largely accounted for by the relationship between cholesterol and blood pressure.

This research highlights the questionable nature of the independent relationship between dyslipidemia and ischemic stroke. Nonetheless, the authors report that statin drugs are still known to reduce the risk of both ischemic heart disease and stroke and should continue to be used to help prevent these events.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.